Social Determinants of Health and Physician Education


Healthcare in the United States ranks last out of 11 developed nations in the world (Citation 1). We lag far behind the UK, Australia, the Netherlands and seven other countries in access, equity, and health care outcomes. Yet, we spend more on healthcare than any of them. However, we spend much less on social services than any of the other 11 countries and therein lies the problem.

The US spends $3 trillion a year on healthcare, which is 16.3% of our GDP. We spend only 9% of our GDP on social services like retirement and disability benefits, employment programs, and supportive housing- the smallest amount of any of the 11 countries. France, Sweden, Switzerland, and Germany spend twice that amount. That tends to highlight the fact that when a country recognizes the importance of social determinants of health (SDH) to a nation’s population, and acts on it, it makes a tangible difference in the wellness of its people. Statistics show what happens when you don’t.

Statistics on health and social services expenditurs as a % of GDP affect the wellness of a population.

The Nation’s Health reported on the results of a public health study conducted in the year 2000 that found “...245,000 US deaths were attributable to low education, 176,000 to racial segregation, 162,000 to low social support and 133,000 to individual poverty.”

Nearly 900,000 deaths annually in the United States are due to five things: heart disease, cancer, lung disease such as emphysema and chronic bronchitis, stroke and unintentional injuries such as those on roads or caused by medication overdoses. According to the CDC report on potentially preventable death, more than a third of those deaths are preventable.

How do we improve the health of America?

Any effort to improve population health must be a tightly woven collaboration between physicians, policy makers and patients. Some efforts have begun at the policy level through Medicaid’s increased focus on social determinants of health, the US Census Bureau’s Healthy People 2020 initiative and the World Health Organization’s creation of a core business unit devoted to promoting health equity across the world. Yet, educating US physicians remains a fledgling effort. Medical school is based on age-old traditions and evidence based medicine and as a result is slow to evolve.That is why continuing medical education for physicians and pilot programs between medical residents and community health centers must take the lead in educating them about about SDH.

Innovative programs take the lead

A 9-month pilot course for medical students was created at a community health center in Philadelphia, PA to deepen their understanding of the impact of SDH on population wellness. Not only did the program work, it highlighted deficiencies in the current medical school model, as reflected in student comments:

  • “Until now, my formal education has not prepared me to work effectively with marginalized populations. Nor is it likely that my medical school curriculum will focus on addressing social determinants of health.”
  • “The better we know our patients, the better we can serve them. This type of course should be a critical component to our formal education in any healthcare setting.”

Improving population health in the US is going to require a vast improvement in health equity and a willingness to address the root causes of chronic disease and illness. It’s time for the US to recognize what the other 10 developed nations of the world already know - fixing illness isn’t enough. We must train our physicians who are on the frontline of healthcare to recognize SDH and advocate for them. While the government struggles to repair our broken healthcare system our good physicians can be advocates and better educated at preventive medicine to help lift patients from chronic wellness into the awareness and practice of health and wellness.

1: Adv Med Educ Pract. 2014; 5: 307–314.Published online 2014 Sep 23. doi: 10.2147/AMEP.S67480

About the Author

Deborah Chiaravalloti is an award-winning writer and former hospital executive. Her insider experience helps healthcare clients launch medical procedures, products including artificial intelligence software and knowledge sharing platforms. Deborah writes for websites like BoardVitals, blogs, opinion pieces, and marketing strategy for elder care, health care consumerism, revenue cycle management (RCM), and the business of healthcare. Her printed pieces have been published and her radio shows syndicated nationally.

Topics: social determinants of health health disparities

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