“What are you doing for others?”

Over the past two weeks, I have been rapidly trying to learn all that I can about racism and how I can help to affect change. As part of my learning, I am doing a great deal of reading. I found this quote that speaks to me from Dr. Martin Luther King “what are you doing for others?” (KeepInspiringme.com, 2020). Doing something for others is part of who I am, and in large part why I became a nurse. However, I need to do more. I can do more. 

As I reflect on the past couple of weeks and on the constructs of injustice, inequity, and racism, I can’t help but come back to the “social determinants of health” (SDOH). To me, this has been a very “safe”, politically correct way to say inequity, disparity, or difference, and it affords us a framework to capture or document that we are aware of these factors. Yet, for all our talk about SDOH, little has changed.

Social determinants of health are the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (World Health Organization, 2005). This term and corresponding definition were coined by the World Health Organization in 2005.

However, despite all the focus on the determinants of health, the inequities and disparities haven’t changed much at all.  It almost seems as though the “social determinants” are “fixed objects” that we have come to accept as immoveable or beyond improvement. Social determinants of health should not be accepted as they are today.   

We collect data and have even built sophisticated queries that become part of our admission assessments and we have become very good at documenting SDOH. But what are we really doing with the data? We have even taken it a step further and developed the concept of “population health” to talk about how we can improve the lives of our communities (Kindig, 2003). After all, what is the goal of collecting SDOH data? What is the goal of population health if we haven’t created healthier populations?

Yet, we haven’t moved the needle. The fact that every American doesn’t have access to healthcare is no longer acceptable, it never really was. The notion that we invented the term “food desert” to gloss over the fact that millions of Americans can’t find adequate healthy foods or fresh fruits and vegetables within their communities is not acceptable. Profoundly disparate education systems and substandard housing can no longer be tolerated. Yes, social determinants do impact health and well-being.

If we know that the social determinants of health are strongly influenced by the “environments in which people are born, live, learn, work, play, and worship”(Healthpeople.gov) which directly impacts “health, functioning, and quality-of-life outcomes”(Healthpeople.gov) why haven’t we done more to directly IMPROVE these factors? Is it the cost? The magnitude of the problems? Lack of clear scope or definition? Let us say the reason that we have chosen not to address these problems.

And yet, there are some great examples of healthcare systems investing in a big way to provide housing, improve food security, and reimagine education. However, we need to do much more. these known social determinants ARE the basis of health.  At this pivotal inflection point, it is the time to be courageous, compassionate, and do the right thing on a large scale to actually “fix” these clearly unequal social determinants. Empathy is the perfect starting point. We can start by listening to our employees and our communities. Using the human-centered approach to designing solutions leads us directly to those impacted by the problem and they often have the best solutions. This is about building cultures of inclusion, equity, and support, where everyone can expect to live their best life. Period. All of us. There are actions that we can take immediately. 

• The composition of organizational leadership teams should reflect the communities that are served, all the way up to the boardroom.
• Organizations (employers) should be partners in the community and find ways to support and resource needs, whether it is housing, healthy food, or education.
• Preventative care should be free and needs to be reimagined so that it can be provided to everyone in an easily accessible manner, whether it be clinics, churches, libraries, or barbershops.
• Education must be addressed. One way is to develop programs for healthy/safe living that starts with elementary school-age children. These programs can be delivered in low-cost ways via industry and community partnerships, think virtual.
• Industry partners should require their leadership teams to mentor in the community as a means of building a sustainable talent pipeline.  

This is just the tip of the iceberg. These conversations should go deep into each of the social determinants. Consider how you can help make changes locally, include community members on your organization's planning committees. We all are part of a community, and change starts locally. Think about your organization/company, how can you be a catalyst for equity, justice, and access?  We aren’t powerless. Use your voice. It is up to each of us to play a part in reforming the social determinants of health. I can no longer accept that social determinants exist. Please join me in making much-needed change.

 KeepInspiringme.com. Martin Luther King quotes. https://www.keepinspiring.me/martin-luther-king-jr-quotes/#:~:text=%E2%80%9CLife's%20most%20persistent%20and%20urgent,%E2%80%93%20Martin%20Luther%20King%20Jr. Accessed June 12, 2020. 

 HealthyPeople.gov (n.d.). https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed June 8, 2020. 

 World Health Organization. (2005). Commission on Social Determinants of Health, 2005-2008. https://www.who.int/social_determinants/thecommission/en/. Accessed June 8, 2020. 

 Kindig D, Stoddart G. (2003). What is Population Health? Am J Public Health.  93(3): 380-383. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447747/. Accessed June 8, 2020.