Addressing social determinants of noncommunicable diseases in primary care: a scoping review

Abstract Background Noncommunicable diseases (NCDs) are the leading cause of global mortality, and their risk factors largely manifest at the community level. In collaboration with public health, primary care is well placed to assess and address the local social determinants of NCDs (SDONCDs). Post-Astana, many countries are reorienting their primary care systems to incorporate these traditional public health functions, but there is little evidence to guide reform. We aimed to collate examples of primary care organisations that already engage in this activity. Methods Following Cochrane guidance, PubMed, MEDLINE, Embase & HMIC were searched from inception to 28/7/2019, along with hand-searching of references for any study designs that examined international primary care organisation(s) that addressed local SDONCDs. Independent dual review was used for screening, data extraction, and quality assessment - for which we used ROBINS-i. Results Searches identified 666 studies of which 17 studies from Canada, South Africa, UK, and USA were included. All used descriptive study designs. Individual-level surveys and interviews were the most common SDONCD data collection methods reported. Fewer studies collated population-level data held by external agencies. Actions ranged from individual-level interventions to novel representation of primary care organisations on system-level policy and planning committees. Several enablers and barriers to collecting and mobilising social determinant data within well- and under-resourced primary care settings were identified. Conclusions Several models of integrated public health and primary care already exist that fulfil the Astana mandate of developing place-based preventive services, tailored to local needs. Public health input at this granular level is required to support primary care services as they extend their scope of practice, and to assist with monitoring and evaluation of new initiatives to mitigate unmet health and social needs. Key messages Primary care organisations are increasingly being encouraged to assess and address local social determinants of noncommunicable diseases but there is weak evidence to guide reform. The different approaches described in our review can help policymakers tasked with integrating public health functions into primary care.

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Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health

Annual Review of Public Health ◽

10.1146/annurev-publhealth-090419-102204 ◽

2020 ◽

Vol 42 (1) ◽

Author(s):

Matthew W. Kreuter ◽

Tess Thompson ◽

Amy McQueen ◽

Rachel Garg

Keyword(s):

Public Health ◽

Health Care ◽

Social Determinants Of Health ◽

Social Services ◽

Social Determinants ◽

Safety Net ◽

Social Needs ◽

Determinants Of Health ◽

Health Improvement ◽

Health Care Settings

There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health. Expected final online publication date for the Annual Review of Public Health, Volume 42 is April 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Skills building seminar: How to enhance collaboration between primary care and public health?

European Journal of Public Health ◽

10.1093/eurpub/ckz185.285 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Keyword(s):

Public Health ◽

Primary Care ◽

Chronic Disease ◽

Chronic Disease Management ◽

Communicable Disease ◽

Communicable Disease Control ◽

Organizational Models ◽

Policy Makers ◽

Public Health Functions ◽

Successful Collaboration

Abstract Many countries in Europe and beyond have recognized that improved collaboration between public health and primary care can yield substantial benefits to populations and patients (e.g. through improved chronic disease management, communicable disease control, and maternal and child health), but it is in practice unclear how this improved collaboration can be achieved. Furthermore, collaboration is often hampered by the way that both sectors are organized and financed, with substantial differences across and sometimes within countries. In most European countries primary care already performs some public health functions, while public health can help to make the provision of primary care more effective. Screening and immunization, for example, as well as interventions to support healthy lifestyles, are public health functions that are nowadays commonly provided in primary care, although with wide variations between countries in the number of preventive care services provided in primary care. The question is how to expand and further develop existing collaborations. This workshop investigates the types of initiatives that have been undertaken, the factors that can enhance or hinder the collaboration between primary care and public health, and what can be undertaken to increase the chances of successful collaboration. It identifies organizational models of primary care that are conducive to collaboration with public health (e.g. through integrating primary care and public health in the provision of care for individuals), as well as systemic, organizational and interpersonal factors that can hinder or facilitate collaboration. The workshop draws on the findings of a forthcoming Observatory policy brief on enhanced primary care and public health collaboration, covering such areas as community engagement and participation, health promotion, health education, prevention activities, chronic disease management, screening, immunization and communicable disease control, information systems activities, development of best practice guidelines, conducting needs assessments, quality assurance and evaluation, and professional education. The workshop will begin with a presentation of the main findings of the policy brief, followed by a panel discussion involving European experts and policy-makers. In addition to sharing the experience of their countries, panelists will reflect on how generalizable or transferable examples of successful collaboration are and what it takes to overcome existing barriers. The workshop is designed to provide ample opportunity for the audience to comment on and discuss presentations and the contributions of panelists and to consider what lessons can be transferred across countries. It will be of interest to public health researchers, practitioners and policy-makers from across Europe. Key messages The workshop provides a forum for discussing how to enhance collaboration between public health and primary care. It explores innovative approaches, organizational models, and policy options.

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Universal Screening of Social Determinants of Health at a Large US Academic Medical Center, 2018

American Journal of Public Health ◽

10.2105/ajph.2020.305747 ◽

2020 ◽

Vol 110 (S2) ◽

pp. S219-S221

Author(s):

Dodi Meyer ◽

Eva Lerner ◽

Alex Phillips ◽

Katarina Zumwalt

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Universal Screening ◽

Medical Center ◽

Academic Medical Center ◽

Social Needs ◽

Determinants Of Health ◽

System Level ◽

Presbyterian Hospital ◽

Academic Medical

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health.

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Primary Care and the Social Determinants of Health: Lessons on Care Models, Capacity, and Culture for the Journey Upstream

The Practical Playbook II ◽

10.1093/med/9780190936013.003.0009 ◽

2019 ◽

pp. 75-86

Author(s):

Rishi Manchanda

Keyword(s):

Public Health ◽

Primary Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Community Health Center ◽

Care Physician ◽

Determinants Of Health ◽

The Social ◽

Care Models ◽

Value Based Care

This chapter looks at the issue of advances in public health and efforts with collaboration from the perspective of a primary care physician at a community health center. It specifically looks at how much has evolved in a ten-year span. Thanks to increasing payer commitment to value-based care, the concept of moving forwards to address social determinants of health appears to be entering the mainstream in US health care. If the last decade was about health care's awakening to the realities of social determinants of health and why they matter, the next ten years will hopefully focus on how to address them as clinicians, as organizations, and as partners to the civic, public health, and social sector peers.

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Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care

Frontiers in Public Health ◽

10.3389/fpubh.2021.674035 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jennifer Tsui ◽

Annie Yang ◽

Bianca Anuforo ◽

Jolene Chou ◽

Ruth Brogden ◽

...

Keyword(s):

Primary Care ◽

Cancer Screening ◽

Food Insecurity ◽

Social Determinants Of Health ◽

Social Determinants ◽

Interpersonal Violence ◽

Social Needs ◽

Housing Instability ◽

Health Related ◽

Primary Care Patients

Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients.Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening.Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions.Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.

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Association of Home Based Primary Care Enrollment with Social Determinants of Health for Older Veterans

Innovation in Aging ◽

10.1093/geroni/igab046.3301 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 918-919

Author(s):

Anna-Rae Montano ◽

Augustus Ge ◽

Christopher Halladay ◽

Samuel Edwards ◽

James Rudolph ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Health Outcomes ◽

Social Determinants Of Health ◽

Social Determinants ◽

Social Needs ◽

Determinants Of Health ◽

Home Based Primary Care ◽

Home Based ◽

High Deprivation

Abstract The Veterans Administration (VA) Home-based Primary Care (HBPC) program provides comprehensive primary care to older Veterans with multiple chronic conditions who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran’s social needs. The objective of this study was to estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of older Veterans. We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than or equal to 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. The VA HBPC program provides beneficial comprehensive, primary care services to Veterans at risk of poor health outcomes. However, a Veteran’s social determinants of health could prevent enrollment. More research is needed to determine the relationship between Veterans’ social needs and HBPC enrollment.

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Social Determinants of Psychiatric Illness

Sociocultural Issues in Psychiatry ◽

10.1093/med/9780190849986.003.0005 ◽

2019 ◽

pp. 69-86

Author(s):

Kristen Nishimi ◽

Esther Howe ◽

Erin C. Dunn

Keyword(s):

Public Health ◽

Mental Health ◽

Clinical Practice ◽

Social Determinants Of Health ◽

Social Determinants ◽

Psychiatric Illness ◽

Childhood Adversity ◽

Determinants Of Health ◽

Individual Level ◽

The Social

The social determinants of health refer to the ways in which societal conditions impact the etiology, course, and treatment of health outcomes. This chapter summarizes four main topics related to the social determinants of mental health in order to provide a framework for clinicians to understand the major social determinants of mental illness and help them incorporate insights about the social determinants of health into their clinical practice. First, we demonstrate how social determinants are related to the field of public health and population health frameworks. Second, we describe how knowledge of social determinants can inform psychiatric clinical practice. Third, we summarize research on four major social determinants—gender, socioeconomic status, childhood adversity, and school and neighborhood environments—with respect to depression risk. Last, we show how information about social determinants can be integrated with more individual-level factors, including genetic variation.

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Translational research: turning research into advocacy

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000416 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000416

Author(s):

Tracey Dechert

Keyword(s):

Public Health ◽

Chronic Disease ◽

Translational Research ◽

Social Determinants ◽

Gun Violence ◽

Social Needs ◽

The Social ◽

Huge Impact ◽

Trauma Surgeons ◽

Access To Surgery

The social determinants of health are increasingly being recognized within the trauma community. These determinants are major drivers of health and have a huge impact on access to surgery and surgical disparities. As trauma surgeons, we continue to struggle with optimizing care for our patients with many social needs and struggle with trauma as a chronic disease. As we are now using public health approaches to combat complex issues such as gun violence, it is ideal to view our work in a wider context which includes addressing the root causes of trauma and advocating for our patients and our communities. In addition, we need to teach and mentor this broader approach for our students and residents.

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Diagnostic testing and vaccination for COVID-19 among First Nations, Metis and Inuit in Manitoba, Canada: protocol for a nations-based cohort study using linked administrative data

BMJ Open ◽

10.1136/bmjopen-2021-052936 ◽

2021 ◽

Vol 11 (9) ◽

pp. e052936

Author(s):

Nathan C Nickel ◽

Wayne Clark ◽

Wanda Phillips-Beck ◽

Julianne Sanguins ◽

Jennifer Emily Enns ◽

...

Keyword(s):

Public Health ◽

Research Ethics ◽

First Nations ◽

Administrative Data ◽

Diagnostic Testing ◽

System Level ◽

Potential Health ◽

Individual Level ◽

Open Access Journals ◽

New Information

IntroductionDecades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses.Methods and analysisOur nations-based approach focuses on FN/M/I populations with separate study arms for each group. Linked administrative health data on COVID-19 diagnostic testing and vaccinations are available on a weekly basis. We will conduct surveillance to monitor trends in testing and vaccination among each FN/M/I population and all other Manitobans, map the geographic distribution of these outcomes by health region and tribal council, and identify barriers to testing and vaccination to inform public health strategies. We will follow the course of the pandemic starting from January 2020 and report findings quarterly.Ethics and disseminationEthics approvals have been granted by the University of Manitoba Research Ethics Board and from each of our FN/M/I partners’ organisations. Our team is committed to engaging in authentic relationship-based research that follows First Nations, Metis and Inuit research ethics principles. Our FN/M/I partners will direct the dissemination of new information to leadership in their communities (health directors, community health organisations) and to decision-makers in the provincial Ministry of Health. We will also publish in open-access journals. The study will create ongoing capacity to monitor Manitoba’s pandemic response and ensure potential health inequities are minimised, with learnings applicable to other jurisdictions where detailed administrative data may not be available.

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