Social Determinants of Health

How do Social Determinants of Health Affect Patient Wellness.
Different social determinants of health affect patient wellness by limiting patient access to key health and lifestyle resources

By Sara Heath – October 09, 2020 [Excerpts] The social determinants of health garnered a lot of attention once it became evident they can impact value-based care success.

As healthcare providers worked to promote overall health and wellness and to prevent unnecessary healthcare utilization, it quickly became clear that certain social factors were at play here. The social determinants of health could affect whether a patient obtained and maintained wellness, regardless of the quality of care they would receive during a clinical encounter.

To be clear, there is a broad array of social determinants of health that impact a patient’s ability to be healthy. For length and clarity, PatientEngagementHIT has identified the top most common social determinants of health and outlined how they directly impact patient wellness.

The social determinants of health garnered a lot of attention once it became evident they can impact value-based care success.To be clear, there is a broad array of social determinants of health that impact a patient’s ability to be healthy. For length and clarity, PatientEngagementHIT has identified the top most common social determinants of health and outlined how they directly impact patient wellness.

Transportation has an effect on patient wellness because it directly impacts whether or not a patient can access her healthcare. When a patient has transportation barriers, she is less likely to attend a wellness check, chronic disease management appointment, or follow-up care.

In 2017, 3.6 million individuals missed an appointment because they did not have access to transportation to that appointment, according to figures from the American Hospital Association (AHA). Four percent of children missed their medical appointments for that reason.

Housing, too, has a direct correlation with health and wellness.
“Chronic medical problems that are prevalent among adults experiencing homelessness include seizures, chronic obstructive pulmonary disease, arthritis and other musculoskeletal disorders,” Homeless Hub reports on its website. “Conditions such as hypertension, diabetes and anemia are often inadequately controlled and may go undetected for long periods. Respiratory tract infections are common and oral and dental health is often poor.”

What’s more, individuals who are homeless are at higher risk for certain illnesses by virtue of living on the streets or having an unstable housing situation. Tuberculosis, for example, is common among individuals who are homeless, Homeless Hub stated.

Income is a pervasive social determinant of health because it has a domino effect on several other social determinants of health. Income can impact:

• Educational attainment

• Healthcare affordability, payer status

• Housing status

• Access to nutritious food

• Numerous other domains

Food security most prominently affects a patient’s ability to manage or stave off chronic illness. When a patient cannot access nutritious food, it becomes more likely they may develop a chronic disease like diabetes, or become non-adherent to dietary components of a care plan.

Utilities stress is defined as challenges in paying for key household functions, like the water bill, electric bill, or heating bill. These utilities are what make a house livable, but payment can be extremely challenging for some populations.

Race has long been regarded as a key social determinant of health, with most of the literature indicating that traditionally marginalized populations are more likely to experience other social determinants of health than White patients. Black and Hispanic patients may be more likely to be low-income, for example.

Per 2020 research out of the Regenstrief Institute and Department of Veterans Affairs (VA), Black patients have picked up on non-verbal cues that could suggest implicit racial bias. Factors like a mostly white clinic staff and strained patient-provider communication can get in the way of Black patients perceiving quality healthcare.

Healthcare is also largely understanding racism as a public health crisis. Although the field of understanding is burgeoning, the concept of “weathering” might have a big impact on chronic illness.

Weathering is the idea that prolonged exposure to adverse conditions, like discrimination, can have an impact on chronic illness. The sustained stress could negatively impact patient wellness.

A July 2020 report gives credence to that concept. The American Heart Association found that individuals with reports of discrimination were more likely to develop hypertension.

For the full article, please visit:

READ MORE: Why Teamwork Is Key to Addressing Social Determinants of Health
READ MORE: HHS Targets Social Determinants of Health With Healthy People 2030

BCRHN Minutes

Youth Mental Health Report RCCbc

RCCbc Site Visits Specialized Report: Youth Mental Health and Addiction Service Successes, Challenges, & Areas of Opportunity

September/October 2020
Prepared by: Erika Belanger

The following information has been collected from physicians, health administrators, First Nations, nurse practitioners, and municipality members from ~95 RSA communities across the province of BritishColumbia between January 2018 – March 2020. The current report introduces themes that have emerged through the Rural Site Visits Project. Themes have been extracted using a qualitative analysis program called NVivo and are expanded upon in further detail. All information has been anonymizedfollowing ethical protocols and guidelines.

Thematic Highlights

• Youth mental health, psychiatry, and addiction services are lacking exponentially compared to that ofadult mental health, psychiatry, and addiction services; which are also lacking across rural communities.

• Youth mental health and addiction needs are not being met across rural British Columbia. A crisis is occurring where a high demand for accessing such services exists across the province, and youth are occurring where a high demand for accessing such services exists across the province, and youth are struggling to receive help.

• Youth mental health and addiction successes have involved strong collaboration initiatives between
local community-level stakeholders and provincial stakeholders.

• Many physicians and nurse practitioners report not feeling comfortable enough or feel that they lack the adequate skillset to treat pediatric mental health patients. More training in this area, or an improved ability to refer to those who do have the necessary training in a time-efficient manner, is needed.

Mental Health and Addiction Successes

Through various initiatives, participants shared how they found the Child and Youth Mental Health Program to be successful at connecting youth to mental health services and supports that they required access to. One community advocated to keep the program in place for as long as possible given its success.

BC Emergency Health Services


Improving health care in rural and remote communities
September 2017


[Excerpt] British Columbia is improving access to health care in rural and remote communities through the Community Paramedicine Initiative and an expanded role for qualified paramedics.

Community paramedicine reflects a transformation in the practice of paramedicine from an emphasis on pre-hospital emergency care to a model that includes prevention, health promotion and primary health care.

Community paramedicine is integrated with other elements of the health care delivery system, with paramedics becoming part of a community-based team of health service providers.

Principles of Community Paramedicine [Excerpt]

o Patients will be referred by their physicians, discharge nurses or other community health care providers, following a referral process established in partnership with regional health authority partners.

Building Blocks of Community Paramedicine
Community paramedics are participating in the following activities:

Community Outreach & Awareness: Getting to know the local community and neighbouring First Nations communities, and helping them understand how community paramedicine can improve access to health care, is a priority. Community paramedics work with local health care providers to identify service gaps and ways of improving the health of residents, particularly older residents with chronic conditions.

Health Promotion: Encouraging patients to take responsibility for managing their own care and treatment – where safe and appropriate to do so – is an important step in improving health outcomes. This is a role community paramedics can readily assume, along with providing seminars on cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED).

Wellness Clinics: Many communities host wellness clinics and/or medical check-ins for patients with specific health issues such as diabetes. By participating at these events, community paramedics can take on some of the services that allow others – doctors, nurses, nutritionists – to spend even more time with their patients.

Wellness Checks: Older people living on their own, often with little or no support, may need someone to check in occasionally to see how they’re doing. Regular visits from a community paramedic can helpthese patients safely live longer in their homes, reduce their reliance on medically unnecessary 911 calls, and help ensure they stay connected with their primary care physician. These patients are those impacted by chronic disease, specifically heart failure, chronic obstructive pulmonary disease (COPD) and diabetes. Patients are referred by their doctor or other community health care provider, with the service provided at no cost to the patient.

Services provided during Wellness Checks may range from measuring vital signs against criteria established by the primary care physician, to services that may be delegated acts from other health care providers andare within the community paramedic’s scope ofpractice.

Services such as chronic disease monitoring, falls assessments and health system navigation can be provided based on the current scope of practice of paramedics, as can support services such as assistance with mobility, oxygen equipment and inhaled respiratory devices.

Additional services may be added as patient need is identified and in collaboration with the health authorities. See Appendix A: Services Provided by Community Paramedics.

To read more:

December 2020

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A Higher Standard in LTC Homes


A Higher Standard
Setting federal standards in long-term care and continuing care

Pat Armstrong and Marcy Cohen
November 23, 2020

[Excerpts] Introduction

The COVID-19 pandemic has highlighted the critical importance of federal government leadership in health care. The pandemic’s impact has been particularly dramatic in long-term care homes, exposing a fragmented and under-resourced system that is heavily reliant on for-profit delivery.

There can be no question that federal leadership is urgently needed in the development of a coordinated approach to long-term care, along with the broader system of home and community-based health services for seniors and people with disabilities (i.e. continuing care). Both the 1964 Hall Royal Commission on Health Services1 and the 2002 Romanow Commission on the Future of Health Care in Canada2, as well as a host of other research, have called for such leadership.

Ongoing concerns about fragmentation and silos within our health care system are legendary. This includes the lack of coordination and communication across di erent parts of the health system—primary, continuing (long-term, home and community based) and hospital care. Effective coordination is essential to facilitate e ective transitions and communication. There is also fragmentation within continuing care itself, where a more comprehensive approach is needed that includes health promotion, prevention, medical and social care, rehabilitation, and palliation.

The idea of working locally in neighbourhoods and/or small communities to support a more integrated and comprehensive approach—including linkages with primary and specialized care, community social supports and affordable housing—is one that has caught the imagination of many who work in or receive continuing care services. Developing, supporting and scaling-up innovative models for service integration and improving connectivity across the health and social support sectors are of paramount importance for the health and well-being of seniors and people with disabilities.

Access based on need and not on ability to pay
An increasing number of the services that older adults and people with disabilities require to maintain their health and wellbeing are not available through the public system and must be paid for through the private market. Many of the people who require continuing care services, however, cannot afford to pay for them privately and some have diffculty in even covering their basic monthly expenses for food and accommodation. Access must be based on need and not ability to pay, as is the case for physician and hospital services.

Not-for-profit delivery

There is a body of accumulated research demonstrating a pattern of lower quality care in for-pro t services. At the same time, there is little justification for profit making in this sector, in which the human right to basic care should be paramount. There is no evidence that for-profit services or a managed market competition in the provision of care services lowers cost, improves quality, access or choice. It is, however, more difficult to ensure health-focused governance, given the responsibility of for-profit firms to their shareholders. Policy and funding at the federal and provincial levels should be developed with a view to eliminating profit taking in publicly funded continuing care.

National standards for long-term care homes

According to the Canadian Institute for Health Information, “countries with centralized regulation and organization of [long-term care],” such as Australia, “generally had lower numbers of COVID-19 cases and deaths.” National standards have helped, but as a recent Royal Commission report from Australia acknowledges, they would be more effective if they provided “incentives to improve,”  which would require standards that are transparent, specific and measurable.

To access the full report, click on:  A Higher Standard: Setting federal standards in long-term care and continuing care.