Social Determinants in Healthcare
Key Insight 2
I never knew a hug could mean so much. Following 5 days of running a free medical clinic in Chuiquel, Guatemala, our group provided stickers, toys, and snacks for the children in the village. It was during this celebration that the villagers started to ask for pictures and the children wanted to play games in the area surrounding the clinic. Earlier in the day I had helped treat a woman who had 2 of her children with her, one boy and one girl each under 5 years old. The boy was unafraid of us, laughing and making faces during his mother’s exam, but her daughter was quiet and shy, avoiding eye contact and refusing to smile. It wasn’t until later that I felt a tap on my leg and turned to see the little girl smiling at me, that I realized her mother wanted a picture of us together. We posed for a photo, and she turned to me and gave me the biggest hug I’ve ever received. She didn’t leave my side for the rest of the day. Some of these pictures, including the moment that she hugged me, can be found below. It was then that I realized how important it is for providers to build rapport by spending time getting to know their patients to fully understand where they come from and their day-to-day lives. It is imperative for providers in the medical field to gain the trust of their patients and being able to identify aspects in their lives that affect their health is one way to determine the root causes of ailments and provide the best possible care.
One of the first times I was taught what aspects of life influence health was in PUBH 302: Introduction to Public Health with a model of the Social Determinants of Health. Study guides with the model and application of the effects of the Social Determinants of Health can be seen as artifact #1. The social determinants of health are aspects of a person’s life that affect their long-term and short-term health. The model shows larger aspects of life including economic stability, neighborhood and built environment, healthcare access and quality, education access and quality, and social and community context, each of which can be broken down into more specific topics that can be connected to a person’s health outcomes. For instance, economic stability can impact one’s ability to pay for healthcare, education can affect literacy and basic medical knowledge, neighborhoods can affect physical activity due to walkability, social context can affect physical safety, and healthcare access can determine the type of care someone can receive. As a provider, understanding how health can be influenced by aspects of people’s lives is crucial in providing practical care that can be sustainable and effective.
I realized how important the social determinants of health were to adequate medical care when I embarked on a medical service trip to Guatemala in March of 2022 as mentioned above. This was one of the first experiences I had involving direct patient care, and it was in a system that is very unlike anything I had experienced before. On our first day we learned basic patient care techniques and went over medical terms in Spanish that would be common and helpful to know during our clinic days. We discussed what the Guatemalan healthcare system looked like what to expect when running the clinic over the following days. The first day in the clinic was nerve-wracking as we had 2 sets of interpreters (from the native language to Spanish and from Spanish to English) and had no idea what the village we were going to was going to look like. After arriving in the village, our first task was to make home visits to introduce ourselves to the villagers and see what their living conditions were like. We asked them questions about their habits and histories such as if they cooked inside the home, where they got their water from, what their daily diet consisted of, what they did for work, how many children they had, how those children were birthed, and if they had any medical conditions, they were aware of. As seen as artifact #2 we did a similar questionnaire whenever a person entered the clinic to receive a checkup and asked them questions about their home life as well as their health history.
When evaluating one patient, the importance of the social determinants of health became clear. She was a young woman, only about 17 years old, and she was pregnant. This wasn’t uncommon in the village as women got married and started having children younger than what we are used to in the US. She was explaining some symptoms she was having, and we weren’t sure what the diagnosis was until we asked her the questions from the questionnaire about her living conditions. She explained that she got water from the river in the back of her house because she didn’t have the money to buy bottled water and when prompted explained that she doesn’t normally boil it before drinking. After hearing this, it made the diagnosis clear- this woman had a parasite. Parasites were a common diagnosis in many of our checkups due to the lack of access to clean drinking water. It was in this moment that I realized the importance of understanding all aspects of these patient’s lives. Without spending the time to talk and ask questions, we would never have been able to narrow down the diagnoses or provide her with feasible treatments. We identified what aspect of the social determinants was causing her ailment- neighborhood and built environment, economic stability, and education- to recommend and educate her on how to avoid this problem in the future. It wasn’t enough to only give her medicine, as that would not fix the root problem. Instead, we educated her on parasitic infections, how to successfully purify water, gave her alternatives to drinking from the river, and wrote a prescription for medication to fix her current issue. It is because of these conversations that we can better identify helpful initiatives that could be implemented to prevent these health disparities. Just because she couldn’t afford to buy bottled water, didn’t mean she should have to do without clean drinking water. Without the knowledge of the social determinants of health, we would not have been able to solve her medical problem or give long-term solutions to attempt to remedy her health disparities.
It was the in-classroom model and my trip to Guatemala that showed the importance of understanding factors that affect health which is vital to know as I continue on to be a provider in the medical field. With these experiences and knowledge I will be better able to serve my patients in understanding what types of programs and initiatives would be beneficial in eliminating health disparities in relation to the determinants of health.
One of the first times I was taught what aspects of life influence health was in PUBH 302: Introduction to Public Health with a model of the Social Determinants of Health. Study guides with the model and application of the effects of the Social Determinants of Health can be seen as artifact #1. The social determinants of health are aspects of a person’s life that affect their long-term and short-term health. The model shows larger aspects of life including economic stability, neighborhood and built environment, healthcare access and quality, education access and quality, and social and community context, each of which can be broken down into more specific topics that can be connected to a person’s health outcomes. For instance, economic stability can impact one’s ability to pay for healthcare, education can affect literacy and basic medical knowledge, neighborhoods can affect physical activity due to walkability, social context can affect physical safety, and healthcare access can determine the type of care someone can receive. As a provider, understanding how health can be influenced by aspects of people’s lives is crucial in providing practical care that can be sustainable and effective.
I realized how important the social determinants of health were to adequate medical care when I embarked on a medical service trip to Guatemala in March of 2022 as mentioned above. This was one of the first experiences I had involving direct patient care, and it was in a system that is very unlike anything I had experienced before. On our first day we learned basic patient care techniques and went over medical terms in Spanish that would be common and helpful to know during our clinic days. We discussed what the Guatemalan healthcare system looked like what to expect when running the clinic over the following days. The first day in the clinic was nerve-wracking as we had 2 sets of interpreters (from the native language to Spanish and from Spanish to English) and had no idea what the village we were going to was going to look like. After arriving in the village, our first task was to make home visits to introduce ourselves to the villagers and see what their living conditions were like. We asked them questions about their habits and histories such as if they cooked inside the home, where they got their water from, what their daily diet consisted of, what they did for work, how many children they had, how those children were birthed, and if they had any medical conditions, they were aware of. As seen as artifact #2 we did a similar questionnaire whenever a person entered the clinic to receive a checkup and asked them questions about their home life as well as their health history.
When evaluating one patient, the importance of the social determinants of health became clear. She was a young woman, only about 17 years old, and she was pregnant. This wasn’t uncommon in the village as women got married and started having children younger than what we are used to in the US. She was explaining some symptoms she was having, and we weren’t sure what the diagnosis was until we asked her the questions from the questionnaire about her living conditions. She explained that she got water from the river in the back of her house because she didn’t have the money to buy bottled water and when prompted explained that she doesn’t normally boil it before drinking. After hearing this, it made the diagnosis clear- this woman had a parasite. Parasites were a common diagnosis in many of our checkups due to the lack of access to clean drinking water. It was in this moment that I realized the importance of understanding all aspects of these patient’s lives. Without spending the time to talk and ask questions, we would never have been able to narrow down the diagnoses or provide her with feasible treatments. We identified what aspect of the social determinants was causing her ailment- neighborhood and built environment, economic stability, and education- to recommend and educate her on how to avoid this problem in the future. It wasn’t enough to only give her medicine, as that would not fix the root problem. Instead, we educated her on parasitic infections, how to successfully purify water, gave her alternatives to drinking from the river, and wrote a prescription for medication to fix her current issue. It is because of these conversations that we can better identify helpful initiatives that could be implemented to prevent these health disparities. Just because she couldn’t afford to buy bottled water, didn’t mean she should have to do without clean drinking water. Without the knowledge of the social determinants of health, we would not have been able to solve her medical problem or give long-term solutions to attempt to remedy her health disparities.
It was the in-classroom model and my trip to Guatemala that showed the importance of understanding factors that affect health which is vital to know as I continue on to be a provider in the medical field. With these experiences and knowledge I will be better able to serve my patients in understanding what types of programs and initiatives would be beneficial in eliminating health disparities in relation to the determinants of health.
Artifacts
Artifact #1: Study Guides With The Social Determinants of Health and Their Effects
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Artifact #2: Questionnaire from Guatemala with Fake Patient