Social Determinants of Health (#SDOH); the bigger solution

When thinking about the health of a population, it seems that many acknowledge the role of public health and preventative medicine. We talk often about the context of the patient, their "Social Determinants of Health."

On a 1:1 clinical encounter, I often feel like I'm hardly doing anything useful. I'm just treating some numbers, doing something to the patient, not really doing anything for the patient.

It Seems I'm  'spit-polishing' the giant dent in the car, when I help an obese, diabetic patient adjust their dose of insulin.

You could take it in for repairs... but maybe better to have prevented this? (Image from Bob Ottenhoff)

You could take it in for repairs... but maybe better to have prevented this? (Image from Bob Ottenhoff)

It's not clear how much of a difference this test-ordering, medication optimizing, target-setting, or patient educating makes. It feels like we are "helping" but at the same time, it feels often that we are just occupying time and resources when we could be investing these in a more effective way.

Dr. Leana Wen, writing Help patients by addressing the health of the community for KevinMD, puts it well:

We need comprehensive strategies that promote health and target problems “upstream.” We need to recognize that health does not exist in a vacuum, that it is intimately tied to issues such as literacy, employment, transportation, crime, and poverty. An MRI here, a prescription there — these are Band-Aids, not lasting solutions. Our communities need innovative approaches to pressing issues like homelessness, drug addiction, obesity, and lack of mental health services.

The Canadian Centre for Policy Alternatives "gets it." Their paper, Sustainable health care begins with the social determinants of health: It’s time to get it right concisely summarizes the data and emphasizes that solutions that decrease spending on the medical aspects of health (eg. private healthcare) will only worsen economic disparity, worsening health.

How do we convince governments, who must work within the bounds of election cycles, that a long-term plan that addresses patients bigger needs is the wisest choice?