Dr. Rosario defined SDOH as “the conditions in which people are born, grow, live, work, and age, and also includes the health system” that affect every individual. She added that SDOH “are affected by the distribution of money, power, and resources and are influenced by policy as well.” She noted that, “We [healthcare professionals] want to ensure that we are addressing our patient’s SDOH in order to promote health equity.”
In regard to health equity, she stressed that medical professionals “strive for health equity and not health equality because each patient has [his or her] own individual, unique needs” to achieve a high health status and to ensure that the patients can have health equity.
She described one model of SDOH comprising of socioeconomic status, the neighborhood/physical environment (access to housing/safe housing, pollution), food environment (access to high-nutrition food and food security), healthcare (insured and uninsured), and social context (family support, community involvement).
A few examples of the relationship between SDOH and diabetes include employment/insurance status, insulin rationing, insulin storage concerns for individuals who are homeless, proximity to healthcare services and grocery stores, food insecurity (which relates to medication use, depression, diabetes distress, and worse glycemic management), patients who are underinsured or uninsured, and formulary restrictions.
Dr. Rosario described how healthcare providers contribute to SDOH. This can include lack of patient support, negative attitudes towards insulin, language/cultural discordances, unrealistic provider goals, lack of ongoing education, lack of trust in the provider, negative experiences related to clinic wait time, and communication styles.
She gave several examples of how healthcare providers can avoid bias in diabetes management. These can include not withholding diabetes resources from eligible patients (such as continuous glucose monitors, insulin pumps, or newer diabetic agents that have cardiovascular/renal benefits); documenting nonadherence with access barriers (such as including reasoning why the patients discontinued a medication); using trained interpreters versus family members or friends; and by not making assumptions about a patient related to diet, physical activity, insurance status, or cultural norms.
Additionally, Dr. Rosario introduced several tools and resources the address barriers to diabetes management. They include culturally sensitive patient education; the utilization of diabetes technologies (e.g., phone applications, step trackers, and meal trackers); cultural humility training for all staff; integrating collaborative care models using interprofessional teams (including primary care physicians, dieticians, social workers, and behavioral health specialists); as well as having language access services.
In closing, Dr. Rosario stressed that every patient has their own SDOH circumstances. She emphasized that, “We [healthcare providers] want to reflect on the biases that we might have towards our patients who have diabetes because we want to ensure that we are providing that equitable care, providing our patients those good opportunities in order to improve their health. We want to think about our patient’s baseline lifestyle and SDOH before making recommendations.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
