Social determinants of health

If social determinants of health are so important, shouldn’t we ask patients about them?

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4150 (Published 24 November 2020)

Cite this as: BMJ 2020;371:m4150

If social determinants of health are so important, shouldn’t we ask patients about them?Patients’ socioeconomic circumstances should be routinely documented in their healthcare record, say Andrew Moscrop and colleagues Health inequities are worsening across Britain. Data from the Office for National Statistics (ONS) show that men in England’s most deprived areas die almost a decade earlier than those living in affluent neighbourhoods.1 For women, life expectancy is falling in deprived areas. During the coronavirus pandemic, the strong emerging relation between covid-19 death rates and area deprivation reported by ONS2 and Public Health England3 has shown the exacerbation of existing inequities and highlighted the need for more comprehensive datasets in order to understand and reduce them. The measurement and description of health and social inequities tends to rely on data at the level of geographical areas rather than individuals. We consider the limitations of using geographical data and look at how the collection of individual level socioeconomic data by healthcare systems could help to deliver care that is responsive to patients’ social contexts and generate an enhanced dataset for research and monitoring of healthcare equity. Between the extremes of life expectancy exposed by the ONS data above, researchers in the UK have described a “social gradient in health.”4 On this gradient, lower socioeconomic position or greater deprivation is associated with increased cardiovascular and cancer mortality56 and more mental health problems.7 Recognised social determinants of health such as employment status, occupation, education, housing, and household income not only affect people’s health8 and health experiences9 but also their access to healthcare, outcomes of care, and engagement with health protection activities.10111213 Yet the UK’s National Health Service has no system for routine recording of patients’ socioeconomic circumstances. Social determinants are not routinely asked about, documented, or coded in clinical settings. The health service is, …

Not seeing anything above? Reauthenticate

Related ideas

Trauma informed care and Adverse childhood events (ACE)

Google Sites

Report abuse