Knowing what Social Determinants of Health are, how they shape illness, how to screen for SDOH, and having a stack of helpful resources – all of this is not enough to bring practical, valuable help to a person who is coping with unstable housing, food insecurity, and other factors. There is a “last mile,” which is how a person can receive help when their day-to-day life is overwhelming.
Like a computer hard drive, the human brain has limited space or “bandwidth” for activity. An erratic work schedule, a drafty rented apartment, flimsy childcare arrangements, and a broken stove all crowd a person’s brain, leaving less resource for higher level thinking. Science shows that coping with poverty not only uses mental resources, but also impairs how the brain works.1 Among the first to go is the brain’s executive function, which analyzes costs-benefits and weighs long term consequences.
In short, when today is complicated, a person has no room for the future. This is not unique to people coping with SDOH factors. It happens to anyone facing a complex, large event. For example, when you have an important deadline or a major life event, your focus narrows down to the immediate. Skipping your gym routine or eating fast food may not even register as decisions; they are simply the fallout of coping with the moment.
Why is this important for helping people who are coping with SDOH? Let’s take a real-life example.
Your job is to encourage low- and moderate-income HIV positive women to have a screening mammogram. These women are at higher risk for breast cancer. The brochure you created last year highlights the American Cancer Society’s guidelines, the age groups that should be screened, and the benefits of early detection. This information is useful to a person who regularly thinks about the future. It’s irrelevant to a person whose present day demands all their attention. Instead, you might choose to focus on practical questions: why should I, will it hurt, how will I get there, and will I have to pay? You might also support the print outreach with a short video of a patient explaining why she did it and her experience. Printed material is less likely to be a trusted source for people living in poverty.2 A story from a peer could have more impact. Help becomes less helpful when a trained, helping professional assumes that what works for them will work for others. “I would read and trust a brochure that quotes the American Cancer Society!” True for you; for your audience, not so much.
When you understand that an overwhelmed brain takes in new information differently, you can see your help in a new way. The next time you set out to offer help, ask yourself, “Does this help assume that the person regularly thinks about things far in the future?” For example, preventive screening tests, quitting smoking, and many other health behaviors require time today in exchange for a benefit in the future. In these cases, ask yourself, “Can I find some immediate benefits to taking the action I am suggesting?” In addition, you need to remove practical barriers. Simply asking the person about obstacles can open a good discussion. You might learn that she is nervous about calling for the appointment (which entails identifying herself as a Medicaid member), or that her friend went and was treated rudely.
A stack of resources is useful only if they make it through that last mile. You can make your help more effective by knowing how it can be best received.
-Linda K. Riddell, MS
Linda K. Riddell, MS is the creator and founder of gettin’ by, a simulation that puts your brain through the same changes as happen to a person coping with poverty. She plays gettin’ by with health, education, and other professionals nationwide and online. She can be reached at lriddell@gettinby.net.
Twitter: @l_riddell
References:
- Sendhil, M., & Shafir, E. (2013). Scarcity: The New Science of Having Less and How It Defines Our LIves . New York: Picador.
- Poverty Institute Guide, Donna Beegle Ed.D.