“Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.” Sir Michael Marmot
Social determinants of health are the conditions in which people are born, grow, work, live and age, and these include housing, access to healthy food, transportation, education and the built environment to name a few. While the focus of healthcare providers has historically been on the biological aspects of health, we know that social factors contribute significantly to health and health outcomes.
It is imperative that we teach our learners about social determinants of health (SDoH) throughout the continuum of health professions education. In undergraduate medical education (UME), the Liaison Committee on Medical Education outlines in its standards for accreditation, the requirement for medical schools to include content about health disparities and social determinants of health in their curriculum. In graduate medical education (GME), the Accreditation Council on Graduate Medical Education (ACGME) through its Clinical Learning Environment Review (CLER) program has outlined requirements for residency and fellowship programs to teach trainees about health disparities and to ensure trainees participate in projects that address health disparities for their patients and communities.
What is still lacking is continuing professional development for faculty to be trained in social determinants of health. It is the faculty who role-model and reinforce either positively or negatively how students and trainees should identify and address social determinants of health. Will the students and trainees dismiss it or become overwhelmed by it? Or will they take the time to work through the issues, connect their patients with resources and follow up to ensure their needs were met?
As more medical schools and GME programs develop or expand their curriculum on social determinants of health, key questions to consider include:
• What are our goals in teaching social determinants of health? Do these goals align with community needs?
• What are the most effective methods of teaching SDoH? Are there best teaching practices on this topic which educators can agree to?
• What are the challenges/barriers educators have faced as they roll out their curriculum and how have they overcome them?
• What are some success stories from educators who have implemented SDoH curriculum in either UME or GME settings?
• How can we ensure faculty receive training to teach SDoH so that they role-model and positively reinforce with learners how to identify and address social determinants of health in clinical practice?
• How can health professions educators effectively partner with their communities and engage their health systems as they teach about SDoH?
With so many questions, it is important to have a community of practice where educators can share their experiences, ideas, questions and curricula. This is the goal of the National Collaborative for Education to Address Social Determinants of Health (NCEAS) Community of Practice. It is a forum where educators from different health professions can find like-minded colleagues who are passionate about teaching social determinants of health.
As issues of access to healthcare, gun violence, housing instability, food insecurity continue to impact our patients and their communities, education remains the most important tool we have to ensure current and future healthcare providers are equipped with the knowledge and skills to tackle these issues. We invite you to explore our resources and connect with our Community of Practice. As Sir Marmot said in the opening quote, health inequalities and social determinants of health are the main issues, and there is no better time than now to join the efforts in addressing these issues.
-Mobola Campbell, MD