Thoughts on Screening for the Social Determinants of Health
Peter F.Belamarich, MD, Editorial Board Member, Pediatrics in Review
Let me say it right now: Given the struggle that I have to complete everything that
Bright Futures has laid out for us to do in the typical 15-minute visit, the announcement that our
practice would be adding yet another screening test, this time for social determinants
of health, was not particularly welcome news to me.
So many public health problems have become part of the agenda of a primary care visit
that, at times, the practice of general pediatrics seems akin to trying to achieve
peace during a war by counseling the soldiers individually. Too much to do in too
little time, and I often feel far downstream from the causes of what I am dealing
with or trying to prevent. This felt no different.
Beyond this, being measurably effective at mitigating the effects of childhood poverty
on a population level with efforts that originate in our pediatric offices will be
very difficult, and we should be concerned with effectiveness. I then thought, even
if we could magically succeed at connecting every family in need to a community service
organization that can offer help (housing, food, legal help, immigration, domestic
violence), I doubt these organizations have enough collective wealth and resources
to substantially fix the childhood poverty problem.
So, why am I excited to be screening for social determinants of health in our practice?
Part of my enthusiasm is that, for once it seems, I don’t have to do the work! In
a completely refreshing change, we actually have the right person, a community health
worker, handling this initiative. She connects families that have screened positive
to community-based organizations that are local to them. Bright Futures advocates
a team-based approach to address its ambitious agenda, and thanks to a New York state
initiative, we actually have that in place.
More importantly, while I bet it will prove difficult to show this effort is effective
on a population level, making the connection between families and community-based
service organizations will undoubtedly help many individual patients. I just recently
saw this happen with the family of a patient of mine who, with the assistance of pro
bono legal service, was able to prevent illegal eviction attempts that, had they succeeded,
would have made his family of 6 homeless.
Moreover, the stories that will emerge about our patients’ hardships will personalize
the pernicious effects of poverty on children for pediatricians like me who have not
systematically “gone there” in the past.
If screening for social determinants of health catches on broadly and begins to illuminate
the scope and frequency of poverty related hardships for the children who we know,
it undoubtedly will help fuel the visionary movement to make childhood poverty a priority
for Pediatricians nationally.
Why? Because detailed stories of childhood social injustice are hard for pediatricians