Surgeon general: How clinicians can address social determinants of health

If there’s one idea that infuses U.S. Surgeon General Jerome Adams’ approach to addressing social determinants of health, it’s empathy. “People need to know that you care before they care what you know,” he says. It’s also important for physicians to understand their own biases, form partnerships and create change in their institutions, Dr. Adams said in a recent webinar for ISMA.

The Dec. 4 webinar, “Understanding the Role of Social Determinants of Health in Primary Care and Hospital Settings,” grew out of the ISMA Board of Trustees’ pledge this summer to help address social determinants of health, health equity and racism. The Centers for Disease Control and Prevention (CDC) defines social determinants of health as “conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.” 

Dr. Adams, who earned his MD at the Indiana University School of Medicine and holds a Master of Public Health from the University of California-Berkeley, was Indiana’s health commissioner from 2014 to 2017. His motto is “better health through better partnerships.”

The webinar was presented in collaboration with Indiana’s county medical societies and sponsored by Bose, McKinney & Evans LLP. The following is a synopsis of Dr. Adams’ answers to some key questions.

Q. What is the greatest lesson you’ve learned as surgeon general?
“People need to know that you care before they care what you know,” Dr. Adams said. “Far too often, we try to beat people over the head with the science without recognizing that they can’t even think about the science because they’re just trying to survive.”

Q: How can physicians address health disparities in their patients?
A. “First, increase awareness about this issue at all levels. Most people recognize there are these things called disparities, but they don’t believe it’s happening in their practices and in their communities,” 
Dr. Adams said. To do this, he suggested:
Screen for social determinants using tools such as these, described in “A Practical Approach to Screening for Social Determinants of Health,” published by theAmerican Academy of Family Physicians (AAFP):

Get to know vulnerable populations in your area and the organizations that represent them, such as the Salvation Army and faith-based communities. Meet with your patients’ trusted leaders to help them understand the health problems you see in your area and how you can work together to solve them.
Ask your institution to begin screening for social determinants of health if it does not already do so. If you’re on a medical executive committee, ask whether screening tools are available and, if not, ask why.

Q. How can physicians partner more effectively with public health?
A. Know your local health officer, Dr. Adams said. Visit the local health department website: Public health officials have epidemiology and surveillance tools that can help in your clinical practice. Foster communication between your health care system and public health organizations. Then, convene partnerships between the academic, public health and clinical care organizations in your area.

Q. How can physicians integrate racial humility and competence into practices?
Recognize your biases. “We have to start by having the humility to admit we all bring bias into our interactions,” which is part of being human, Dr. Adams said. Take one or more of Harvard’s free Implicit Association Tests online.
Provide or demand implicit bias training at your medical institutions to better understand local subpopulations and how to build trust and communicate with them.
Use motivational interviews. This style of interviewing emphasizes empathy and reflective listening to create trust.
Diversify health care. We need to do a better job of making sure our health care providers and our health care systems look more like the people we’re trying to serve, Dr. Adams said: “People are more likely to relate to and trust someone who talks and looks like them.”

A recording of Dr. Adams’ webinar will be available soon on the ISMA Online app.