Best practices for integrating social determinants of health into your practice

To get a full picture of a patient’s or client’s healthcare, providers should – but sometimes still fail to – consider social determinants of health (SDOH), the conditions in the environments where people are born, live, learn, work, play, worship, and age. Integrative healthcare practitioners, however, are likely more able to move the needle in the right direction as they are uniquely positioned to get a more holistic view of patients and clients.

Historically, the failure to consider SDOH factors has resulted in inequities in healthcare delivery. This is not surprising as SDOH factors account for 80 to 90 percent of an individual’s health outcomes, while medical care only accounts for 10 to 20 percent of outcomes, according to a study in the American Journal of Preventive Medicine.

“Minority communities in many instances have been either poorly treated or disenfranchised when they seek care. That's part of the well-documented systemic racism in traditional healthcare,” said Charles Sawyer, DC, special assistant to the president, Northwestern Health Sciences University in Bloomington, Minnesota. 

According to a 2020 policy paper  written by Sawyer and Michele Maiers, DC, MPH, PhD, executive director, research, and innovation at Northwestern Health Sciences University, “a complex legacy of racism in the United States continues to create health inequities among people of color. Systemic biases in education, employment, housing, healthcare, access to food, accumulation of wealth, and the legal system contribute to poorer health among communities of color. These social determinants of health are driving factors behind the ‘weathering hypothesis,’ where chronic exposure to discrimination and disadvantage lead to accelerated decline in health outcomes, particularly among Black individuals.”

To address this situation, both traditional and integrative care practitioners need to start to incorporate SDOH into their practice. “Whether you're part of conventional medicine or an integrative healthcare practitioner, it is your responsibility to address SDOH. It’s your moral or ethical obligation, but also, it's what's required to really optimize outcomes of care,” Maiers said. The good news is that integrative care practitioners are in the perfect position to right the course.

“Integrative healthcare providers are actually uniquely suited to help do something about SDOH beyond just having that awareness,” Maiers said. “Because integrative health providers have a level of trust with their patients that is unique in the broader healthcare system, [they] have an opportunity to identify and address the sometimes-sensitive social factors that may be creating or contributing to a healthcare complaint. These relationships allow providers to not just understand from a demographic perspective the social determinants of health that might be influencing this patient or client, they can help address these factors when providing treatment.”

Moving forward with purpose

To accomplish this, integrative healthcare practitioners should consider implementing a number of best practices such as:

Including SDOH as a routine part of the intake process. “During your exam, you should be taking a history that incorporates a broad range of influences on a person's state of health and wellbeing, including SDOH factors. Understanding this is important to arriving at the right diagnosis and treatment for an individual,” Maiers said.

Digging deep into SDOH topics. “When we see patients, they're on the table, so to speak, either getting acupuncture, massage therapy or chiropractic care and so forth. That creates opportunities for conversations. And during that time, the care provider can really get to know patients and clients, particularly those from minority populations,” Sawyer said.

Understanding the needs of local populations. “There is a lot that a practitioner could do on the community level. It’s important to understand the needs of the community that your practice is in, or the community you are primarily serving,” Maiers said. “Taking the time to understand that community and what barriers to social justice they experience can help integrative care providers deliver more effective care.”  

Leveraging community resources. “A lot of alternative healthcare providers are solo practitioners or are in small group practices. So it's extra important for those folks to really know where their local food pantry is, who to contact if they had a patient who needed transitional housing, or other social support services,” Maiers said. “Integrative care professionals need to have a good referral network for mental health issues or addiction treatment. You really need to make sure you have a robust network of services and organizations you can refer people to, and you can do a warm handoff to make sure that people do get the support they need to address the things that might be outside of your scope.”

Taking specific steps to incorporate SDOH assessments and referral systems into everyday practice. The American Osteopathic Association’s SDOH Toolkit specifically prompts practitioners to do the following to ensure that SDOH factors are considered when delivering healthcare services:

• Work with the practice team on adopting a “whole-person” approach.
• Educate staff on the importance of screening for and documenting patients’ SDOH needs.
• Identify SDOH assessment tools and resources appropriate for your practice.
• Collaborate with the practice team on developing an effective workflow system.
• Obtain training for the practice team on identifying SDOH risk and protective factors and effective referral to community resources.
• Document any SDOH needs by utilizing the established SDOH International Classification of Diseases (ICD)-10 Z codes.

Advocating for SDOH to be included in curriculums. “As educators, we need to examine our academic programs and make sure that we are training and acclimating our students and practitioners to understand the importance of social determinants of health,” Sawyer said.  “So a lot of that is on us and we should break out of our boutique practices in many cases and be more educated and responsive to the needs of patients and their families.”

Educating marginalized communities about the value of integrative healthcare. “Minority populations often don't talk about integrative healthcare because they think it's not for them. They think that it's boutique healthcare that may be financially out of reach. The integrative healthcare community has a responsibility to make sure that we are both educating BIPOC [Black, Indigenous, and People of Color] communities about their healthcare options, and also making sure those services are available to them,” Maiers concluded. “We have a lot of room for improvement because utilization of integrative healthcare among racial minority populations is significantly lower than among their white counterparts, but when they do utilize it, research that shows that they feel like they have more agency over their healthcare and have lower stress, better sleep, and improved overall health.”