Addressing Social Determinants of Health

Abstract

Purpose: Social determinants of health (SDOH) continue to gain attention as the factors that weigh heavily on physical and mental health. In response, professional case managers need to develop a deeper understanding of the entrenched nature of SDOH, particularly the spiraling and compounding effects of economic, environmental, and social factors on the health and well-being of individuals and populations. Professional case managers are essential to helping identify both the barriers experienced by individuals in accessing and receiving the care they need and the resources to eliminate or mitigate those barriers. These responsibilities should be most keenly felt by case managers who are board-certified and therefore held accountable by codes of ethics to ensure justice and fairness. By embedding greater awareness of SDOH into the case management process—from intake and assessment through implementation, evaluation, and across care transitions—case managers can establish rapport with clients (known as “patients” in some care settings) and support improved outcomes through best practices in care coordination, thus contributing to the Triple Aim of improving the health of people and populations and reducing the per capita cost of care. Primary Practice Settings: SDOH impact individuals across the health and human services, including acute care, subacute care, primary care, community-based care, and workers' compensation. Implications for Case Management Practice: Case management plays a vital role in providing people with episodic care and ensuring adequate follow-up. The latter includes if and how people are able to access the ongoing care they need, including medications (access and affordability), doctors' visits, therapies and other services, healthy nutrition, and more. However, a lack of affordability undermines an individual's ability to receive preventive care and treatment of chronic illnesses and potentially more serious and life-threatening conditions such as cancer. Compounding the impact of affordability can be a lack of transportation that inhibits access to health care professionals, which can affect individuals in both rural and inner-city environments. Although poverty and homelessness play a direct role in SDOH, case managers cannot assume which clients are impacted by these factors and which are not. Higher costs of living, loss of job or reduced income, unexpected expenses, and death of, or divorce from, a partner/spouse can negatively impact a client's ability to access and afford care. With this understanding, case managers can meet individuals where they are to explore how SDOH affects their lives, without judgment, bias, or assumption.

Reflections on Case Management—Past, Present, and Future

“…Among all health care professionals, professional case managers uniquely address the needs of the whole person, beyond a particular care episode. Increasingly, this will mean acknowledging the impact of SDOH, such as economic, environmental, and social factors that weigh heavily on physical and mental health, particularly among at-risk and underserved populations (Campagna et al, 2022).…”

Advocacy into and Beyond Retirement

“…While most organizations welcome helping hands, that assistance is raised to a higher level when it is also accompanied by a highly regarded accreditation such as CCM or Certified Disability Management Specialist. This is our "street cred," which is particularly meaningful when assisting those who are impacted by social determinants of health, such as poverty, low levels of literacy and education, limited access to healthcare resources, and similar factors (Campagna et al, 2022).…”

SDOH and Immigration Status

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As advocates in care settings across health and human services, case management professionals must be cognizant of the impact of social determinants of health (SDOH), defined as the economic, environmental, and social conditions in which people are born, work, live, develop, and age (Campagna et al, 2022). Beyond the widely recognized SDOH, such as poverty, lack of education and literary skills, and substandard living conditions, there are also broader forces and systems that impact people's daily lives and health; among them is immigration status.

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