Center for Diversity and Health Equity
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The AAFP supports the assertion that physicians need to know how to identify and address social determinants of health in order to be successful in promoting good health outcomes for individuals and populations. The Results of an AAFP member survey indicate that while 85% of surveyed physicians state they believe social needs are directly related to worse health, 80% are not confident in their capacity to address their patient’s social needs. In response to this stated need and to a 2016 AAFP Congress of Delegates resolution, the AAFP formed the Center for Diversity and Health Equity to address social determinants of health with The EveryONE Project.
The EveryONE Project aims to address social determinants of health by:
- Providing AAFP members with education and information about health equity.
- Identifying and developing clinical tools and resources to address patients’ social needs.
- Supporting research and policy development.
- Advocating for policies that encourage health equity.
- Encouraging workforce diversity.
- Serving as a resource center for AAFP members.
Due to their comprehensive training, family physicians are uniquely qualified to care for people of all ages—newborns to seniors. They provide the majority of health care for underserved rural and urban populations in the U.S., and treat a more diverse population of patients than any other medical specialty. This often places family physicians as leaders in their communities. As leaders, family physicians have an important role to raise awareness about health disparities and help patients address social and economic drivers of health inequities.
The AAFP has a long history of supporting health equity and reducing health disparities in patient care. One of the AAFP’s key strategic objectives is to “take a leadership role in addressing diversity and social determinants of health as they impact individuals, families, and communities across the lifespan and to strive for health equity.” The EveryONE Project is our vehicle to help achieve this objective.
In order to address health inequities, we must first identify the factors that have the greatest impact on health outcomes and are the primary drivers of health inequities. These health factors, often referred to as SDOH, include a range of sub-factors.
University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2017.
The County Health Rankings & Roadmaps(www.countyhealthrankings.org), a program of the Robert Wood Johnson Foundation, ranks the health of nearly every county in the U.S. They identify four classifications of health factors: health behaviors, clinical care, social and economic factors, and physical environment. Based on the group’s methodology, as well as previous research, each health factor is weighted1 and shown with activities and specific factors that contribute to social determinants of health.2 According to the County Health Rankings & Roadmaps, factors such as health behaviors (30%), clinical care (20%), social and economic factors (40%), and physical environment (10%) are attributed to SDOH.
Race, gender, and geography(518 KB PNG) are not implicit in the County Health Rankings & Roadmaps model, but also impact health outcomes through discrimination and social stratification, and as a result, impact life expectancy rates. Gaps in life expectancy are evident among racial and ethnic groups, as well as between genders and by education level.3
Additionally, a nearly 20-year gap exists in life expectancy at birth(381 KB PNG) between counties with the highest and lowest life expectancy rates.4
A complex system of political, economic, social, behavioral, and medical factors influence health equity. Health equity scholars use an analogy of a stream of causation to describe this system. Upstream factors refer to underlying root causes of health inequities, such as the structural socioeconomic and political environments that leads to social stratification.5 Downstream factors refer to those factors that are nearer to where health outcomes are observed, such as behavior and disease.5 This upstream and downstream continuum reflects key factors that determine health outcomes.6
Achieving health equity requires actions to address both upstream and downstream factors. Upstream interventions are more population-based in nature and include actions such as advocacy, policy change, and community empowerment. Downstream interventions are more individual in nature and include actions such as education, healthy behaviors, and access to health care.6
The AAFP recognizes the complexity of these systems and the challenges our members face in helping their patients address their individual health factors. Additionally, the new Medicare payment model, the Quality Payment Program (QPP), focuses Medicare payments on measuring the quality of care you provide more than ever before. Understanding the SDOH of your patient population and helping them address factors that improve health outcomes is imperative to your patients’ overall health and potentially your bottom line.
- Booske BC, Athens JK, Kindig DA, Park H, Remington PL. Different perspectives for assigning weights to determinants of health. 2010. University of Wisconsin Population Health Institute. Accessed February 27, 2018.
- County Health Rankings and Roadmaps. What and why we rank(www.countyhealthrankings.org). Accessed February 27, 2018.
- Health Affairs. Health policy brief. Health gaps(www.healthaffairs.org). Accessed February 27, 2018.
- Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. Inequalities in life expectancy among US counties, 1980 to 2014. Temporal trends and key drivers. JAMA Intern Med. 2017;177(7): 1003-1011.
- Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19-31.
- Bay Area Regional Health Inequities Initiative (BARHII). BARHII Framework(barhii.org). Accessed February 27, 2018.