Focus on the workstreams: Social determinants of health

How can we as healthcare professionals address social determinants of health?

Gavin Giovannoni, Professor of Neurology at Barts and The London is the chair for the national ‘Raising the bar’ steering group and the lead for this workstream.Dr Helen Ford, consultant neurologist and MSologist at Leeds Teaching Hospital, will co-chair the workstream.

‘The social determinants of health (SDoH) are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.’

the World Health Organisation

Objectives:

• To review how the social determinants of health affect disease, and MS, outcomes.
• To discuss social capital and how social prescribing may be useful for improving the quality of life (QoL) of people with MS.

Why this workstream?

At ‘the Way Forward’, Paola Dey outlined her team’s ‘international evidence base for access to health and social care for MS patients’ stimulating widespread discussion around the social determinants of health.Startling findings were shared, such as that access to services generally tended to be worse amongst men, older age groups, those from lower socio-economic groups or the least educated, non-caucasians, those with mental health problems and those from rural areas. However, women less likely to see a urologist or have a powered wheelchair and younger patients were less likely to be in receipt of personal assistance, highlighting the complexity of the social lines seemingly being drawn.‘We are all taught to take a social history in medical school, but do any of us act on that history?’ asks Gavin. ‘What does the average MS healthcare professional do to minimise the impact of social circumstances on MS outcomes? Can we configure MS services to be more proactive in addressing SDoH?’These findings prompted discussions around social prescribing and how we can incorporate this into our treatment models, as delegates observed that people with MS who engage from a social perspective do much better in terms of health and wellbeing outcomes. A recent dramatisation of the repercussions of social isolation with MS was also shared, with this challenge entering mainstream social commentary.Gavin sums up why this workstream is so important, saying, ‘The SDoH are critical if want to ‘Raise the Bar’ for everyone. It may prove relatively easy to improve services for well-educated engaged people, but it is important not to ignore the needs of the more vulnerable pwMS, i.e. the less educated, less eloquent, less well off and less demanding patients. We want to provide MS services for all.’

What to expect?

‘As part of this holistic management of MS, we want to imprint on all participating MS centre a ‘no patient left behind’ philosophy.’

If you attend this workstream, you put forward your MS centre to actively participate in making this philosophy a reality. This will require systems to make sure that all people with MS, who are covered by a particular service, will have access to that service. ‘We don’t want vulnerable, less educated or less well off patients to be disadvantaged by the service.’Participating centres will:

• be working differently and managing MS holistically including through programmes to screen and manage comorbidities and to promote lifestyle interventions.
• collect data on these new activities as part of the annual national audit.

More information:

• Read an interview with Gavin where he delves more deeply into this workstream and why it’s so essential.
• Listen to Gavin introduce the problem of service and quality variance at ‘the Way Forward’ last year.
• Listen to Paola Dey outline a recent study on social inequalities in MS, specifically considering some of those social determinants.
• Watch Sir Michael Marmot discuss Social Determinants of Health (2014 WORLD.MINDS) and Developing further action on reducing the social gradient in health
• Read our Spotlight article on inequalities in access to health and social care.