Let's Talk About Social Determinants of and Risks to Health

We have probably all seen diagrams that indicate the drivers of health like this one with the clear message that clinical care plays a minor role when compared to social determinants and health behavior.

We hosted two speakers last week whose research is adding to that evidence base. Portia Cornell is interviewing for the health technology assessment role in the Validitron. She has shown that embedding social workers in primary care teams in the US Veterans Administration (VA) system reduces emergency department visits. As an economist, she emphasized the new model as a high-value investment with little cost and great benefit. She has also mined the extensive VA data to identify the association of social risk with unplanned care like ED visits and readmissions. This graph shows the highest predictors:

Douglas Pires hosted Leo Celi from MIT as part of the ANZICS critical care datathon. He championed the need for open data and transparent algorithms so that we have a better chance of identifying the rampant bias in our data (representing our biased systems) and correcting it in the future. He also spoke to the relatively low risk of re-identification of open health data: nobody hacks the MIMIC (Medical Information Mart for Intensive Care) dataset he leads, because there is no prestige in hacking a dataset that's already available.

“We agree that there is some risk to patient privacy, but there is also a risk of not sharing data,” he says. “There is harm when data is not shared, and that needs to be factored into the equation.”

Leo is working to encourage the development of more openly available databases in low- and middle-income countries to increase the diversity of patients represented in the datasets we use to derive our knowledge and make decisions about care of everyone.

Grahame Grieve asked me the important question: how does knowing a patient's social determinants or social risk factors help in treating them? Daniel described a meme I couldn't find of a doctor telling her patient "Just stop being poor."

Portia referred to a universal screening tool for social needs and the acronym ACORN indicates its intent for Assessing Circumstances & Offering Resources for Needs. In a value-based healthcare model, investments in addressing the needs can be justified by the healthcare organization, but we aren't there yet most places in the world. Interestingly, the top social need was in relation to the digital divide!

Give a big welcome to our newest researcher Olivia Metcalf, who officially starts today but joined us at a two-day workshop for our MRFF DELIVER grant. She brings extensive expertise in psychology, behavior change, and digital mental health app development and evaluation. We are thrilled to be learning from and working with her!

Regional Linguistic Quirk: A surprising learning for me this week demonstrates Australian's more frequent use of profanity in regular language. I apologize if I offend anyone with this learning: "Shit (or Shits) me up the wall" is basically another way of saying "Drives me crazy", often used among Australians. It's assumed to be similar to "Drives me up the wall", although nobody's quite sure what it means exactly. Still; it's commonly used.