Holistic Care Requires Care Coordination
Emergencies related to avoidable chronic conditions can be costly and can turn into a vicious cycle of clinical care that does not address the root of the problem: SDoH.
HCOs understand the impact of SDoH on overall health outcomes, but many organizations are unclear about how to approach SDoH interventions. A 2017 survey, found that physicians who felt they should help address these issues said they probably weren’t in a position to do anything. For example, 48 percent said physician offices were not capable of helping patients find affordable housing. The solutions to this problem lie beyond the walls of clinical care. To improve patient outcomes, especially for chronic diseases, HCOs must partner with CBOs to coordinate care. By partnering with CBOs, HCOs are better positioned to address SDoH within their communities. Because CBOs are closely embedded in the community and have the capacity to provide nonclinical, social support to address SDoH, CBOs can fill a critical gap in care coordination.
To learn more about addressing SDoH and partnering with CBOs to drive SDoH interventions, download our white paper, Overcoming Obstacles: Challenges & Solutions for Providers Addressing SDoH. In this white paper, we explore some of the central challenges providers face when addressing the social determinants of health and high-level solutions to overcome them.
The Social Determinants Of Asthma
In all communities, poverty is strongly related to ill health 1. This has not generally been the pattern for asthma, where the lifetime prevalence of symptoms is usually higher in more affluent societies 2, 3, and a rising prevalence of asthma is a price paid for increasing national prosperity. This trend is probably inevitable since to date, no public health strategy for large-scale primary prevention of asthma has yet proved feasible or effective.
Why Coordination Is The Key To Addressing Sdoh
Today is World Asthma Day, and on this day, we are reminded that the social determinants of health have a significantly adverse effect on children and adults who are exposed to environmental factors like allergens, tobacco smoke, and indoor and outdoor air pollution. Asthma is a major contributor to disease and disability in children, and social factors have given rise to unhealthy residential environments where risk factors of asthma are clustered.
Studies show that there is a pattern in asthma risk based on race and socioeconomic factors. Many individuals and families living in poverty are more likely to be exposed to polluted air and water, reside in noisier, lower quality, and more crowded homes and live in more dangerous neighborhoods with physical deterioration and poorer city services.
The reality is that asthma triggers are largely avoidable. According to the Centers for Disease Control and Prevention , asthma accounts for 11 million doctors office visits, 439,435 discharges from hospital inpatient care and 1.7 million emergency department visits each year. Each day, ten Americans die from asthma, and in 2015, 3,615 people died from asthma. Many of these deaths are avoidable with proper treatment and care.
Poverty And Risk Of Asthma
Interpretation of the relationship between asthma and GNI PPP in the study by Sembajwe et al.19 is also limited by the paucity of information on other variables that may have an influence. First is inhomogeneity of populations within countries, and a secondly is the impact of urbanisation. As an example, Brazil, which has the highest reported prevalence of wheezing, is categorised as a middle-income country. This assessment is skewed by a small proportion of its very large population that has a high or very high income. A majority of the population are in the low-income category. This inequality is captured in figure1, which clearly presents the contrast in housing between that of the majority and that of the privileged few in Salvador, Bahia, a large urban center in Brazil. Classifying a country according to a single measure is often uninformative and is usually an oversimplification.
Landscape of inequality in housing in Salvador , a city of 2.8million inhabitants. The contrast between the majority of homes in an overcrowded underprivileged neighbourhood and the minority household located 500m away. Both pictures were taken on 18 April 2009 from the same location on the top of a hill nearby.
Population Projections By 2021
In Ballarat, more than 15% of the population is over 65 years old, the projections are that by 2021 quarter of the population will be above this age . Ageing population requires improved health services to cater for the rising needs among these people. This is a challenge to Ballarat because the available health institutions do not match the rising needs. Other determinants of health include environmental factor, education and housing.
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Asthma And The Social Determinants Of Health
Annals of Allergy, Asthma & Immunology
Accreditation: The American College of Allergy, Asthma & Immunology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Designation: The American College of Allergy, Asthma & Immunology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Perception Of Society On Aged Employees
According to a report by Australian Human Rights Commission , mature age workers encounter massive barriers to employment due to their age. This group of people is prone to sicknesses like asthma, yet they cannot access the resources to fight off the ailments. This trend is likely to boil down to workers aged above 45 years in very recent future.
According to this human rights watchdog, this poses a great threat to economic development. By 2056, the proportion of people aged over 65 years will overtake those aged below 15 years in Australia . This is a great challenge to the future of economic status of Australia. What is the government doing about this? Review of labor laws is inevitable if the government is to deal with these challenges effectively. The human rights watchdog has to become proactive and step up campaigns to sensitize the public on the dangers of discriminating aged workforce. With figures indicating that the proportion of people over 65 years will overtake those under 15 years, the government has to review its strategic plans.
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How Do Health Disparities Affect African Americans
In 2017, there were 41.4 million African Americans living in the U.S., representing 12.7% of the total population 5. Across the board, African Americans have lower life expectancy than whites 5. Conditions such as hypertension, obesity, asthma, and diabetes are more prevalent in African Americans 6,7,8,9. Historically, the African American community distrusts the medical community, and public health guidance, and they are often hesitant to engage in clinical research 28.
Current Health Outcomes Experienced By Old People 65+ In Ballarat
The current health outcomes experienced by people over 65 years in Ballarat are appalling. According to Page, Ambrose, Leah and Glover , in 2005 Ballarat recorded relatively high levels of asthma cases compared to Australia as whole .
This raises many questions why such a high prevalence rates exist in this particular place. According to a discussion paper for the 2009 Ballarat community summit , the people above 65 years old are at risk of developing health complications. This resulted from disadvantaged economic state of inhabitants of this town. Ballarats salary and wage earners averaged $37,411 compared to that of the State of Victoria, which hit $42,603 in 2005. The report indicated that 37% of households in this ancient town survived on less than $650 per week while the Victorian average was only 30.6% .
This clearly shows the how this town is economically disadvantaged and alienated. Consequently, the people living in this place withstand the worst of this backdrop and live with the consequences thereof. The authorities need to ask some crucial questions here, and take a firm step in scaling down these economic disparities. Has the government or the local authorities developed strategies that addresses the employment needs of the rising population effectively? From this question, the authorities will formulate and implement long-term strategies that deal with this issue perfectly.
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How Do Social Determinants Of Health Affect American Indians And Alaskan Natives
There are several disparities in the social determinants of health for American Indians and Alaskan Natives. While 22% of the population lives on reservations or trust lands, another 60% live in metropolitan areas, but that is lower than any other racial or ethnic population in the U.S.21. American Indians and Alaskan Natives have lower rates of educational attainment from high school through graduate degrees that non-Hispanic whites 21. The average household income is $45,448 and 21.9% of households live in poverty 21. The percent of American Indians and Alaskan Natives without health insurance is 14.9%. Nearly 25% of households lack regular access to foods that support an active life and healthy diet 24. Specific to the Navajo Nation, 30-40% of residents do not have running water and the nation is considered a food desert 25.
How Do Social Determinants Of Health Affect Hispanics
Over 70% of Hispanics speak a language other than English at home, with nearly 30% reporting that they are not fluent in English 18. This can be a barrier to accessing health care, finding culturally competent health care providers, and understanding health information. Less than 70% of Hispanics have a high school diploma and fewer than 16% have a bachelors degree or higher 18. The average household income in Hispanic families is $49,793, with unemployment at 6% and poverty levels of 19.4% 18. Affording healthcare is significant issue within the Hispanic community as they have the highest number of uninsured people at 17.8% 18. While nationally, 13.9% of households lack regular access to foods that support an active life and healthy diet, that number is higher in Hispanics at 16.2% 14.
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What Is Health Literacy
Health literacy is the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions 30.
Literacy does not mean a person has good health literacy. Health literacy goes beyond the ability to read or write to reflect an understanding of basic health information as described above.
Social Determinants Of Health Tied To Morbidity For Pediatric Asthma
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Inaction Is Not An Option
There are two great barriers to asthma prevention and control throughout the world. The first is a major gap in knowledge concerning causation and primary prevention. Asthma is a syndrome with multiple phenotypes related to complex geneenvironment interactions. To address these gaps there is a need to scale up research on the topic worldwide. More funding, more collaboration and innovative approaches are urgently needed. Meanwhile, the outcomes of nationwide strategies based on plausible biological reasoning with simplification and standardisation of interventions and treatment such as those implemented in the Finnish Allergy Programme 26, should be closely considered for their potential application in LMICs. Lack of control of asthma is associated with avoidable reliance and expenditure on emergency care by underprivileged families and health systems that can hardly afford it 30. Simple interventions for management of asthma can control the disease, and reduce mortality, hospital admissions and costs 3034, but they are not yet integrated to primary care policies or widely available. A crucial move towards feasibility and sustainability in LMICs would be the full integration of asthma management into primary healthcare routines, as reported in South Africa 35. Moreover, most subjects with asthma have concomitant rhinitis 36, which has been strongly associated with lack of control of asthma 37 and is usually neglected by the health systems in LMICs.
Comparison Of Cai Children With Those In Similar Neighborhoods
No significant differences between the intervention and the comparison groups were found in demographic variables . In the comparison of CAI intervention participants enrolled during the pilot period with children from similar neighborhoods, the mean number of patient hospitalizations for asthma among CAI participants during the pilot period demonstrated a greater decrease between 1 year before and 1 year after the enrollment date compared with the children in the comparison group . The decrease in mean number of asthma-related hospitalizations per child among CAI participants between 1 year before the intervention and 1 year after the intervention was 0.32 hospitalizations per child , and the decrease in the mean number of hospitalizations for asthma per child in the comparison group was 0.16 . A significantly greater decrease occurred in mean number of hospitalizations per child for the intervention group compared with the comparison group from 1 year before to 1 year of follow-up .
In contrast, the decrease in mean number of asthma-related ED visits per child among CAI participants was similar to the decrease in the comparison group , with no significant difference in decrease in ED visits between the two groups . For the intervention group, the correlation was high between parent/guardian reports in the case management data and Boston Childrens administrative data for hospitalizations and ED visits .
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Improving Social Determinants Of Health Can Reduce Asthma Disparities
Update as of March 2, 2021:Advocacy Action Alert!Use our simple tool
Social and economic factors play a big role in health disparities in the United States. A health disparity is when a health condition, like asthma, affects one group of people differently than another group. In the U.S., Black, Hispanic, and Indigenous people carry the greatest asthma burden. The Asthma and Allergy Foundation of Americas Asthma Disparities in America report looks at these differences.
Social Determinants Of Health And At
Jordan Tyris, Anand Gourishankar, Maranda C. Ward, Nikita Kachroo, Stephen J. Teach, Kavita Parikh Social Determinants of Health and At-Risk Rates for Pediatric Asthma Morbidity. Pediatrics August 2022 150 : e2021055570. 10.1542/peds.2021-055570
Compared with population-based rates, at-risk rates account for underlying variations of asthma prevalence. When applied with geospatial analysis, ARRs may facilitate more accurate evaluations of the contribution of place-based social determinants of health to pediatric asthma morbidity. Our objectives were to calculate ARRs for pediatric asthma-related emergency department encounters and hospitalizations by census-tract in Washington, the District of Columbia and evaluate their associations with SDOH.
This population-based, cross-sectional study identified children with asthma, 2 to 17 years old, living in DC, and included in the DC Pediatric Asthma Registry from January 2018 to December 2019. ED encounter and hospitalization ARRs were calculated for each DC census-tract. Five census-tract variables were selected by using the Healthy People 2030 SDOH framework: educational attainment, vacant housing, violent crime, limited English proficiency, and families living in poverty.
Place-based interventions addressing SDOH may be an opportunity to reduce asthma morbidity among children with asthma.
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Sdoh Leads To Asthma Exacerbation
Studies show that housing is the main SDoH contributor to asthma. Inadequate housing is linked to increased indoor allergen exposure and higher asthma morbidity and mortality, particularly for low-income racial/ethnic minority children living in urban areas. Findings from a cross-sectional study among children < 6 years of age revealed that roughly 39 percent of doctor-diagnosed cases of asthma among children in the United States are avoidable by eliminating indoor environmental exposures.
Another study also found that low-income minority populations are more affected by these factors. Researchers studied 140 lower-income households with an asthmatic child in the Kansas City region and assigned their living environments a concern-level score with zero as no concern and 53 as the highest. Households of those who identified as Latino had an 18.7 concern score, and those identifying as Black had a 17.8 score, while non-Latino white households had a 13.2 score and an unclassified group scored 13.3.
Why Are Faith Communities The Setting For Not One More Life
It is really very simple. Communities of faith are enduring bases of leadership in the community and foster both physical and spiritual well-being in their neighborhood. NOML screenings found that only 17% of participants had a low symptom score and normal lung function, while 38.5% had a high symptom score and abnormal lung function. The best news of NOML is that 90% of the participants reported seeing a physician after a NOML session.
Theres a lot of work to be done to improve asthma care for communities of color and NOML is a model program of bringing care to where it is needed most.
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