Module 3: Health Disparities & Social Determinants
Health disparities are the avoidable differences that result from cumulative social disadvantage, including health outcomes, health care access, coverage and quality of care between groups of people, etc. Health disparities are caused by a multitude of systemic factors often referred to as social determinants of health, including access to safe housing, heathy food, access to health services, transportation, public safety, media and technology, etc.
Some system-wide barriers to accessing care for mental health and substance use challenges also need special consideration because the issues are heightened by cultural dynamics. Barriers to mental health and substance use treatment services can occur at three different levels: individual, organizational and systemic. The barriers at the individual level are related to the individual’s characteristics such as demographics, health beliefs and attitudes, personal enabling resources, perceived illness and personal health practices. The barriers at the organizational level are related to provider and organization characteristics such as skills and attitudes. Barriers at the system level are related to the system characteristics in the organization of the health care system, including system-wide policies, cost of care, scope and types of services offered, etc.
- Define health disparities and social determinants.
- Acquire additional resources for their toolbox to address health disparities and social determinants.
- Apply the skills and tools acquired in this module to a case vignette.
Step 1: Let’s Get Started
This step briefly introduces health disparities and social determinants of health and provides specific objectives that will move you closer to your goals.
Step 2: Time to Engage
The information in this step is accessible and provides a general introduction to health equity. You can listen to a podcast on your morning walk, download a resource to help your client or get a short audio summary of an article that caught your eye before fully engaging with the reading.
Step 3: Creating a Stronger Foundation
This list of materials and resources provides a more detailed description of how to apply the tools introduced in Step 2. This step requires you to engage in deeper analysis of the topic through documentaries, research articles, trainings and books. Some of the tools, like research articles and books, may have a cost attached and we recommend that your organization provide them and that share them with other team members. Tools like trainings may require you to engage for longer periods of time than the initial resources.
Step 4: Your Turn
This step encourages you to apply what you have learned through a case vignette. We recommend that you explore the gaps present within the vignette and implement any new skills acquired through this module. Consult with others on your team to explore the multiple ways to address the issues, especially as you take your role within your organization and your experience, skills and worldview into account. We provide reflection questions from the following perspectives: individual learning and beliefs, organizational learning and systemic. You can use the questions to have discussions with others and think through all the facets that are relevant to your work.
Rob is an experienced therapist, but Carolina’s referral from Luz, a nurse practitioner, made him pause. As Rob read over her chart, he felt overwhelmed by her long history of trauma. Initially, Carolina had been seen for somatic symptoms consistent with panic attacks, but a cursory history revealed indications of a possible psychotic disorder, depression and sexual trauma. Carolina was an immigrant from Nicaragua and was in a series of relationships where there was serious interpersonal violence. Rob set the chart down. He wondered what he could possibly do to help someone who experienced this kind of extensive depravation and poverty. As much as he hated to admit it, Rob felt pessimistic about his ability to help, which was a rare feeling.
He thought about a continuing education seminar he had attended at his most recent national conference about understanding health disparities and the complex web of social determinants of health. Rob remembered that that presenters emphasized that getting bogged down in the cumulative effect of disadvantage was not helpful to the client. Rob remembered that Luz mentioned how much she liked Carolina and admired her for her positive outlook. Rob remembered concepts he had learned about such as resilience and cultural strengths.
Rob drummed his fingers on the file and reminded himself why he wanted to be a therapist. He couldn’t ignore the cumulative effects of health disparities, but he also couldn’t simply focus on pathology. Rob decided to try to understand how Carolina navigated her personal history and the U.S. medical system to help bolster her coping skills, maintain her health and access resources that could be helpful. Rob chuckled as he recognized that he was nervous. A deep breathing exercise helped him center himself before he walked to meet Carolina to begin their therapy relationship.
- In the vignette, Luz, the nurse practitioner, helps humanize the client. What are some ways to keep the person front and center, rather than her history? (individual learning and change)
- How can you ensure your organization sponsors and offers training that emphasizes resilience and cultural strengths? (organizational learning and change)
- A client experiencing health disparities due to inequities in the social determinants of health may not get help right away and present with highly acute symptoms. How might new client intake sessions be structured to take acuity as a result of inequity into account, rather than an individual factor? (systemic change)