The Daily Dose • Thursday, May 13, 2021

Social Determinants for Trauma Patient Recovery

Amanda Decimo, RN, MSN, MPH

Social determinants play an important role in the recovery for trauma patients. A care model interweaving these determinants into the healthcare system ensures their needs are met.

As a nation, the United States spends more on healthcare than any other industrialized nation and has the worst health outcomes.

Rochelle A. Dicker, MD, Head of Advisory Board & Founding Director, San Francisco Wraparound Project, broke down why spending more on healthcare hasn’t led to better patient outcomes in the Host Program Panel I: University of California, San Francisco: Health Equity and Social Determinants of Health on Thursday, May 13 at the Association of University Anesthesiologists 2021 Annual Meeting. She is also Founding Director for the Center for Global Surgical Studies; Vice Chair for Critical Care, Chief of Surgical Critical Care; and Associate Chief of Trauma and Emergency General Surgery at UCLA Department of Surgery.

Social determinants of health include economic stability, physical environment, education, food, community, and healthcare. These determinants critically impact health outcomes. Most providers fail to take these determinants into consideration during patient care — a clinical blind-side — leaving patients vulnerable to their unmet social needs. Dr. Dicker recommends adopting a model where these determinants are threaded into the healthcare system ensuring social needs are met.

Structural racism is the normalization and legitimization of an array of dynamics that routinely advantage Whites while producing cumulative and chronic adverse outcomes for people of color.  She describes the term “redlining” by looking at impoverished red zone districts in San Francisco. These red zones also have the highest burden of disease and violence, and they are inhabited primarily by people of color. Redlining is defined as the systematic denial of various services or goods by governments or the private sector either directly or through the selective raising of prices for housing.

She shared the following homicide facts for the US:

#1 cause of death among African American males, 15-34 years old

#2 cause of death for Latino males, 15-34 years old

Dr. Dicker uses a map of Los Angeles County homicide rates to illustrate a powerful point. Areas with the highest homicide rates overlap with higher rates of chronic disease, poverty, unemployment, and food scarcity. This alignment of poverty and disease holds true in cities across the US.

As trauma surgeons and trauma anesthesiologists, it’s often hard to see beyond the massive blood transfusions and patient instability that occur in the OR. She urges providers to consider the broader impact on the individual and communities of trauma patients. Dr. Dicker and colleagues developed the multidisciplinary ISAVE group to improve social determinants to attenuate violence. This group’s focus includes a nimble, trauma-informed care curriculum, investing in at-risk communities, integration of social care, and characterizing the medical center’s role in patient advocacy.   

COVID-19 drew attention to the healthcare disparities that have always existed. Dr. Dicker urges that now is the time for transformation. Opportunities are available for leveraging funds and addressing social determinants in these vulnerable communities.