Which Has Greater Healing Power: Social Determinants or Healthcare?

Determinants of health encompass the factors that contribute to the pattern of health for groups or individuals within a population. Biological determinants play a large role in this conversation, but the wide range of social aspects tend to be more malleable and therefore allow greater opportunities to affect real change within the scope of a community, province or country. James Frankish goes so far as to say that social determinants of health play a larger role in the well-being of a population than the healthcare system itself (Frankish, J., Kershaw, P., Shoveller, J., Evans, R. and McLeod, C., 2017).

Politicians are in a position to create policies that will affect change, for better or worse. One concern is that politicians are not the most capable of assessing the utility of such programs. Additionally, nearsighted public expectations often dictate that short-term pain (upfront cost) for long-term gain (reduced population illness and associated expenses down the road) may present a career hazard to the politicians brave enough to trial such solutions. This means that prevention takes a back seat while parties jockey for re-election and systems continue to fail the disadvantaged, widening the gap in access across demographics while ballooning healthcare expenses.

Pinto and Bloch (2017) suggest that primary care providers including physicians and nurse practitioners possess an appropriate combination of knowledge and access to the population in a capacity that allows these professionals to screen for and take steps in addressing social disadvantages that may lead to decreased future health and resultant increased future health care expenditures (p.478). A committee has been organized to help integrate this proactive approach in Toronto (Pinto & Bloch, 2017, p.476). The process starts with the primary care providers collecting detailed history with an eye on factors that may complicate health or access to healthcare in the future while addressing current health issues. The interdisciplinary approach to treatment allows for pooling of expertise to supply the best resources and outcomes for these patients, but an added focus is on regular follow up and retro-active review to identify trouble areas. These deficiencies are then addressed by policy development or the creation of new agencies or programs tailored to specific shortcomings.

The state of healthcare in New Brunswick has suffered due largely to the oscillating political landscape over the past decade and a half (“Premiers of New Brunswick,” n.d.). Energy has been focused on allocating resources just to have them clawed back and re-allocated differently every four years. The result is that New Brunswick has the highest rate of chronic illness in Canada (New Brunswick Medical Society, 2016). Though this is largely due to having the highest proportion of seniors among all provinces, it is not helped by the fact that over fifty percent of the population is either overweight or obese and that the physician-to-population ratio is among the highest in the country (New Brunswick Medical Society, 2016). This creates the very real public perception that the province’s residents are drowning in illness. This in turn motivates political campaigns to promise relief by pouring more funding into reactive healthcare, limiting resources geared toward social determinants of health, thereby dooming another generation to a similar fate.

References

Frankish, J., Kershaw, P., Shoveller, J., Evans, R. & McLeod, C. [UBC Medicine – Educational Media]. (2017, January 13). The Social Determinants of Health [Video file]. Retrieved from https://www.youtube.com/watch?v=nTqknri15fQ

New Brunswick Medical Society. (2016). Finding a Family Doctor. Retrieved June 11, 2019, from https://www.nbms.nb.ca/patient-information/finding-a-family-doctor/

Pinto, A. D., & Bloch, G. (2017). Framework for building primary care capacity to address the social determinants of health. Canadian Family Physician Medecin de Famille Canadien, 63(11), e476–e482. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/29138172

Premiers of New Brunswick. (n.d.). Retrieved June 9, 2019, from Wikipedia page website: http://www.gnb.ca/legis/leglibbib/special_projects/premiers.asp