This document discusses how social determinants of health like income, education, housing, and food security significantly impact patient health outcomes. It provides evidence that people from low-income neighborhoods have much higher rates of chronic diseases and that life expectancy can vary by over 20 years between wealthy and poor areas. The document advocates that healthcare providers consider social determinants when individualizing patient care in order to better address patient needs, build trust through open communication, and help enable behavior changes and access to care.

1. CARE BEYOND
MEDICATION
May 4, 2019
Robyn Despins,
BSP

2. OBJECTIVES
1. Discuss social determinants of health and why they are an
important factor in health outcomes
2. Relate and apply examples of how social determinants of health
can affect every practice
3. Gather patient specific information related to values, motivators
and patient specific factors that will help individualize patient care
and influence health behaviours
4. Recognize the way that knowing more about patients and building
better relationships is an important tool in providing better care
and filling gaps within current health care systems for your
patients

3. CLINICAL
OUTREACH
PHARMACI
ST
Wellness Wheel
A interprofessional team of health care providers
committed to providing quality outreach primary and
chronic disease care in rural Saskatchewan.
My Role:
• Health Promotion Events
• HCV/HIV clinics with an Infectious Disease Specialist
• Addiction clinics
• Diabetes clinics with a Nurse Practitioner
• Nephrologist and Internist clinics
• Pharmacist-nurse lead clinics
• Pharmacist smoking cessation clinics

4. WHAT DETERMINES THE
HEALTH OF OUR
PATIENTS?

5. DETERMINA
NTS OF
HEALTH
Genes and biology
Physical environment
Social environment
Health behaviours
Health services or medical care

6. Social environment
Health
behaviours
Health services or
medical care

7. SOCIAL ENVIRONMENT
THE CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE,
WORK AND AGE.
•Employment
•Income
•Housing
•Transportation
•Safety
•Literacy
•Education
•Food security
•Access to healthy food
options
•Support systems
•Discriminations
•Etc.

9. EVIDENCE OF THE
IMPACT
“Health Disparity by Neighbourhood
Income”
• Comparison of health indicators between
the six lowest-income neighbourhoods in
Saskatoon to the rest of the city
• People in the lowest income
neighbourhoods were:
• 4x more likely to have diabetes
• 4-7x more likely to get a STI
• 15x more likely to have Hepatitis C

10. EVIDENCE OF THE
IMPACT
“The Code Red Project”
• Hamilton, Ontario
• Showed a difference in life expectancy of
21 years between the wealthiest and
poorest neighbourhoods

11. EVIDENCE OF THE
IMPACT
Food Insecurity
• Adults in food insecure households are
more likely to suffer from chronic diseases
such as diabetes, hypertension, mood and
anxiety disorders
• Food insecurity makes it more difficult to
manage existing chronic diseases such as
diabetes and HIV
• Children who face hunger repeatedly are
more likely to develop chronic health
conditions, such as asthma

12. EVIDENCE OF
THE IMPACT
After adjusting for other social
determinants, total annual health
care costs in Ontario were 121%
higher for adults living in severely
food insecure households than in
food secure households.

13. EVIDENCE
OF THE
IMPACT

14. SOCIAL ENVIRONMENT
THE CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE,
WORK AND AGE.
•Employment
•Income
•Housing
•Transportation
•Safety
•Literacy
•Education
•Food security
•Access to healthy food
options
•Support systems
•Discriminations
•Etc.

16. Social environment
Health
behaviours
Health services or
medical care

17. Social environment
Health behaviours
Health services or
medical care

18. WHY DO THESE
DETERMINANTS OF
HEALTH MATTER TO
PHARMACY
PROFESSIONALS?

19. OUR GOALS
Collaborative Accessible Trusted
Educators
Drug therapy
experts
Provide patient
centered,
individualized care

20. INDIVIDUALIZING CARE
Our care plans include:
• Patient demographics – age, gender, height, weight
• Medical history
• Drug allergies and intolerance
• Medications – prescription, OTC, herbal
• History of presenting illness – what they’ve tried, how long, etc.
• Review of systems – are there other symptoms?
• Vitals and laboratory tests

21. PATIENT
CENTERED
CARE
 To place the patient’s needs, wants and
preferences before your own
 To serve as an advocate and do what is
best for the patient
 To treat patients as individuals
On the other side of the counter is our
patient, who innately has a set of values,
beliefs, culture, motivators, health
behaviours, and social environment that are
going to influence their engagement,
adherence and outcomes.

22. DETERMINA
NTS OF
HEALTH
Genes and
biology
Physical
environment
Social
environment
Health
behaviours
Health services
or medical care

23. INDIVIDUALIZING CARE
Our NEW care plans include:
• Patient demographics – age, gender, height, weight
• Medical history
• Drug allergies and intolerance
• Medications – prescription, OTC, herbal
• History of presenting illness – what they’ve tried, how long, etc.
• Review of systems – are there other symptoms?
• Vitals and laboratory tests
PLUS:
 Social environment - housing stability, food security, education,
employment, support systems
 Health behaviours – tobacco, alcohol, cannabis, other drug use, diet,
exercise, sleep
 Access to health care

24. THE INDIVIDUAL
Build trust.
Be curious.
Be flexible.

25. BUILD
TRUST
Reliability
NonjudgementGenerosity
Interest

26. BE CURIOUS
Ask questions
Better
understanding
Develops
appreciation and
empathy
Builds a trusting
relationship with
our patients…
Note: sometimes
just listening is
enough

27. BE FLEXIBLE
What is important to us
is not always important
to them
Ask questions, listen
and allow the answers
to make an impact on
your care plan
INDIVIDUALIZED,
PATIENT-CENTERED
CARE!

28. CARE
EQUATION
Guidelines, evidence, knowledge
PLUS:
• Patient demographics – age, gender, height, weight
• Medical history
• Drug allergies and intolerance
• Medications – prescription, OTC, herbal
• History of presenting illness – what they’ve tried, how long, etc.
• Review of systems – are there other symptoms?
• Vitals and laboratory tests
PLUS:
 Social environment - housing stability, food security, education,
employment, support systems
 Health behaviours – tobacco, alcohol, cannabis, other drug use, diet,
exercise, sleep
 Access to health care
PLUS:
 Critical thinking
 Flexibility
= INDIVIDUALIZED PATIENT CARE

29. OPPORTUNITY Let your optimism run
wild.

30. OPPORTUNITIES
Know our patients
Meet them where
they are
Understand their
social
environment
Influence positive
health behaviour
change
Be a main point of
access to quality
care
Engage
Practice our full
scope
Fill gaps in care

31. Thank you! Discussion, questions,
comments.

32. REFERENCES
 Center for Disease Control, NCHHSTP Social Determinants of Health;
https://www.cdc.gov/nchhstp/socialdeterminants/faq.html
 Lemstra, M., Neudorf, C. & Opondo, J. Can J Public Health (2006) 97: 435.
https://doi.org/10.1007/BF03405223
 DeLuca, P.F., Buist, S. & Johnston, N. Soc Indic Res (2012) 108: 317.
https://doi.org/10.1007/s11205-012-0068-y
 Tarasuk, T., et al. CMAJ October 06, 2015 187 (14) E429-E436; DOI:
https://doi.org/10.1503/cmaj.150234
 Valerie Tarasuk, Andrew Mitchell, Lindsay McLaren, Lynn McIntyre, Chronic Physical
and Mental Health Conditions among Adults May Increase Vulnerability to
Household Food Insecurity, The Journal of Nutrition, Volume 143, Issue 11,
November 2013, Pages 1785–1793, https://doi.org/10.3945/jn.113.178483

33. OPPORTUNI
TIES
Know our patients
Meet them where they’re at
Understand their social environment
Influence positive health behaviour change
Be a main point of access to quality care
Engage
Practice our full scope
Fill gaps in care