Social Determinants of Health

My professor posited an interesting situation in class this week. She introduced to us a patient named Juan Peréz. While her story was much longer than what I will relay to you, it basically went as follows: Juan Peréz is a 40 year old Dominican male living in the mountainous regions of the DR. He has a wife (who does not work) and two children. Being the sole financial provider of the house, he works long hours in the tobacco plantation located 1 hour away from his home. As we follow his life, we find that various pressures, stresses, and catalysts lead to him having a malnourished diet, unhealthy use of tobacco and alcohol, irregular low quality sleep, high levels of stress, and much more. He comes down with a slight cough by Day 90. Despite the urges of his wife, the machismo culture instilled in him refuses to allow him to see a doctor. Within a couple more weeks, he collapses on the job. His friends travel 2 hours to the nearest hospital, but to their dismay, they are unable to be served because it is a private hospital, which is not covered by the government's insurance. His friends then transport him again to now the nearest publichospital, but he passes away upon arrival. 

Now the question remains, what killed Juan Peréz?

Answering the question of "what killed patient X?" requires much more scrutiny than I realized. The social determinants of health (individual behavior, socioeconomic and cultural factors, environmental factors, and healthcare systematic factors) all play into the status of our health. Do we point fingers at the inefficiencies of emergency services in rural communities in which Juan Peréz lived? Or is the culprit his alcohol use and unhealthy diet from Day 1? When there are so many factors at play, which one should we place blame on?

Rather than playing the blame game, I now see that there is more value into understanding there is never one principal reason for the status of one's health. Among all of us, there a myriad of cogwheels not only affecting the micro-movements of each gear but also the macro-movements of the machinery as a whole. While some of these components are within our control to change, there are also so many other uncontrollable social determinants that define our health. I see that good physicians must understand these nuances and various levels of analysis.  It is critical that doctors are able to consult their patients in a way that collaborates with all these social determinants- both the controllable and uncontrollable. Understanding what type of community you serve, what various resources are out there for each type of need, and what microchanges can be made within that individual patient's life are just a couple of the many elements doctors must wrestle with. This week I find myself in awe, once again, at how much conscientiousness and wisdom that goes into the career of physicians, nurses, and medical personnel. I hope to continue building my repertoire of knowledge so that one day I may be qualified to provide the most effective medical counsel that serves the needs of future patients. ​​