Citizen Brief

Social Determinants

The key to a successful battle against optimal well-being will be prioritizing interventions aimed squarely at environmental risk factors in order to address the true impacts that social determinants have on health and well-being.

Background:

 

Social determinants such as poor housing conditions are often accompanied by neighborhood-level conditions that limit access to health care, risk-reduction information, and treatment alternatives, which are protective resources and can disrupt behaviors that ultimately lead to opioid addiction.

 

Economic conditions

 

Economic hardship and high rates of unemployment consistently characterize vastly different communities hit hard by the opioid crisis such as Appalachia and urban centers in the United States, as well as Russian communities dislocated by the Soviet Union’s economic collapse, plausibly shows that social determinants contribute to hopelessness and social trauma that “set the stage” for opioid abuse and dependency. Leading social scientists understand that social factors play a key role in directly and indirectly determining the incidence and prevalence of addiction disease. The reasons, however, are not yet well understood. Some researchers suggest that low educational attainment, income, and employment success produces poor social networks, low levels of power, prestige, and self-mastery that contribute to illicit drug use. Also, social conditions such as homelessness or high exposure to violence can shape health behaviors by increasing opportunities and perceived reasons for engaging in high-risk behavior. Social determinants such as poor housing conditions are often accompanied by neighborhood-level conditions that limit access to health care, risk-reduction information, and treatment alternatives, which are protective resources and can disrupt behaviors that ultimately lead to opioid addiction.

 

 

 

Education 

 

Patients in pain deserve compassionate care just like any other patient physicians treat, and stigmatizing patients who require opioid therapy is often a barrier to optimal treatment. In medicine, we do not use terms such as “malingerer” or “drug seeker” because these terms carry with them damaging psychological stigma. Patients who need care are simply “patients,” and we should seek to change the tone of the debate toward more attention on multidisciplinary, patient-centered approaches to pain management and ensuring that evidence-based alternative pain management treatments and strategies are covered by insurance while supporting opioid-based therapies when clinically appropriate and effective.

 

 

Housing

The impact of housing on health is now being widely considered by policymakers. Housing is one of the best-researched social determinants of health, and selected housing interventions for low-income people have been found to improve health outcomes and decrease health care costs. As a result, many health care systems, payers, and government entities are seeking to better understand the totality of the health and housing literature to determine where they might intervene effectively. This brief outlines the literature and provides high-level direction for future research and policy agendas.

Health Affairs

 

 

Demographics 

New research indicates that an increase in minimum wages can have important health benefits—a finding that is relevant to public debates about both health and economic policy. 

Health Affairs

 

Criminal Justice (Public Safety) 

 

 

Food and Nutrition

Epidemiological research suggests that nutrient imbalance is a strong predictor of substance use and may be partially mediated by depression. Some authors have recommended dietary supplements for use in early recovery from heroin. It remains unknown how these supplements interact with MAT, and the reader is referred to a more comprehensive review. Methadone maintenance patients have received nutritional counseling aimed at reducing diet-related morbidity but a lack of measurable changes (e.g., weight) reduces the scientific salience. Meanwhile, nutrition services provided within the Veterans Affairs health care system have been associated with significant improvements in treatment outcomes.     Learn More

Healthcare

Positive incentives to promote physician  education and public awareness, useful tools that physicians can use at the point-of-care to support medical decision-making, concerted attention to increasing access to quality addiction treatment.

 

  • Individuals can rate their experience with their physicians associated with attitude of the health care system and providers. (The challenge of rating)

  • Avoid the  use terms such as “malingerer” or “drug seeker” because these terms carry with them damaging psychological stigma. Patients who need care are simply “patients,”

  • Establish bill of rights for individuals suffering with pain or opioid related challenges

 

 

Transportation (Mobility) 

Montgomery County should create a comprehensive day-long symposium aimed at public education around overdose awareness. This symposium should offer different tracks, including healthcare professionals, educators, family and friends of those in recovery, law enforcement, among others.

 

 

The media

We can challenge the media, entertainment, and other social organizations that may have a negative approach.

 

 

  • The media’s stories about how the opioid crisis cuts short promising lives are renewing public attention, commitment, and concern.

  • Viewing substance use disorders as a chronic disease that waxes and wanes, not as a moral failing, may help overcome stigma that prevents affected people from seeking treatment.

  • Encouraging public dialogue that refers to a “person with a substance use disorder” (instead of “addict”) and “person in recovery” (instead of “former addict”) can medicalize what many still view as primarily a criminal problem.