Health Equity Through Action on Social Determinants of Health

This summer, I had the opportunity to participate on a panel moderated by The Hill, a Washington, D.C., newspaper and website, where we addressed equity in maternal and infant health (watch a recording of the session). The session reminded me of how important it is for us as ob-gyns to consider social determinants of health when caring for our patients.

Social determinants of health are conditions in a person’s environment that can affect a wide range of health, functioning, and quality-of-life outcomes and risks. We may not think of social determinants as influential factors when it comes to health, but the environments in which our patients are born, live, work, and spend their time all impact their health outcomes. Availability of resources to meet daily needs such as safe housing and local food markets; access to educational, economic, and job opportunities; access to health care services; and social norms and attitudes such as discrimination, racism, and distrust of government — these are all determinants that affect conditions we see in our patients every day.

Social determinants also affect pregnancy outcomes. Disparities in maternal mortality and morbidity rates between women of different races, ages, geographic locations, and more can be linked to different social determinants of health. Because social determinants vary so widely, their effects manifest differently for different groups of women.

For example, maternal mortality and morbidity rates are three to four times greater for black women than for white women. Studies have shown that hospitals who serve primarily black women tend to have much higher rates of maternal morbidity. There are also numerous personal accounts, some from figures as prominent as Serena Williams, that show black mothers can feel that their health concerns are disregarded. While many factors contribute to black women’s elevated maternal mortality and morbidity rates, we can’t overlook the roles of social determinants in contributing to poorer outcomes.

So why am I telling you all of this? As providers, we can benefit immensely from understanding how our patients’ environments affect their health and allowing that understanding to inform our practice. If we want to secure better health for all mothers, we must take social determinants as seriously as we would any other pre-, peri-, or postnatal condition. Once we understand how environments can affect health outcomes, we can treat our patients more holistically. We can not only address those influences but also help create and maintain healthy environments that promote better health outcomes. Read through ACOG’s Social Determinants of Health resource overview, which offers resources that may be helpful for you and your patients related to social determinants of health.