There is increasing attention being given to the relationship between social factors and health care. This month, the Robert Wood Johnson Foundation’s Commission to Build a Healthier America released a set of recommendations calling for a broad look at how to improve health. Macy President George Thibault talks about what health professions schools are doing to instill students with needed skills to understand the connections between health care and the social factors that influence patient’s health.
Are we doing a good job training students about the social factors that impact health?
We are getting better but can and should be doing a lot more. That is why the Macy Foundation has been promoting new-curriculum-content and new models of clinical education. The traditional way of teaching, which has been rooted in biomedical sciences and the hospital setting, is important but not sufficient and misses other elements related to health that students need to learn. A broader curriculum content that incorporates social factors that are determinants of health, population health, and an understanding of the relationship between medicine and society is increasingly vital. We need to see these areas embedded in curriculums in a more seamless way.
Also, much more of the clinical training needs to move out of the hospital setting. Students must learn in the settings where illness occurs, and understand what community resources may or may not be available to the patients they are treating. You can’t possibly know any of this if you just stay in the ivory tower. We need to complement the current curriculum with the societal context for students.
Are any schools out there doing a good job of this?
We are definitely seeing a shift take place. At Duke, under the direction of Lloyd Michener, he and his colleagues have done a lot to get practitioners and learners out into the community. A branch at the University of Oklahoma at Tulsa is another fine example in which students are working in the community and in the neighborhoods where patients live and work.
Many health professions schools are doing a decent job, but the shift is not as widespread as it needs to be. The purpose of health professions is to better care for society, so students need to know more about the society they are serving.
Should doctors be checking patients for non-medical background information (e.g., income, housing situation, access to healthy foods, etc…)?
Absolutely. All of these things should be recorded during checkups. This won’t happen though unless the learners get out into the community and know what resources and barriers exist. They need to have that experience and awareness so they are better prepared to ask appropriate questions to properly care for patients.
This will start to happen if we change our education models and reinforce for teachers and learners that their role is to better care for society.