The Social Determinants of (Women’s) Health

Women’s health requires its own discipline, therefore it seems only natural we should focus on social determinants of health. According to the American College of Obstetricians and Gynecologists (ACOG), 85 percent of women’s health providers felt that their patients’ social needs were as important as their medical care, but 80 percent did not feel comfortable addressing it.

This reticence to address social issues manifests itself in multiple ways that can directly affect patients, as demonstrated in by the following:

• Women are more likely to die of certain health conditions like heart disease, stroke, alcohol-related complications like increased risk of breast cancer, and mental health disorders.
• Women, especially women of color, are misdiagnosed more often than men. Coined by mainstream media as “healthcare gaslighting,” downplaying patient symptoms, results in misdiagnoses that kill between 40,000 to 80,000 female patients each year.
• Women who are part of the LGBTQIA+ community are less likely to get preventive screenings for cancer. They are also at higher risk of sexually transmitted diseases, more likely to abuse alcohol and other substances, and less likely to have access to health insurance due to legal discrimination.

Knowing the facts, what can women’s health providers do to help their patients get access to the care they need?

Start the conversation. Start with having a compassionate discussion with your patients during their visit. It’s often said that a zip code says more about a patient’s access to care than most other information. Talk with noncompliant or no-show patients about what is preventing them from making or arriving for their appointments. Your patients may struggle with reliable transportation or be unable to easily access your office. Offering your patients telehealth services for visits that do not require them to see you in person can significantly decrease transportation obstacles.

Utilize your electronic health record (EHR) system to create a dynamic intake form for your patients to fill out about their current state. For example, you can add an alternative field in the gender column for patients who do not identify as male or female.

Adopt the right technology. With the right technology, you can screen patients for social determinants during their first visit. Women’s health providers can leverage the full potential of their patient portals to identify gaps of patient care, including missed preventive care visits or a patient’s predisposition to cancer.

Expand Your Patient Base. OB-GYNs can reach patients with different cultural backgrounds by hiring multilingual staff and/or enlisting help from interpreter services. The small things matter too — provide a variety of magazines in other languages in your waiting room to help patients of different backgrounds feel more comfortable, invest in art from different cultures for your office decor and add a multilingual option to your phone line.

Get to Know Your Local Community Services. OB-GYNs can refer patients to community resources in their area, such as programs that offer affordable housing, food assistance, health insurance, and behavioral health services. In addition, women’s health providers can advocate for their patients by writing them a letter they can use to get access to the services. Women’s health providers can also form partnerships with local legal and medical facilities to refer patients for supplemental care outside of their practices.

Beyond accounting for social determinants within a practice, ACOG recommends that women’s health providers remain aware of implicit biases and stigmatization, advocate for policies that help women gain access to health insurance and proper care. By addressing clinical and social factors within and outside of the practice, women’s health providers can help mitigate the negative effects of social determinants on their patients.

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