Denise Hooks-Anderson, M.D.

As many of you are aware, practicing medicine is more than just providing prescriptions and advice. The health of the community is a result of many factors, such as neighborhoods, health insurance, race, ethnicity, gender, and educational attainment. These factors contribute to what scholars have labeled the “social determinants of health.”

Social determinants of health are the conditions under which people are born, grow, live, work, and age. They play a pivotal role in exacerbating health inequities.

The infant mortality rate is more than double among infants born to non-Hispanic black women compared to infants born to non-Hispanic white and Hispanic women.

LGBT individuals are more likely than cisgender or heterosexual people to experience violence, victimization, harassment, and discrimination.

There is more than a 20-year gap in life expectancy between U.S. counties with the highest and lowest life expectancy, and this gap has continued to grow since the 1980s. Life expectancy gaps of up to 25 years have also been identified between different neighborhoods within the same city.

Income inequality is associated with greater health care expenditures, health care use, and death from cardiovascular disease and suicide.

Healthcare providers typically view our roles as limited to morbidity and mortality, access to care, living conditions, and behavioral risk factors. However, a complicated web of events and situations have occurred prior to that patient entering our exam room. Therefore, it is our responsibility as leaders to help others in authority understand the importance of social determinants of health so that collectively we will not ignore those circumstances that are influencing the overall health status of the patient.

With the help of the American Academy of Family Physicians (AAFP), there are resources that can help assist providers in asking those sensitive questions, such as, “Do you worry about your food running out before the end of the month?” A few years ago the AAFP rolled out the “Everyone Project.” Per the AAFP’s website, the vision for this project is “to transform health care to achieve optimal health for everyone.” One of the resources associated with this project is a social determinants of health screening tool addressing issues such as food scarcity, violence in the home, transportation, etc.  There are provider forms and forms for the patients. For more details, visit

Information from social determinants of health screening tools can help guide providers in obtaining the correct resources for their patients. This information can then be used as evidence of the obvious needs within certain communities.  Legislators, city planners, school officials, and business leaders respond best when presented with actual data about the situations in which their constituents live and work.

Providers are on the frontline and must serve as the patient’s number one advocate. But physicians cannot act alone in pushing an agenda that promotes social equity. Tackling social determinants of health is not a one-entity job but one in which collaboration is crucial.

What are you doing to tackle these issues?

Denise Hooks-Anderson, M.D., FAAFP, is associate professor at SLUCare Family Medicine and the medical accuracy editor of The St. Louis American. Email

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