A CDC report, Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health, defines social determinants of health as “life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life.” These factors “influence health-promoting behaviors, and health equity among the population is not possible without equitable distribution of social determinants among groups.”
I have a master’s degree in public health, so I had the advantage of formal training in social determinants of health before it became a mainstream topic of discussion in our curricula and our scientific meetings, and before health equity (rightfully) became the lens through which we assess the real impact of our progress against cancer. But you don’t need an MPH to know that social determinants of health are an area where we can have a meaningful impact on health disparities. The tools are there, if we have the will to act.
(However, if you are interested in health equity and social determinants of health as a field of study, I highly recommend pursuing an MPH—it’s excellent preparation for the work ahead of us.)
Our cover story discusses ASCO’s next steps in its longstanding and ongoing commitment to equity, diversity, and inclusion, and the article offers several practical ways that all of us can take action in our own spheres of influence. An exercise that you can start today, right now, is to look at the end-to-end experience in your practice or center with fresh eyes. How does a patient make their appointment? How do they get to your location? Whose faces do they see when they walk in the door? How do they get their follow-up information when they leave? And then consider who has the easiest time navigating the steps of that process, and who has the hardest time. Where can you reduce the friction that people with different backgrounds or life experiences might feel as they move through this space? Those details matter.
I’m inspired by the next generation of oncology leaders who are responding to and acting on equity issues with passion and commitment. Dr. Manuel R. Espinoza Gutarra offers a look at public policy and cancer health disparities, citing public health, climate change, and economic factors as critical considerations in our ongoing pursuit of health equity in oncology. The big picture also matters.
When we say that equity, diversity, and inclusion is not one thing, it’s everything, this is what we mean. It’s the clinic’s proximity to transit, it’s the cost of parking at the hospital, it’s the diversity of the workforce in the office, it’s the intake forms, it’s the scheduling system, it’s how information is communicated and followed up on. It’s the disproportionate impact of climate change on communities of color. It’s everything. It’s about who our spaces were designed to accommodate, and who has to work harder within that system in order to get the same needs met and experience the same outcome. Cancer is hard on everyone, to be sure, but it is uniquely hard on the people who encounter the most friction as they move through our health care system, and through the larger systems and institutions of our society.
It’s everything, and that can be overwhelming. But it also means that there is no wrong place to start, and no area of health care and the patient experience that wouldn’t benefit from your action.