Perspectives in Primary Care: A Conceptual Framework and Path for Integrating Social Determinants of Health Into Primary Care Practice

The editorial by DeVoe and colleagues brings a much needed perspective on social determinants of health to primary care. It is clear that these factors play a stronger role in determining the health and longevity of our vulnerable patients than any prescription for particular medications do; the risk of developing preventable diseases or dying from job related injuries are all powerfully predicted by such factors. Educational attainment is a traditional predictor used by sociologists for generations for health outcomes (longevity and childbearing being the most common) and in fact use this as a proxy for the granddaddy of social determinants - socio-economic status. An important addition to the framework that is presented in this editorial however is the life course perspective - the most powerful manner in which to understand and act on social determinants of health since they have cumulative negative effects and influence trajectories of health for individuals and populations. Family medicine is the only physician specialty which is fully positioned to impact trajectories of health influenced by these social determinants through a multi-generational family health approach. An excellent example of an evidence based intervention for literacy - a powerful social determinant of health that predicts both teenage childbearing and high school dropout - already delivered by many primary care sites serving low income children is the Reach out and Read intervention which has been shown in randomized trials to increase reading time of parents with young children. This reading time predicts subsequent literacy which in turn is a predictor of teenage childbearing, adherence to care for chronic illness, and even mortality. This is something we can and should do within primary care.

Competing interests: None declared