Association of the Social Determinants of Health With Quality of Primary Care

The authors have highlighted an urgent public health issue: how the social determinants of health are negatively affecting patients' health and wellbeing in primary care. Compellingly, more than half of the primary care patients in this study were living with at least one social complexity factor. Sadly, I imagine few primary care providers would be surprised at this statistic. On a daily basis, we see the negative consequences that the social determinants of health can have on our patients and often feel powerless, at least in the 1:1 clinical setting, to make any substantial improvements to our patients' lives. These patients who are already struggling with the social complexity of their lives are now put in a position that biases them toward poorer health in the long term e.g. lower rates of cancer screening, poorer quality of chronic disease management, higher use of benzodiazepines. The consequence will be that these patients will suffer unnecessarily in the future from these chronic diseases. Ironically, we tend to see these patients more often in our offices than those without social complexity. But often these visits are focused on putting out fires and on trying to struggle through the social system to address social factors.

But there are real possibilities for widespread positive change. The move to patient-centred medical homes may increase continuity of care for socially complex patients. Data on the social determinants is being directly and systematically entered into patients' medical records in some jurisdictions; this can guide focused primary care initiatives. Novel social interventions are being embedded in primary care settings. As primary care providers, we are compelled to explore these opportunities to strive for health equity for all our patients.

Competing interests: None declared