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MCW researcher: Total picture of health incomplete without including where you live, work, play

Holistic medical approaches may decrease the impact social determinants have on people's health.
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Holistic medical approaches may decrease the impact social determinants have on people's health.

Social determinants of health are a major factor in people’s quality of life. These determinants include things like where you live, go to school, work and what you’re surrounded by. But our health care system generally focuses on specific illnesses, instead of these cultural factors.

Health systems and physicians are starting to become more aware of social determinants of health, as research gives more data showing the challenges they present as well as potential solutions to addressing them.

Dr. Leonard Egede, the inaugural Milwaukee community chair in health equity research at the Medical College of Wisconsin, conducted his initial study on the impacts of social determinants of health in 2010 as researchers began to understand that the environment patients live in alters their health outcomes.

In a study conducted with about 3,600 participants, Egede gauged the impact food insecurity has on people with diabetes, how neighborhoods affect overall care, and how depression and other psychological factors influence health. Then, he began to look into what connected these social determinants.

“Things like discrimination, high incarceration rates, high levels of poverty, racial segregation, substance abuse, housing instability, food insecurity, low education retainment, unemployment — the common pathway was because of this level of chronic stress,” Egede explains.

After three years of focus groups, structured interviews and extensive surveys, Egede says the best way to address those suffering from chronic stress is through programs that combat these social determinants. He says so much happens in patients' lives outside of their clinical encounters that is not accounted for in their medical evaluations.

“The way people live, the neighborhoods that they live in, the environment that they have to interact in, the resources they have available to them, the jobs they have — all of these factors are just as important as the medical encounter. Actually, we would argue that those factors are more powerful than what happens in the doctor’s office," he says.

Egede adds that people will continue to stay sick if these factors are not understood. He urges physicians to see people as more than patients and examine the complete self.

“The more we take the holistic approach, we move away from the idea of designating someone as a disease," he says.

Egede says the next step to make actual change in the medical field is to hand off his research to people who can make those changes, such as legislators. He points out that adopting new medical practices can take anywhere from 10 to 17 years, so this process should begin as soon as possible.

“I am an optimist. I believe that things can get better. It’s not optimism that comes from nowhere, I’ve been in medicine for a long time and I have seen major changes," he says. "Even if you look at the pandemic, the speed at which we were able to get the discovery of the vaccine, gives me hope that every situation we find if we can ride it together we have the ability to generate enough knowledge to address the problem.”

Audrey is a WUWM host and producer for Lake Effect.
Cait Flynn was an assistant producer for Lake Effect 2022 to 2023.
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