How social determinants impact healthcare | Veronica Scott-Fulton | TEDxFondduLac
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- čas přidán 25. 06. 2024
- Veronica Scott-Fulton is Regional Senior Vice President and Chief Nurse Executive of SSM Health. She is an accomplished Executive with proven success leading teams in the achievement of a vision for transforming and creating value in healthcare. She has expertise in lean leadership, strategic planning, innovation and process redesign, creating measurable and sustained results. Veronica Scott-Fulton is Regional Senior Vice President and Chief Nurse Executive of SSM Health. She is an accomplished Executive with proven success leading teams in the achievement of a vision for transforming and creating value in healthcare. She has expertise in lean leadership, strategic planning, innovation and process redesign, creating measurable and sustained results. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at www.ted.com/tedx
That intro of picking your parents was so powerful and hit right at the core of the issue. 👏👏👏
A really heartfelt and thought provoking talk. Thank you from a student nurse :)
Veronica Scott-Fulton's words and insight really shed light on how social determinants impact our healthcare system. By making assumptions on someone's health based on their race, gender, religion, etc., the physician would be violating the ethical principle of justice which is to treat patients fairly and equitably. When asked, I believe that many people would say that they don't have any biases or prejudices, and would get defensive when brought up. We all have some sort of unconscious bias, but that is why it is important to be aware of it and leave those behind. Especially in healthcare, unconscious biases could do more harm than good which does not abide by the ethical principle of nonmaleficence. If the first step is awareness of these unconscious biases, it makes me nervous because I have met many medical professionals who lack the ability to self-reflect and seek constructive criticism to improve oneself. Ego plays a big role in this, and when that is big, how can we count on physicians to be aware of their own biases and ensure that it does not get in the way of patient care? Can we teach medical students self awareness and reflection? I do think that social determinants have been more incoporated in the medical system lately or at least emphasized more in the medical school curriculums.
When she also said the comment on how she understands because she was once broken too, it really resonated with me because my family also grew up very poor, so I also understand the struggle of low income and poor families. Assumptions and unconscious bias whether good or bad could really hinder someone's healthcare. Location and access to care is also another big factor in health and by incorporating more social determinant of health questions into someone's care, a physician can really understand who a person is and provide well-rounded care. I feel like a good perspective is to always ask the question 'why' such as why are they feeling this way, why this job their whole life, and try to understand the reasoning behind instead of labeling and judging others.
There are a lot of people in our country who do not understand how impactful social determinants of health can truly be on our nation’s communities. Dr. Scott-Fulton does such a great job of presenting the issues that plague so many individuals who are unable to receive proper or any healthcare because of their social standings and surroundings. Towards the end of the video, she mentions that individuals in these communities often do not have access to any regular healthcare and will show up to the emergency room on the brink of death over a chronic issue that could have been resolved. I think this is such a spot-on example of how impactful this issue can be on an easily preventable or chronic disease.
The same message she is trying to convey here is seen in the pillars of ethics in healthcare. There are two key pillars that have been give the names beneficence and a non-maleficence. Beneficence is the protecting and benefit of the patient and it’s the job of the healthcare system to put the needs and rights of the patient on the top of their priorities. Non-maleficence is the obligation to not inflict harm on others. Social determinants of health are not necessarily caused by a direct action of non-maleficence, but they are also not cured by a non-direct form of beneficence. In other words, it is not enough to say we are in good moral and ethical standing by not causing harm to those who suffer from certain social determinants of health, no we need to do more and demonstrate beneficence to those with these social determinants of health by providing for their needs and getting them the healthcare they need. I think that is what she means when she says we need to flip the narrative, we cannot just simply sit back and assume that because these things are not happening to us or our communities they must not be happening. This is not Justice for everyone, justice implies that we are all receive just care and that our needs are being fulfilled the same way the needs of others are being fulfilled.
These concepts of beneficence, non-maleficence, and justice are best demonstrated in her last major point about making assumptions. As physicians and healthcare workers we cannot simply ignore our unconscious biases and assume that by trying to provide care we are doing enough. This is not fulfilling the needs required by beneficence or justice even though we may not be maleficent in our treatment we need to be doing more. We need to go above and beyond, because only by doing more are we going to be able to decrease the impact that these social determinants of health have on communities like those mentioned by Dr. Scott-Fulton.
I am so speechless, and yet so proud of you been the voice for the inequality population. I am Emergency Nurse in DC and cannot tell you how bad its in this area, but I try to place a seed whenever i can to extend my knowledge, and open education to navigations resources. thank you
I love how relevant this is and how you brought COVID into the conversation. The unconscious bias is real. It is up to us to educate ourselves to recognize the faults we unconsciously make. Thank you, Veronica, for being so empowering.
I would like to applaud Ms. Scott-Fulson for bringing up the issue of how social determinants impact healthcare along with her ideas of how to can tackle that as a society. The importance of social determinants of health can be easily forgotten by people because we don’t see the impact of it on health during our everyday life unless we are the ones being personally affected by it. However, the COVID19 pandemic has enlightened us all on the significant role that social determinant (living and working conditions, transportations, education, racism, stigma) have on health and life expectancy. The high number of death tolls with COVID has made the world realize that marginalized groups are suffering significantly more because these social determinants of health exacerbate the health inequalities among the marginalized groups. I understand it is very difficult to reach equality when some people are just born with resource. However, the ethical principle of justice obliges us to equitably distribute benefits, risks, costs, and resources. Therefore, it should be our responsibility as a society to collaborate together to eliminate the barriers to access quality healthcare. To ensure equal access to quality healthcare services, we need to address social determinants of health such as equal job opportunities, racism, housing insecurity, food access, and access to equal education opportunities. As Ms. Scott-Fulson pointed out, we can also narrow the inequality gap if everyone becomes an activist and get to know people, so we make less unconscious bias. Although some of us may not have the resources or abilities to make significant changes as an ordinary citizen, we can at least be more accepting towards the people around us so they will reach out when they need the help. Change doesn’t happen in just one day. Each of us needs to take small steps to make that change so that we, as a society, can take a large step together to achieve justice.
I thought Ms. Scott-Fulton had several fascinating points from an ethical standpoint on medicine. What first hit me, was that it takes a village to raise a kid. We’ve all heard this phrase numerous times in our own lives and probably all say it ourselves, but do we really think about what it means? A village isn’t simply just our family and friends, it’s our grocery store, the post office, the landfill, and yes, a healthcare clinic. It’s true that minorities were disproportionately affected by covid and it occurred due to many reasons. Ms. Scott-Fulton discusses the economical differences of her hometown. Money, work, access are all issues when it comes to healthcare, leading us to the principle of justice in medical ethics. The principle of justice means to ensure fairness, in other words enable everyone to the treatments and help that they need regardless of their situation. We have resources to help with justice in the medical field, Medicaid and Medicare insure those that economically can’t insure themselves, we have low-income clinics and instacares, but it’s not enough. We as a society need to do better at helping everyone get access to quality healthcare. As a medical student myself, I’m not sure how we do this. Doctors go through years and years of school that costs hundreds of thousands of dollars and mountains of stress and anxiety, when we finish school, the first thing we need to do is pay off our student loans and try to live a normal life for once. That’s hard to do at a low-income clinic. Money is not why any of us go into healthcare, we go into it for the ethical principle of beneficence, to do good and help others. Our society needs to figure out a way to expand healthcare opportunities. Everyone needs access, we don’t know when the next pandemic will come or what it will entail, we don’t have a cure for cancer, we can’t avoid occupational/environmental exposures, we can’t stop car accidents and abuse from happening, but we can be there to treat everyone after these happen.
What an impactful presentation! That beginning just made me sit up and draw me in. Thank you
There are so many factors that influence one’s health. Veronica Scott-Fulton touched on some very foundational elements that influence one’s health which is social determinants of health. As a second year medical student, we are taught to assess patient’s social determinants of health. Living situation, financial situation, home stressors, access to parks, education about dietary choices are all things that could fall under the category of social determinants of health.
Veronica Scott-Fulton talked about how race can impact social determinants of health. A culture in which one grows up in does influence health greatly. I grew up in a rural community in the Appalachian mountains. I witnessed the impact social determinants have on health. Many of the rural farmers did not seek out preventative healthcare due to many reasons such as being self-employed leading to no health insurance. Other reasons included the distance these individuals lived from physician offices. The lack of availability of healthcare to these rural famers was compounded by their lack of education. Many had poor diets and did not seek out regular exercise.
Social determinants of health is a concept founded in medical ethics. Medical ethics are founded on four pillars which include non-maleficence, beneficence, autonomy, and justice. Justice is the principle of fair and equitable healthcare access to all persons. Social determinants of health could exclude entire people groups from receiving fair and equitable healthcare.
Many social determinants of health could result in an individual not receiving healthcare. Per my example above, many self-employed, rural farmers are uninsured. This causes them to not seek out preventative healthcare due to cost. Other examples include populations living in ghetto situations, where the available healthcare is subpar.
As a future physician, I hope to decrease the disparity amongst certain population groups by living and serving in a rural community. In order to be a country that upholds the four tenants of medical ethics, including justice, we must be ever working towards developing a system that minimizes social determinants of health. I recognize that social determinants of health is a multifaceted issue, steps such as increasing staffing in rural hospitals or inner cities could help minimize such issues.
Very touching conversation, thank you
What a presentation!!
One line of great interest was, not quoting,..the number of years/ time passed away and the discussion continues.
Is it premeditated and therefore an intentional strategy?
Just critically thinking...
One love!!
Fantastic talk, thank you Veronica.
Thank you, Ms Veronica. You have made me understand this topic on a greater depth. You look amazing at 51. I would have put you at 40. Inspiring indeed.
well said, an eye opening talk. thank you.
This was a great speech. Fantastic!
Dr. Scott-Fulton brings up such a valuable topic in our society, which is the idea that social determinants of health impact the way patients are treated. This issue brings up an ethical dilemma that physicians have an unconscious bias. Patients are not treated the same because of race, gender, and ethnicity. For example, it is harder to access healthcare for certain populations, such as Chaldean people, because of the language barriers. Furthermore, patients are less inclined to seek out their physicians since they are part of different cultures. This leads to bad outcomes because patient’s will not follow up with their physicians and potential preventative care treatments. Another issue with access to care is that some jobs offer good healthcare insurance and some jobs do not. This causes inequalities in who gets better healthcare. To illustrate, if a blue-collar worker gets a health insurance plan with a high co-pay, those patient’s will be less inclined to go to a physician if they must give half their paycheck to do so. Another important part of Dr. Scott-Fulton’s talk is that people that live in “ghettos” or in a bad area, they will not have as many resources to get healthcare. Even with Medicaid, if clinics are not at arm’s reach, patient’s will not go see their doctor. What ends up happening in a lot of these cases is that marginalized patients come to the ED at the brink of death. Her final point in this TedTalk is that we need to get closer to these people. We need to become proactive and to understand these patient’s by becoming their friends, going to their communities, and bridging the gap as much as possible. That way patients will feel comfortable with healthcare workers and allow us to treat them before it is too late.
I thought it was interesting how Veronica started discussing how we have no control over many of the social determinants of health that affect our life and tied that into COVID and how certain communities were disproportionately hit. I think that many of us weren’t even aware of this because we just kept watching the death toll rise and rise and we were told by news outlets that the “vulnerable” populations were elderly and the immunocompromised, but we forgot about the impact it was having on entire communities just a few streets away from many of us. If we would have had a better community with the people around us, both those in healthcare and the general population then we may have recognized this sooner and improved on the resources that were provided to these at-risk communities. I say this lightly though, because I don’t want people to think that we are looking down upon where they live. I once heard from a friend not to call any place “sketchy,” just because we don’t feel comfortable there, because to others that is their home and where they find comfort. To go into these communities we need to do so in a manner that shows that we truly care about the people there and want to make a difference and better their lives, not just point out all the things that are wrong with it because then we aren’t really solving any problems. Another point that really stood out to me was she said, “You need resources to be well in America,” because unfortunately that is so true. Having visited other countries and learned about other healthcare systems, it is unfortunate how much it takes for someone to be able to access high quality medical care here. If I am being honest, in America, we don’t do a very good job with the justice principle of ethics/healthcare. Even though there are programs with the goal of assisting certain populations such as Medicaid, and community health clinics, there are still many barriers for people to access this care. I know that each system of healthcare has its advantages and disadvantages, but I wonder if there is a way that we can find one that doesn’t marginalize so many communities and make it so difficult for them to even receive basic care. If people can’t receive even basic care, then they will be unaware of underlying conditions that put them in higher risk categories for major adverse events. If we could stop the progression of these conditions before it gets to this point, we are not only saving lives and families, but we would ultimately be saving healthcare costs as well because these people would not be patients in the emergency room or hospital who now require 24/7 care and multiple machines and medications. I know this is a big proposal, and it can’t be fixed overnight or even in a matter of years, but we do need to start somewhere and soon.
Awesome, thank you, keep sharing your story. Maybe you could speak at Sherman College in Spartanburg, SC.
We talk a lot about justice in our society, but there seems to be some real injustice happening in these communities. It's heartbreaking hearing about how COVID affected those areas of our country. A country founded on the idea that everyone should be treated equal. I'm in medical school right now, and it seems like the people doing the hardest, and least appreciated jobs, are being left behind. They don't deserve that sort of treatment, and I love the ideas this video presents about it.
We were recently told to make sure to include social determinants of health in our patient encounter notes for medical school. I always knew, at least at some level, that they played a big role patients' lives, but I don't think it really hit until this year when we began to be taught to ask specifically about things like income, ethnicity, education, and geographic location of their home. As mentioned in the video, these really do directly affect one's quality of life and life expectancy.
I personally believe the sins of the parents should not fall on the children. And I DEFINITELY believe that the sins of the polititians and cultures of our past should not fall on anyone but those who commited them. Unfortunately, that sort justice is hard to enact. Years of damage is going to take years of repair, that much is sure.
I wish there was a sure-fire way to make the changes to save more of those communities, but I definitely agree that focusing on improving education is a great step. Helping kids feel safe and welcome at school can only improve things. I hope to be able to contribute in a similar way as a physician someday, by making sure everyone, and especially those who's social determinants of health are less than ideal, feel they are receiving the best care possible. Maybe that way I can put some actions behind my words, and really bring some justice to these communities.
This is very educative indeed .
Medical ethics and social determinants of health are two concepts that are vital to ensuring equitable access to healthcare for all people. The applicable medical ethics to this topic refers to the principles and values that guide healthcare professionals in providing care to their patients. These principles include respect for autonomy (the right for a patient to decide what treatments they do and do not want to receive) beneficence (doing what’s right), non-maleficence (do no harm), and justice (equitable and equal treatment is available to all patients). Social determinants of health are the socioeconomic and environmental factors that play a role in a person’s health and their access to healthcare.
The COVID-19 pandemic has highlighted the significant inequalities of healthcare in the United States. As Ms. Scott-Fulson pointed out, COVID-19 has killed a disproportionate amount of people of color in the United States when compared to their Caucasian counterparts. The factors behind these deaths is multifactorial, however, the vast majority of them had underlying medical conditions that were caused by lifestyle “choices” (obesity, hypertension, diabetes, etc.) that were primarily driven by access to healthy food, medical care and medications, and other factors. Even after COVID-19 was brought under control through masking and vaccination efforts, we are still seeing patients of color disproportionally impacted by the failure of the US health system to provide just and equitable care.
As Ms. Scott-Fulson eloquently pointed out, social determinants of health have played a significant role in the impact of COVID-19 on marginalized communities outside of just the health of an individual. For example, people with lower socioeconomic status may have had jobs that did not allow for remote work, making them more vulnerable to exposure to the virus. Additionally, individuals with underlying health conditions, who are more likely to come from marginalized communities, are at higher risk for severe illness and death from COVID-19. All of these factors played a considerable role in the disproportionate mortality experienced by communities of color.
Addressing social determinants of health both in the context of COVID-19 and all other conditions is necessary for ensuring equitable access to healthcare and mitigating the impact of inequality on marginalized communities. This includes addressing issues such as housing insecurity, food insecurity, and access to healthcare services. Healthcare professionals can play a crucial role in advocating for policy changes that address these social determinants of health and in ensuring that their patients have access to the resources and support they need to stay healthy during the pandemic.
Justice and social determinants of health are critical considerations in the context of healthcare. Healthcare professionals must make difficult ethical decisions about resource allocation and prioritize addressing social determinants of health to ensure equitable access to healthcare for all individuals. Furthermore, we all should demand more equitable care for all people in the United States, which should be implemented at a policy level.
Well said!
From an ethical perspective, social determinants impacting healthcare access is a concern because it violates the principle of justice, which requires that healthcare be distributed fairly and equitably to all individuals, regardless of their socio-economic status. In order to effectively address social determinants of health, healthcare providers must consider the principle of non-maleficence, which requires them to avoid causing harm to their patients. Providers must be aware of the potential harm that can be caused by ignoring social factors, such as delayed diagnoses or exacerbation of chronic health conditions and take steps to mitigate these risks. Providers must also consider the principle of beneficence in the context of social determinants of health. Social factors can impact a patient's health outcomes, and they have a responsibility to address these factors in order to provide optimal care. It is important for healthcare providers to be aware of their unconscious biases and to take steps to mitigate their impact on patient care. This can include increasing awareness of unconscious biases through education and training, using evidence-based guidelines and decision-making tools, and actively seeking out patient feedback to identify and address any biases in their care.
Veronica did a fantastic job illustrating the negative impacts that unconscious bias can have in healthcare. This unconscious bias can manifest in various ways - differences in treatment recommendations, misdiagnoses, and disparities in access to care. For example, a healthcare provider may unconsciously assume that a patient from a certain racial or ethnic group is less likely to comply with treatment recommendations, resulting in a lower quality of care for that patient. Similarly, a provider may unconsciously attribute certain symptoms to psychological factors for a patient from a certain gender or racial group, leading to a delay in diagnosis and appropriate treatment. Addressing these issues of unconscious bias and how social determinants impact health is essential in providing ethical, optimal healthcare to all.
It's really informative
In the recent years the idea of healthcare a fundamental human right has gained overwhelming support. Yet this “fundamental” right is not accessible or available to everyone. In part this can be attributed to social determinants that often create barriers to access to healthcare and delivery of treatment. Social determinants include factors such as race, education, housing, socioeconomic status and even environmental quality. These determinants play a significant role in health outcomes in communities. Addressal of these factors is essential for achieving health quality. Social determinates help to create inequalities in healthcare utilization and access as a whole. Population who live in poverty or people who live in low income neighborhoods often lack access to quality healthcare services due to financial constraints. Often this can lead to a viscous cycle where treatment cost leads to poorer health outcomes for the community. This is unacceptable and should bring to light that each person should have equal access to healthcare regardless of their financial abilities. More so, social determinates often effect can affect behavior and lifestyles. People who live in unhealthier environments such as in areas where pollution is higher may have a higher risk of developing respiratory issues, cardiovascular issues and even cancer. Similarly, individuals and their families who do not have great access to healthier foods are more likely to develop conditions such as obesity, diabetes and even hypertension. This in turn creates a health equity problem in which some people are mor likely to develop preventable diseases due to their living situations. Another issues that social determinates cause is disparities in health outcomes. People who have lower levels of education, income and even differing occupation statuses are more likely to suffer from chronic disease states than those with higher social status. This creates an ethical issue in the sense that health outcomes should not be determined by one background but by the individual needs within that circumstance. Finally social determinants affect the quality of the healthcare being delivered. Areas in which poverty rates are higher may struggle to provide high quality care due to the financial and human resource constraints implied on these areas. Leading to inadequate treatment, treatment errors, and even delayed diagnosis of disease all leading to patient compromise and decreased safety to our patients. If we seek to address these determinants, we can improve healthcare outcomes by creating a more supportive environment for our patients to feel safe and welcome in.
I did pick my parents
As Veronica mentioned, health disparities most commonly exist along lines of race/ethnicity and socioeconomic class in American society. More work within the US healthcare system, which is guided by innumerous bioethical principles, needs to be done to address these disparities and do better for our patients. Health disparities are ethically wrong because they potentiate historical injustices that have existed in this country since its very beginning. As stated in an article published by the American Journal of Public Health by Cynthia Jones, PhD, Kantian ethics, as a duty-based ethical theory, argues that we have a moral duty to address health disparities because the required basic respect for all persons is violated by the presence of significant differences in health for some populations of people. According to Kantian ethics, it is immoral for us to treat individuals simply as means to our ends, a principle that is derived from the proposition that sensible individuals are inherently worthy of respect. It goes without saying that this ideology is undeniably violated by the pervasiveness of health disparities. Following this ideology, health disparities are a significant moral wrong because they offend a basic respect that is ubiquitously owed to individuals. Thank you for sharing your story and urging the US medical system to do better.
The obsession with race in this country is not healthy for us as a society. The greatest and most likely the only real social determinate is income, a condition that all races and cultures experience from poor to rich. Assuming that because some one is white, that they are less disadvantaged than another race is dangerous and potentially destructive for us as a society, and can have even more significant and dangerous impacts on quality of care and continuity of care. I am not arguing against the plight of certain racial groups, but I cannot see us progressing as a society and becoming a more unified nation as long as we willingly segregate ourselves based on our races.
The left are perpetuating inequality because if they were to admit it it doesn't exist in today's world, they would have no excuse to explain the vast differences shown in crime statistics.
genetics is difficult to overcome. so if you have a propensity for some disease it is your responsibility to have better life style choices in your life. what I see is rampant obesity because of the poor food choices they make. there is nothing structural racists about the food you put in your mouth. take responsibility for yourself.