SDOH vs. Access to Care: The Rematch

December 16, 2013

Today’s guest post was written by Tonya Wiley, Connecticut Health Foundation Leadership Fellow.

Which is the best way to expand health equity for people of color: address the social determinants of health (SDOH), or increase access to better care?  This is the proverbial chicken-before-the egg debate but a very important and needed conversation.

As a CT Health Leadership Fellow, I am very interested to the discussions and actions around health equity. But as someone who recently went through a very severe health issue, I was thrilled to make one of my first ventures as a healed and healthy individual to support Health Justice CT’s December 4th forum, “Health Equity: Two Sides of the Same Coin.”

The panelists were up to the challenge of having Zachary Janowksi, Investigative Reporter for The Yankee Institute, get down to brass tacks.


Team SDOH:

  • Kat Ellington, a physician-in-training and health equity advocate
  • Brad Plebani, Deputy Director of The Center for Medicare Advocacy

Team Access to Care:

  • Yvette Bello, Executive Director of Latino Community Services
  • Robin Lamott Sparks, Director of Policy and Research at the Bridgeport Child Advocacy Coalition

Informed arguments, lively debate, and hard questions from the audience followed. Four major points and one big question that really struck me:

  1. Kat Ellington noted health happens outside doctors’ appointments and hospitalization and, “…the continuum beyond the clinical is where health happens.”
  2. Brad Plebani pointed out that eventually everyone pays in some way or another for unhealthiness and it is important to go to communities to hear from them exactly what they need to be healthier.
  3. Yvette Bello clarified what real access to health meant to her: it is timely, affordable, it is close to the patient and is culturally and linguistically competent. It is difficult to maintain health if one cannot afford the care, cannot get to the care, cannot get an appointment or cannot overcome the cultural and language barriers between patient and provider.
  4. When asked by the moderator how violence and safety affect primary care, Robin Lamott Sparks argued stress and insecurity certainly factors into violence and safety. Food insecurity, poverty and other issues cause stress and people need to feel secure to be healthy.

But it doesn’t have to be either/or. It can be, as we say in the Fellows Program, both/and. Both teams can win. How do we, as advocates, bridge SDOH and access to care and make an action plan?

Robin said one social determinant we could work on now is transportation. Brad pointed out the Department of Transportation (DOT)  has been included in the health equity conversation. He also said that although DOT is at the table, the struggle is getting DOT staff to see HOW they fit into the health equity equation.

And there’s the rub. Lots of talk. Not enough action. So, my throw down to you, friends: what action can you take today to help win the battle for health equity?

2 Responses to SDOH vs. Access to Care: The Rematch

  1. Lorenz Finison says:

    This is a very clever way of engaging in an important discussion. Of course, in the end, its both access to care and social determinants. Let’s not forget that access isn’t enough. Utilization and all-important followup aren’t guaranteed with access alone. And social determinants may affect who utilizes, even when they have access (important gender differences, for example).

  2. Tonya Wiley says:

    Thanks for the comment! As mentioned in the post, we feel it can be both/and. Thanks for pointing the importance of followup. How else will we measure how effective we are? Thanks again!

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