Thanks, I appreciate your thoughtful assessment comments and your articles.
In NS some have argued (unsuccessfully) that administrators and policy makers should use the massive amounts of data collected at clinical encounters to assess the ongoing impact of social policy, environmental policy and public health measures.
It seems that clinicians have surprisingly little impact on the social determinants of health. Although from time-to-time doctors are effective at finding resources for individual patients or discouraging pollution in their area.
Clinicians can lobby for better early, and high school education including health education. Many people know what they should do about diet and exercise, and we hope that information about healthy behavior is part of grade school and high school curricula.
We can nag pharmacists to hide candy away from the checkout counters - the way magazine stores used to hide pornography.
We can use social capital to help a few people find worthwhile work, but not most.
I'm sure you are more effective than most of us at finding solutions for your patients because of your interest and knowledge in the local supports for patients.
best wishes
David Zitner
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Hi David:
Outcomes-focused studies are slowly emerging in this area. It is somewhat difficult to measure impact on hard health outcomes from social interventions, as I would expect the most significant effects to take years to express themselves - as those on this
list are well aware, social factors impact health in varied and complex ways. I alluded to some of the key evidence in a practice-focused overview of social interventions published a little over a year ago:
https://www.cmaj.ca/content/193/44/E1696.
The conversation about outcomes is also more complex than impact on individual patients - this is (for me) equally about political sensitization and mobilization of health providers (and maybe health systems). It is also about fortifying communities of
politically progressive health providers to advocate for change in social policy and social structures from their position as health experts. And it is about strengthening the argument that social structures need to change for (individual and community) health
reasons, not just moral or ideological reasons.
So it’s a little more complex in my mind than just looking for improvements in sugar control in diabetes. But there are certainly people looking for evidence of those impacts, and with some degree of success.
Gary
Thanks for sharing. The innovators are thoughtful, admirable and creative. Is there any information available about how health results changed for the people they serve? or how the behavior changes of communities and patients?
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