Alexander CookA University of Alberta study found that the social determinants of health play a vital role in pediatric emergency department utilization and health outcomes.
Social determinants of health are non-medical factors that influence health. They include income, education, food security, early childhood development, access to health services, and more.
Researchers looked at 58 studies involving a total of about 17 million children and over 103 million emergency department (ED) visits. They found that children’s social circumstances play a substantial role in dictating ED utilization and subsequent health outcomes.
“There [are] clear indicators that ED utilization is different. There are groups that are not well served in the health-care system. And children are a vulnerable group,” Dr. Brian Rowe said. Dr. Rowe is an emergency medicine physician and a professor in the department of emergency medicine.
Social factors differentially impact access to health services
According to Dr. Rowe, social circumstances determine the types of health services that are available to individuals, to what extent individuals utilize health services, and how often individuals utilize health services.
“People [who are] in positions of privilege and power don’t come to the ED, but pretty much everybody else does,” Dr. Rowe said.
Dr. Rowe added that individuals residing in rural, remote areas, or Indigenous communities in Canada, utilize EDs differently than their urban-residing counterparts. He said another barrier to receiving adequate health care during a visit to the ED is language.
“If you don’t speak the language of the providers, that’s a big problem. You stay longer in the ED, [and] you can’t advocate for yourself or your family,” Dr. Rowe said.
Access to health services, especially a family medicine physician, is another factor that influences children’s and caregivers’ ED care-seeking patterns. Dr. Rowe said the ongoing primary care physician shortage is making it difficult for many Albertans to find family doctors. Without access to primary care, many Albertans have to rely upon the ED, he added.
“If you [don’t] have a family doctor, [the ED] becomes the default,” Dr. Rowe said. He added that it’s difficult for researchers and physicians to address barriers to quality health care.
“These are difficult things to change. Poverty is difficult to change. Employment is difficult to change. And they are not in the realm of our skill set as doctors or researchers,” Dr. Rowe said.
However, Dr. Rowe highlighted several possible steps researchers can take to help advance the effort to ease the impact of social determinants on health-care outcomes. He said the first solution is training researchers to better understand social determinants and their affects.
“The more people [who] are trained and aware of this lens, the more we’ll understand health issues better.”
“I think that it’s going to be a multidisciplinary, multi-pronged approach to reducing ED visits for patients in general”
Dr. Rowe emphasized the importance of reporting data using an intersectional approach to better understand ways to deliver quality health care.
“We’ve always looked at sex and gender in our analytic work, and we often find differences in outcome [that are] not always good” Dr. Rowe said. He added that studying those differences can make barriers to proper health care better understood.
Collecting race and ethnicity data along with information on the social determinants of health “in a granular enough detail” is crucial to making recommendations to improve the health outcomes of Canadians, Dr. Rowe said.
Dr. Rowe addressed the need for a multi-disciplinary approach to best address the social determinants of health.
“I think that it’s going to be a multidisciplinary, multi-pronged approach to reducing ED visits for patients in general.”
