Posted on January 11, 2024
By Haleemah Atobiloye, M.A., she/hers, Program Manager
Advancing Breast Cancer Health Equity Part I: Why Social Determinants of Health are Necessary for Improving Health Outcomes
2023 marks the 46th year the San Antonio Breast Cancer Symposium (SABCS) has gathered pharmaceutical companies, oncologists, and breast cancer researchers all in one place to discuss clinical trial outcomes and advances in breast cancer treatments. Over the years, this symposium has expanded to include the voices of patient advocates, healthcare workers other than doctors, and experts across multiple fields that are working to address the breast crisis.
Thanks to the growth of who has been included in this space, it has been refreshing to see behavioral scientists working in cancer care better humanize the people living with breast cancer, bringing their stories and voices to the conversation, and discussing the multifactorial issues that widen disparities and negatively impact the lives of people living with cancer.
Social Determinants of Health (SDoH)
“Health is not merely the absence of sickness or disease, but entails complete mental, physical, and social well-being of a person.” This definition of health was shared by Dr. Brian Rivers, one of the six panelists at the SABCS Special Session 3, “Social Determinants of Health: Impact on Cancer Care,” and attributed the definition to the World Health Organization during their presentation, “How do Hospitals/Clinics Utilize SDoH Data?”
This definition of health underscores the importance of social well-being in relation to medical outcomes, and aligns with the broader concept of Social Determinants of Health (SDoH), a concept all six panelists in this session presented on and discussed.
The following are my takeaways from the presentations, with my thoughts written in italics, from this session:
- SDoH are the social and environmental conditions where people live, work, play, and grow up, influencing their overall well-being. These factors include food availability, healthcare access, economic stability, education, social context, and the environment. SDoH demonstrates that health is shaped by broader environmental and societal conditions.
- SDoH is a multifactorial issue, meaning that health disparities are not driven by a single factor, but rather they involve contributions from various domains. These domains include environmental, social, cultural, psychological, clinical, biological, genetic, and behavioral factors. The resulting complex nature of health disparities requires national-, state-, local-, community-, and individual- level interventions.
- Dr. Brian Rivers shared that in November of 2023 the White House released its first ever U.S. Playbook to Address Social Determinants of Health. This is great news, and a step in the right direction. A national strategy that acknowledges the shortcomings of our healthcare system is the first step in crafting solutions to address them. The data on Page 7 reads “Disparities resulting from these structural inequities often disproportionately impact historically underserved individuals such as Blacks, Latinos, members of Tribal Nations, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; persons who live in communities with environmental justice concerns; older persons; women and girls; and persons otherwise experiencing persistent poverty,” acknowledging and naming disparate impacts on specific communities. We must also pass effective legislation that impacts communities affected by environmental injustices, like the A. Donald McEachin Environmental Justice for All Act. The policies outlined in this bill will reduce health disparities caused by environmental injustices.
- The core of Dr. Sandi Pruitt’s presentation “Once Social Determinants of Health are Determined, what Processes Need to be in Place to Reduce the Burden on Patients?” is that food is one of the most important tools we have to tackle to address healthcare disparities. Pruitt emphasized the importance of food justice with the example of a case study of a 72-year-old woman with a history of stage four breast cancer. The woman lives in a small town and had reported a major weight loss of over 10lbs. The oncology team went on to do several complicated evaluations, including imaging done to look for the cause of this weight loss. Eventually, she was referred to a Primary Care Provider (PCP), who, after a series of ongoing conversations, discovered that the solution this woman needed was food, not further medical intervention. This doctor then connected the woman to local community resources that work to address food insecurity. According to Dr. Pruitt, with the help of this community organization, this woman was able to get back to a healthy weight and is doing well. The direct impact of food insecurity on health outcomes is why the speaker concluded their presentation by encouraging healthcare providers to be sensitive to the issue of food scarcity, food desserts, and food swamps occurring in increasing locations across America.
The matters raised by these researchers and community leaders affirm Breast Cancer Action’s core approach to the breast cancer crisis: that this disease is an intersectional public health crisis and must be addressed through a health justice lens. We must consider the whole person, the social determinants of health, and the relevant systemic forces and barriers that impact a person’s overall health.
Strategies to Address Health Disparities
The presenters went on to discuss methods, frameworks, and approaches that they currently use to address health disparities and foster the social determinants of health. Read Part II of my analysis to learn more.