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2 The Social Determinants of Mental Health
Pages 7-24

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From page 7...
... (Shim) • Contained in the National Academies report A Framework for Educating Health Professionals to Address the Social Determi nants of Health was the need to emphasize experiential learning that is interprofessional and cross-sectoral.
From page 8...
... They are not intended to reflect a consen sus among workshop participants. SOCIAL DETERMINANTS Following the brief opening remarks, Kennita Carter, senior advisor in the Division of Medicine and Dentistry at the Health Resources and Services Administration, then welcomed the first speaker, Ruth Shim, professor in cultural psychiatry at the University of California (UC)
From page 9...
... Shim illustrated health inequities with an example from Health Canada illustrating how a toddler's "Why? " questioning can illustrate the social determinants of health (see Box 2-1)
From page 10...
... There are a number of factors that influence a person's likelihood of premature mortality, including genetic predisposition, behavioral patterns, health care, environmental exposures, and social circumstances (see Figure 2-1)
From page 11...
... Understanding how social determinants lead to health inequities, Shim said, requires attention to the concept of intersectionality. "­ ntersectionality," I a term coined by Kimberle Crenshaw in 1989 to explain the oppression of African American women, refers to the way in which people have multiple overlapping and interacting identities and specifically to the fact that individuals who are members of multiple disadvantaged groups have unique and often compounded disadvantages.
From page 12...
... . Poor mental health outcomes, Shim said, have been associated with multiple social determinants, including adverse childhood experiences, discrimination, poverty, unemployment, income inequality, food insecurity, and the built environment.
From page 13...
... Shim concurred and stressed that psychiatric disorders are defined and diagnosed through the lens of experts and their experiences, and these experts may not be familiar with the day-to-day lived experiences of the people who receive these diagnoses. Social Justice, Public Policy, and Social Norms Addressing health inequities due to social determinants requires addressing the underlying policies, structures, and resource allocation that create and perpetuate the social determinants.
From page 14...
... "All policies are health policies,"2 Shim said. All policies have an impact on people's health and mental health, yet "we don't always consider what that impact is before we enact laws." Moving the needle on the SDMH will require health professionals to step outside of their professions and to collaborate across sectors in order to influence and form relationships with elected officials.
From page 15...
... In addition to working on the local level to affect policy, health professionals need to work on the federal level to increase spending for social care programs. The United States, Shim said, is the only developed country that spends more money on health care than on social care, yet it has poorer health outcomes than other developed countries (APHA, 2020)
From page 16...
... . To this end, the workshop participants engaged in two sessions targeted at faculty and other health professional educators to explore effective educational methods based on the National Academies consensus study A Framework for Educating Health Professionals to Address the Social Determinants of Health (NASEM, 2016)
From page 17...
... changes. In order to truly care for their patients and promote their wellbeing, health professionals must seek to understand and address the "hills" that their patients are facing.
From page 18...
... Zohray Talib, senior associate dean for academic affairs and chair of medical education at the California University of Science and Medicine, added to the conversation, saying that while the framework may be centered around the individual health professional's commitment to lifelong learning, it is also framed by the larger systems-level determinants of education, organization, and community. Incorporating SDH into the health FIGURE 2-6 Framework for lifelong learning for health professionals in understanding and addressing the social determinants of health.
From page 19...
... A broader PACT unit -- which includes providers such as pharmacists, social workers, and mental health specialists -- provides support to the teamlets. Each teamlet is assigned a group of patients, and the entire PACT team works together to meet the patients' needs, from finding durable medical equipment to setting patients up in community living centers.3 In 2011 the VA established the Centers of Excellence in Primary Care Education; five of these centers were selected to teach the PACT model to learners.
From page 20...
... A bridge between the academic and professional experiences is needed in order to continue the integrated team care approach initiated in academia, he said. Similarly, Frank Ascione, professor of clinical and social and administrative sciences at the University of Michigan College of Pharmacy, said that his table discussed the fact that at the University of Michigan Medical School there is a longitudinal, multidisciplinary approach to education that brings t ­ ogether students from 14 different disciplines to share perspectives.
From page 21...
... . Potential and Existing Educational Activities In the second half of the session, Crewe asked workshop participants to take a few minutes to discuss ideas for effective interprofessional educational activities specifically related to the SDH.
From page 22...
... In the UC Davis environment, this model of education works primarily due to the commitment of the community leaders and the student advocates dedicated to enhancing the education of peers and colleagues. Guided Assessments Reamer Bushardt, professor and senior associate dean in The George Washington University School of Medicine and Health Sciences, shared an example of a powerful interprofessional training experience that he had during a rural family medicine clerkship.
From page 23...
... At the beginning of the development of a program, institutional representatives go out into the community and engage with various organizations and indi­ iduals v about what the community needs and how the institution could help. Interprofessional teams of learners and other health professionals go into the community, learn from the community, and assist where they can.
From page 24...
... 2016. A framework for educating health professionals to address the social determinants of health.


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