Transforming Society Will Require Attention to Social Determinants of Health

By Todd E. Davenport, PT, DPT

I want to discuss APTA’s vision to “transform society,” and how physical therapists can become societal change agents consistent with the APTA Vision Statement. To do that, I’m going to talk about social determinants of health.

The social determinants of health are characteristics that predict your health and your access to health care. They are race, gender, sex, sexual orientation, occupation, education, wealth, built environment, and geography. In other words, your health depends on who you are, where you live, what you do, and who you’re attracted to and partner with. It really means being healthy where you live, work, play, learn, and worship. These social environment and individual behaviors chip in 60 percent of the variance in premature deaths. And I believe they are our greatest opportunities to promote societal change as a profession.

We are not going to “treat our way out” of the relatively poor health outcomes we have here in the United States. We have to work to make our society healthier, zip code by zip code, town by town, and household by household. And I believe that we physical therapists should lead the way.

I believe we, as a profession, should focus less on DNA and a lot more on our ZNA.

I believe a social justice orientation to the physical therapy profession would transform the way we think about providing care. It will make us think critically about how well and fairly care is delivered, and to whom, when, and how much. Science can inform us what and how to do, but is limited to inform us when and why to do it. Those questions have to do with how we see ourselves, our profession, and our public through an ethical lens. And they have everything to do with our potential as societal change agents.

Here are some ways to get started:

Know yourself. Actively identify needs for difficult improvements to your clinic. Start with language, health education, and implicit bias. Then work on this stuff. It could pay dividends in happier patients and better outcomes. You also can identify what special knowledge and skills you can leverage to address social determinants of health in the broader world.

Know your community. My experience is that physical therapists often know their patients, that business owners know their target demographics, but that no one really knows their communities even if they live there. Ask yourself what the community needs to be healthier, and what barriers exist to obtaining it. And they could be very different than what you thought they were. Here’s the hard part. I can’t give you a cookbook. Your community and my community may have some of the same health outcomes. But there may be unique social, political, and regulatory barriers to address them.

Keep it simple. As courageous as entrepreneurs are, there are very few conceptual “jumps off cliffs” that turned into successful businesses. Entrepreneurship is the hard work of making commodities out of small changes and simple ideas. Similarly, choose one simple thing that will help your community be healthier.

Don’t overthink it. The details will complicate themselves. Always keep safety in mind. But I believe we have to pump the brakes on “evaluating” and “screening” people so much. That work has yet to yield scientific validity to most tests. And your goal is to engage and empower populations with this work, not just find a more creative way to make and treat patients. Avoid giving people a new diagnostic label or reason to think they’re sick. So, while clinical screening measurements have their place, you don’t need biometric data to help people move a little more, to eat a little less, to eat more plants, to stress less, and to form and maintain healthful relationships.

Add by subtracting. Find out how you can reduce the frequency of a health problem. Find out how you can lower costs associated with upstream care. Find out how you can raise revenues from reducing presenteeism and absenteeism. Unlike how most physical therapists are paid to practice, you won’t succeed in population health by adding costs and charges. The money you make, most likely, will represent someone else’s cost savings.

“Go where the money is.” This is the Willie Sutton principle of population health. Everyone has someone or some organization that has a vested interest in keeping them healthy. These people and organizations can be good resources for contracts and grants. Look for community benefit grant opportunities to improve the health of your community. It might just change your relationship with an insurer. The money is there. You may need to realign your own actions with the incentives implied by these resources.

To leave you with a parting thought:

If you constantly try to argue your worth, people will dispute you have value. If you try to make yourself obsolete, you will make yourself indispensable.

I think if physical therapists work to make themselves obsolete—to keep people healthy by lowering social barriers to health, to engage and empower our communities—we will show our transformative power to society and realize our professional vision

Todd E. Davenport, PT, DPT, is associate professor and program director, Department of Physical Therapy, University of the Pacific, Stockton, California. He can be reached at tdavenport@pacific.edu.