When it comes to systemic lupus erythematosus (SLE) and social determinants of health (SDoH), it’s clear that these issues go hand in hand, especially for the Black community. Dr. Sam Lim, Chief of Rheumatology at Grady Health System, and his team examined this connection in a study presented at the American College of Rheumatology, and their findings were eye-opening.
“Nearly 80% of patients, most of whom were Black women, screened positive for at least one social risk factor,” Dr. Lim said.
This includes financial strain (up to 72%), food insecurity (51%), and housing and utilities issues (35%). These aren’t just numbers; they represent real barriers to accessing care and better health outcomes.
BHM: Can you start by summarizing the key findings of your study, particularly highlighting specific data that applies to the Black community?
Dr. Lim: Nearly 80% of patients, mostly Black women, screened positive for at least one social risk factor. Common challenges included financial strain (up to 72%), food insecurity (up to 51%), and housing and utilities (up to 35%). Importantly, 91% of patients expressed comfort in discussing social risk factors, highlighting the value of integrating SDoH screenings into routine care.
BHM: Can you explain what social determinants of health (SDoH) are and why they are important when considering the health outcomes of the Black community?
Dr. Lim: Social determinants of health refer to the conditions in which individuals are born, grow, live, work, and age. These factors, including income, education, housing, healthcare access, and experiences of discrimination, account for 30-55% of health outcomes. In the Black community, adverse SDoH, like poverty and housing instability, are associated with increased disease activity and poorer health outcomes. Systemic racism and discrimination further worsen these effects by increasing stress and reducing access to resources.
BHM: How does SDoH specifically affect Black patients with SLE, and what did your study reveal about these impacts?
Dr. Lim: Black people with SLE face adverse SDoH, like poverty, food insecurity, and inadequate housing, increasing the severity of SLE and associated comorbidities.
Discrimination is highly correlated with increased lupus disease activity and organ damage in Black women.
Despite these challenges, patients were willing to engage with healthcare providers to address these barriers. This underscores the need for systemic changes to address the impact of SDoH on Black people with SLE.
BHM: How important is trust and cultural competency in conducting these screenings within the Black community?
Dr. Lim: Trust and cultural competency are crucial. Nearly all patients were comfortable answering these questions and valued discussing their social needs. Building trust involves acknowledging historical and ongoing healthcare inequities and engaging in culturally competent care.
When patients perceive their healthcare providers as empathetic and nonjudgmental, they are more likely to share sensitive information, essential for addressing SDoH effectively.
BHM: How do barriers like transportation, financial constraints, and limited healthcare resources affect Black patients with SLE, and what strategies can help address these issues?
Dr. Lim: Barriers like transportation difficulties, financial constraints, and limited healthcare resources often lead to missed appointments, delayed diagnoses, and interruptions in treatment. To address these barriers, community-based initiatives and systemic changes are needed. Mobile clinics, telehealth services, and financial assistance programs can help. Healthcare navigation support and cultural competence among providers are also crucial. Addressing these barriers requires a collaborative approach that combines systemic healthcare reform, community-based solutions, and patient-centered support.
BHM: The study emphasized the importance of institutional leadership in addressing health inequities. Why is it crucial for healthcare institutions to prioritize SDoH, especially for marginalized communities?
Dr. Lim: Healthcare institutions have the unique capacity to identify, address, and mitigate the structural and social barriers that impact patient outcomes. By prioritizing SDoH, institutions can improve individual health outcomes and foster equity within the broader community. Institutional leadership sets the tone for cultural competency and trust-building, helping to rebuild trust and demonstrate a commitment to equitable care. This is vital for managing complex diseases like SLE. Institutional efforts to address SDoH can also influence policy and funding priorities at local, state, and national levels.
BHM: Given that the SDoH screening tool was tested and found to cause minimal disruption to clinical workflow, what steps are needed to make it a standard healthcare practice, and why should it be widely implemented?
Dr. Lim: Embedding the screening tool into electronic health record systems allows seamless integration into clinical workflows. Training healthcare staff on the tool’s use and the significance of SDoH is essential. Institutional leadership and funding mechanisms are also critical for long-term sustainability. Reimbursement models and partnerships with community organizations can support the implementation of SDoH screenings.
BHM: What are the best strategies for healthcare providers to engage patients in discussions about social determinants of health?
Dr. Lim: Healthcare providers must build trust through engaged listening, a nonjudgmental approach, and follow-through in addressing concerns.
Cultural competence is crucial, and providers should respect the cultural, social, and personal contexts shaping a patient’s experiences. Using inclusive language and open-ended questions helps create a welcoming environment.
Providers should also be equipped to connect patients with community resources and social services.
BHM: What long-term impacts do you anticipate from integrating SDoH screenings into routine care, particularly for marginalized communities?
Dr. Lim: Addressing SDoH early can prevent chronic disease exacerbations, reduce hospitalizations, and improve quality of life.
Integrating SDoH screenings can also strengthen trust between patients and providers and make healthcare more proactive and preventive.
Over time, this can reshape healthcare delivery by shifting resources toward upstream solutions that keep patients healthier.
Focusing on social determinants of health in lupus care isn’t just about ticking boxes. It’s about understanding the real-life challenges patients face. Dr. Lim and his team’s study is a call to action for healthcare providers to dig deeper and foster genuine connections with their patients. By acknowledging these social factors, we can create a more compassionate and equitable healthcare system that truly sees and supports every individual.
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