Clinical Prevention and Population Health in Health Professions Education: Tackling the Social Determinants of Health

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By: APTR Healthy People Curriculum Task Force

How do we create a future healthcare workforce dedicated to improving health outcomes and reducing health disparities across populations? Most fundamentally, we must educate health professions students about the importance of prevention, the social determinants of health, and give them the skills needed to function effectively in interprofessional teams. There is increasing recognition among educators and policymakers that the social determinants of health (SDOH) and prevention-focused strategies are important to address community health issues and achieve health equity. Health equity is defined by Healthy People 2020 (HP2020) as “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” This requires addressing social and environmental determinants through both broad and targeted approaches focused on communities experiencing the greatest disparities.

The Healthy People Curriculum Task Force (Task Force), convened by the Association for Prevention Teaching and Research (APTR), has worked to achieve the HP2020 Educational and Community-Based Programs Objectives (ECBP Objectives 12-19) to increase the inclusion of core clinical prevention and population health content in health professions education, and to increase interprofessional learning experiences for health professions and public health students. For the past 15 years, the national health professions associations that comprise the Task Force have published curriculum guidelines and tools and have collected data from their member institutions to track progress toward integrating clinical prevention and population health content into health professions curricula.

Today, there is a growing awareness that we must also address social and environmental upstream factors influencing health status. Health professions students must consider the social determinants of health and their wide-ranging effects on the patients and populations they serve. To assist educators in this mission, APTR, with support from the U.S. Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP) has published a case study series aimed at deepening health professions students’ understanding of the HP2020 SDOH topic area, as well as perspectives calling for an expansion of public health practice to emphasize cross-sectoral, environmental, policy, and systems-level actions that directly affect SDOH and advance health equity.

The three problem-based case studies, summarized below, are designed to teach health professions students how to identify social factors that affect the health of their patients and communities, include community-based and other social services and programs in the care of their patients, and describe how the choices and civic/community engagement of health professionals can influence the health of patients and populations.

Educators are invited to review the case studies and provide feedback on their use to APTR. Instructor guides are available to faculty on the APTR website. Additional resources and national guidelines for teaching population health across the health professions can be found in the Clinical Prevention and Population Health Curriculum Framework (APTR, 2015) at www.teachpopulationhealth.org.

https://www.teachpopulationhealth.org/sdohcases.html

Seeking Health Equity: Examining Racism as a Social Determinant of Health​
The University of North Carolina at Greensboro
Department of Public Health Education and Department of Family and Community Nursing

This module presents two case studies based on real-world, actual events that demonstrate the significant and negative impact of racism on the health of individuals and populations. It is vitally important for future health professionals to understand the significance of racism as a social determinant of health if they are to help achieve health equity across racial and ethnic groups. Students need to increase their ability to examine historical factors leading to racial inequities and acquire the tools necessary to begin incorporating this information into their work. Participants review four videos and answer assessment questions. Additional teaching tools addressing institutional racism are available through the APTR Anti-Racism Policy and Toolkit titled, “Role of Academia in Combatting Structural Racism in the United States” at http://www.aptrweb.org/page/toolkitoverview.

Addressing the Effects of Psychological Trauma in a Community Using a Social Determinants of Health Approach: A Case Study
Rutgers, The State University of New Jersey
School of Nursing

This teaching case study examines psychological trauma in a community context and the impacts, both positive and negative, of SDOH. Healthy People 2020 views people residing in communities with large-scale psychological trauma as an emerging issue in mental health and mental health disorders (Healthy People, 2017). The case study, which focuses on Newark, New Jersey, addresses three of the five key determinants of health: social and community context, health and health care, and neighborhood and built environment. Upstream interventions designed to improve mental health and well-being that support trauma-informed care are analyzed. The use of Newark as the case study setting allows a real-life exploration of each of these three key determinants of health. Learners work together on the four-part case and access and share information resources designed to enhance the quality of the learning experience.

Targeting the Social Determinants of Health in Geriatric Populations
University of Utah
Department of Family and Preventive Medicine
The Training for Health Equity Network (THEnet)

This module includes three clinical case videos demonstrating a variety of geriatric patient circumstances. Participants view each case with attention to the medical care provided, as well as the impact of SDOH in each scenario. The provider in each case models ways of integrating SDOH into the patient’s care plan to optimize the patient’s health and functionality. Students are encouraged to discuss the complexities of the growing aging population’s health needs as they relate to SDOH, assess local resources, services, programs and policies, and reflect on their own assumptions and biases, so they can ultimately improve patient care.

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