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National Alliance of Healthcare Purchaser Coalitions

Health as More Than Illness: Impact of Social Determinants and Trauma

Laura Joszt
Treating illnesses is important, but it would be a mistake to think that is the full extent of health. Panelists during the National Alliance of Healthcare Purchaser Coalitions’ 2019 Leadership Summits, held June 24-26 in Pittsburgh, Pennsylvania, discussed the impact of social determinants and past trauma on health and how employers can ensure they are addressing these issues to improve health and outcomes.

ACEs look at 10 factors of trauma in 3 categories: abuse, neglect, and household dysfunction. The higher the ACE score (out of 10), the greater a person’s risk of certain health issues, Bishop explained. An ACE score of 4 or higher puts a person at a 3 times greater risk of lung disease and smoking, a 2 times greater risk of liver disease, a 4 times greater risk of developing depression, and at 14 times greater risk of suicide attempt. People with an ACE score of 6 or higher are likely to die 20 years earlier than people with an ACE score of zero.

“This isn’t ‘those’ people. This is ‘us.’ These are our friends, our family,” Bishop said. “In every community in the United States. So, people don’t think that it’s just a certain ethnicity or certain socioeconomic class. This is across the board.”

The trauma these individuals face early on in life is interwoven with their social determinants of health and how they cope with what happens to them. Food becomes more than just sustenance—it becomes a way to cope or protect oneself. As a result, these people are facing chronic diseases.

“People are trying to cope, but in their coping, those poor health habits become lifelong problems,” she said.

A high ACE score is not a death sentence, though, Bishop stressed. There are ways to help these individuals and the best way is through positive relationships and mentoring. She advocates for having discussions around these issues rather than hiding these issues.

Finally, Jaclyn Wainwright, chief executive officer, AiRCare, noted that too much focus on health outcomes and chronic diseases can make the system lose sight of the person.

“If we continue to have health-oriented problem conversations with our employees, we’ll look at our employees and see really sad, sick, unconnected individuals,” she said.

Context is important and can be understood by asking what matters to the individual, but it’s often not a conversation that happens in the workplace. AiRCare is trying to solve for what is missing from communities: compassion, empathy, and connectedness.

Wainwright outlined how trauma and social determinants impact health through the example of someone her company helped. The 47-year-old construction foreman had back pain that was affecting his work. He went to the doctor, who prescribed opiates and also put him on medication for his high blood pressure.

After AiRCare reached out to him and put him in touch with a physician, his back pain was diagnosed as a mental issue resulting from the trauma of his wife leaving him. The back pain was an emotional trauma and not a physical pain. He was recommended to start meditating and taking more time for himself, and after a few months, the back pain was going away, and he was off his blood pressure drugs.

“When we’re just looking at the symptom and not the root cause, we aren’t treating the problem at all,” Wainwright explained.

1. Dyer O. US life expectancy falls for third year in a row. BMJ. 2018;363:k5118. doi: 10.1136/bmj.k5118.

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