Existing practices of health workers and feasibility for implementation of the CLEAR Toolkit to address the Social Determinants of Health:A descriptive cross-sectional study in Pakistan

Syed Babar Ali; Javeria Saleem; Muhammad Ishaq; Sohail Mahmood Khan

Authors

Syed Babar Ali Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Pakistan https://orcid.org/0009-0006-6527-7475
Javeria Saleem Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Pakistan. https://orcid.org/0000-0003-4295-7057
Muhammad Ishaq Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Pakistan https://orcid.org/0000-0001-5699-1737
Sohail Mahmood Khan Association for Quality Assurance in Pre-Tertiary and Higher Education, Business School-Ulster University Partnership Program, United Kingdom https://orcid.org/0009-0000-2066-9279

Keywords:

social determinants of Health, health care workers , CLEAR toolkit

Abstract

The social determinants of health (SDH) are the conditions in which people are born, develop, live, and work. These conditions are made by disseminating wealth, power and resources at universal, nationwide and local levels. SDH are commonly accountable for health inequalities, and the imbalanced and preventable variances in health status observed within and among countries. The study focuses on exploring existing practices of healthcare workers in addressing SDH, and feasibility for implementing a Community Links Evidence to Action Research (CLEAR) toolkit designed to assist clinical decisions, which helps doctors, nurses, and other allied health personnel tackle the social causes of poor health in clinical practice.

References

Schramme T. Health as complete well-being: The WHO definition and beyond. Public Health Ethics. 2023 1;16(3):210-218.https://doi.org/10.1093/phe/phad017

Wilkinson RG, Marmot MG, World Health Organization. Centre for Urban Health. The solid facts : social determinants of health. Centre for Urban Health, WorldHealth Organization; 1998. https://iris.who.int/handle/10665/108082

Whitehead M, Dahlgren G. Concepts and principles for tackling social inequities in health: Levelling up Part 2. 2007;(2).

Naz A, Rosenberg E, Andersson N, Labonté R, Andermann A. Health workers who ask about social determinants of health are more likely to report helping patients: mixed-methods study. Canadian Family Physician. 2016 Nov 1;62(11):e684-93.https://www.cfp.ca/content/62/11/e684.short

Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. Cmaj. 2016;188(17-18):E474-83. DOI: 10.1503/cmaj.160177

Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. https://doi.org/10.1016/S0140-6736(05)71146-6

Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129(SUPPL. 2):19–31. https://doi.org/10.1177/00333549141291S206

WHO Commission on Social Determinants of Health, World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health: Commission on Social Determinants of Health final report. World Health Organization; 2008.

Marmot M. Fair-Society-Healthy-Lives-Full-Marmot Report. Fair Soc Heal lives. 2013;1-74.

Solar O, Irwin A. A conceptual framework for action on the social determinants of health. WHO Document Production Services; 2010.http://hdl.handle.net/1903/23135

Adler NE, Rehkopf DH. US disparities in health: descriptions, causes, and mechanisms. Annu. Rev. Public Health. 2008 Apr 21;29(1):235-52.https://doi.org/10.1146/annurev.publhealth.29.020907.090852

Krieger N. Embodiment: A conceptual glossary for epidemiology. J Epidemiol Community Health. 2005;59(5):350–5.https://doi.org/10.1136/jech.2004.024562

Marmot M. Health equity in England: The Marmot review 10 years on. BMJ.2020;368:1–4. http://dx.doi.org/doi:10.1136/bmj.m693

Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A, Ahmad F, Bhutta S, Hazir T, Zaidi A, Jafarey SN. Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. Lancet. 2013;381(9884):2207-18. doi: 10.1016/S0140-6736(12)61999-0

Barros R, Fox L, Mendonça R. Female-headed households, poverty, and the welfare of children in Urban Brazil. Econ Dev Cult Change. 1997;45(2):231–57.

Lloyd M. Domestic violence and education: Examining the impact of domestic violence on young children, children, and young people and the potential role of schools. Frontiers in psychology. 2018 Nov 13;9:2094.https://doi.org/10.3389/fpsyg.2018.02094

Radell ML, Abo Hamza EG, Daghustani WH, Perveen A, Moustafa AA. The impact of different types of abuse on depression. Depression research and treatment. 2021;2021(1):6654503.https://doi.org/10.1155/2021/6654503

Cullen D, Woodford A, Fein J. Food for thought: a randomized trial of food insecurity screening in the emergency department. Academic pediatrics. 2019 Aug 1;19(6):646-51.https://doi.org/10.1016/j.acap.2018.11.014

Willems SJ, Swinnen W, De Maeseneer JM. The GP’s perception of poverty: A qualitative study. Fam Pract. 2005;22(2):177–83. https://doi.org/10.1093/fampra/cmh724

Cantor T, Anderman A. CLEAR Toolkit advanced pilot study: helping health workers address the social causes of poor health. Can Fam physician. 2017;63(2): S61.https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01409855/full

Andermann A. Taking action on the social determinants of health in clinical practice: A framework for health professionals. Cmaj. 2016;188(17–18):E474–83. https://doi.org/10.1503/cmaj.160177

Artiga S, Hinton E. Beyond health care: the role of social determinants in promoting health and health equity. Kaiser Family Foundation. 2018;10.

Seymour J. The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care. J Palliat Med. 2018;21(S1):S-30. https://doi.org/10.1089/jpm.2017.039

Jacobsen GD, Jacobsen KH. Health awareness campaigns and diagnosis rates: Evidence from National Breast Cancer Awareness Month. J Health Econ. 2011;30(1):55–61.http://dx.doi.org/10.1016/j.jhealeco.2010.11.005

Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129(SUPPL. 2):19–31.

WHO. Closing the gap in a generation. 2008.

Marmot M. Fair-Society-Healthy-Lives-Full-Marmot Report. Fair Soc Heal lives. 2013;1-74.

Solar, O., & Irwin A. A Conceptual Framework for Action on the Social Determinants of Health. Soc Determ Heal Discuss Pap 2 (Policy Pract [Internet]. 2010;79. Available from: http://apps.who.int/iris/bitstream/10665/44489/1/9789241500852_eng.pdf?ua=1&ua=1

Adler NE, Rehkopf DH. U.S. disparities in health: Descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29(February):235–52.

Krieger N. Embodiment: A conceptual glossary for epidemiology. J Epidemiol Community Health. 2005;59(5):350–5.

Marmot M. Health equity in England: The Marmot review 10 years on. BMJ [Internet]. 2020;368(February):1–4. Available from: http://dx.doi.org/doi:10.1136/bmj.m693

Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A, Ahmad F, et al. Health Transitions in Pakistan 2 Reproductive , maternal , newborn , and child health in Pakistan : challenges and opportunities. 2015;381:2207–18.

Barros R, Fox L, Mendonça R. Female-headed households, poverty, and the welfare of children in Urban Brazil. Econ Dev Cult Change. 1997;45(2):231–57.

Lloyd M. Domestic violence and education: Examining the impact of domestic violence on young children, children, and young people and the potential role of schools. Front Psychol. 2018;9(NOV):1–11.

Radell ML, Abo Hamza EG, Daghustani WH, Perveen A, Moustafa AA. The Impact of Different Types of Abuse on Depression. Depress Res Treat. 2021;2021.

Danielle Cullen, Ashley Woodford JF. A Randomized Trial of Food Insecurity Screening in the Emergency Department. Physiol Behav. 2019;176(5):139–48.

Willems SJ, Swinnen W, De Maeseneer JM. The GP’s perception of poverty: A qualitative study. Fam Pract. 2005;22(2):177–83.

Cantor T, Anderman A. CLEAR Toolkit advanced pilot study: helping health workers address the social causes of poor health. Can Fam physician [Internet]. 2016;63(2):S61‐. Available from: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01409855/full

Andermann A. Taking action on the social determinants of health in clinical practice: A framework for health professionals. Cmaj. 2016;188(17–18):E474–83.

Artiga S, Hinton E. Beyond Health Care : The Role of Social Determinants in Promoting Health and Health Equity What are Social Determinants of Health ? Focus on Health in Non-Health Sectors. 2018;(May).

Seymour J. The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care. J Palliat Med. 2018;21(S1):S30–6.

Jacobsen GD, Jacobsen KH. Health awareness campaigns and diagnosis rates: Evidence from National Breast Cancer Awareness Month. J Health Econ [Internet]. 2011;30(1):55–61. Available from: http://dx.doi.org/10.1016/j.jhealeco.2010.11.005