Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.
Pediatr Res. 2018 Jul;84(1):10-21. doi: 10.1038/s41390-018-0012-1. Epub 2018 May 23.
The social determinants of health (SDoH) are defined by the World Health Organization as the "conditions in which people are born, grow, live, work, and age." Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and "adult diseases" such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.
健康的社会决定因素（SDoH）被世界卫生组织定义为“人们出生、成长、生活、工作和衰老的环境”。在儿科学领域，研究已经强调了这些潜在的社会、经济和环境条件与一系列与急性和慢性疾病相关的健康结果之间的联系。此外，在成人文献中，多项研究表明，儿童时期经历的社会问题与糖尿病和高血压等“成人疾病”之间存在显著联系。已经探索了多种潜在的关联机制，包括获得医疗服务的差异、接触致癌物质和病原体、影响健康的行为以及对全身适应负荷（即毒性应激）的生理反应。这一丰富的文献支持 SDoH 的重要性以及社会需求干预措施的制定和评估。这些干预措施也是由不断变化的经济现实驱动的，最重要的是，从按服务收费模式向基于价值的支付模式转变。本文回顾了针对 SDoH 的以儿科为重点的临床干预措施的现有证据，这些措施针对的是食品安全、住房安全和医疗服务获取减少等基本需求。本文总结了此类干预措施评估中常见的挑战。最后，本文通过介绍未来研究的主要机会结束。
