Williams Andrew M, Sahel José-Alain
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ophthalmol Ther. 2022 Aug;11(4):1371-1382. doi: 10.1007/s40123-022-00531-w. Epub 2022 Jun 8.
Social determinants of health encompass the quality of an individual's social and physical environment and its effect on health outcomes. Disparities in these social and environmental factors have a significant role in vision health disparities and inequity in eye care. In this review, we discuss how disparities in visual impairment and eye care utilization are affected by each of the five core domains of social determinants of health, namely economic stability (income, employment, and food security), education (education level and health literacy), health care access (insurance and medical costs), neighborhood environment (housing conditions, home ownership, pollution, and crime), and social context (race and racism). Moreover, we describe a framework by which ophthalmologists can take action to address social determinants of vision health. These actionable strategies are guided by recommendations from the National Academies of Sciences, Engineering, and Medicine and have five complementary components to address social needs: awareness (screening for social needs), assistance (connecting patients with social care resources), adjustment (altering clinical care in recognition of social needs), alignment (understanding social assets and collaborating with community organizations), and advocacy (promoting policies to address social needs). Addressing social determinants of health is complex but achievable through collaborative strategies. Ophthalmologists have an important leadership role in addressing eye care disparities by taking action on underlying social determinants of vision health.
健康的社会决定因素包括个人社会和物理环境的质量及其对健康结果的影响。这些社会和环境因素的差异在视力健康差异和眼科护理不平等中起着重要作用。在本综述中，我们讨论了视力损害和眼科护理利用方面的差异如何受到健康社会决定因素的五个核心领域（即经济稳定性（收入、就业和食品安全）、教育（教育水平和健康素养）、医疗保健可及性（保险和医疗费用）、社区环境（住房条件、房屋所有权、污染和犯罪）以及社会背景（种族和种族主义））中每一个领域的影响。此外，我们描述了一个框架，眼科医生可据此采取行动解决视力健康的社会决定因素。这些可采取行动的策略以美国国家科学院、工程院和医学院的建议为指导，并有五个互补的组成部分来满足社会需求：意识（筛查社会需求）、援助（将患者与社会护理资源联系起来）、调整（认识到社会需求后改变临床护理）、协调（了解社会资产并与社区组织合作）以及倡导（推动解决社会需求的政策）。解决健康的社会决定因素很复杂，但通过协作策略是可以实现的。眼科医生在通过对视力健康的潜在社会决定因素采取行动来解决眼科护理差异方面具有重要的领导作用。
