SLU College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63104, USA.
Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA.
Nutrients. 2023 Dec 19;16(1):5. doi: 10.3390/nu16010005.
Social Determinants of Health (SDOH) impact nearly half of health outcomes, surpassing the influence of human behavior, clinical care, and the physical environment. SDOH has five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Any adversity arising out of these interlinked domains predominantly affects children due to their greater susceptibility, and the adverse outcomes may span generations. Unfavorable SDOH may cause food insecurity, malnutrition, unbalanced gut microbiome, acute and chronic illnesses, inadequate education, unemployment, and lower life expectancy. Systematic screening by health care workers and physicians utilizing currently available tools and questionnaires can identify children susceptible to adverse childhood experiences, but there is a deficiency with respect to streamlined approach and institutional support. Additionally, current ameliorating supplemental food programs fall short of pediatric nutritional requirements. We propose a nutrition-based Surveillance, Screening, Referral, and Reevaluation (SSRR) plan encompassing a holistic approach to SDOH with a core emphasis on food insecurity, coupled with standardizing outcome-based interventions. We also propose more inclusive use of Food Prescription Programs, tailored to individual children's needs, with emphasis on education and access to healthy food.
社会决定因素健康（SDOH）几乎影响了一半的健康结果，超过了人类行为、临床护理和物理环境的影响。SDOH 有五个领域：经济稳定、教育机会和质量、医疗保健机会和质量、邻里和建筑环境以及社会和社区环境。这些相互关联的领域中出现的任何逆境主要影响儿童，因为他们更容易受到影响，并且不良后果可能会跨越几代人。不利的 SDOH 可能导致食品不安全、营养不良、肠道微生物失衡、急性和慢性疾病、教育不足、失业和预期寿命缩短。医疗保健工作者和医生利用现有工具和问卷进行系统筛查，可以识别易受不良儿童经历影响的儿童，但在简化方法和机构支持方面存在不足。此外，目前的缓解性补充食品计划不符合儿科营养需求。我们提出了一个基于营养的监测、筛查、转介和重新评估（SSRR）计划，该计划涵盖了 SDOH 的整体方法，核心重点是食品不安全，并结合了基于结果的标准化干预措施。我们还建议更广泛地使用针对个别儿童需求的饮食处方计划，重点是教育和获得健康食品。
