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Breaking it down with Dr. James Brown: The social determinants of health and the people of Flint (part 1)

Written by Tanya Terry

It is critical for the people of Flint to be familiar with the social determinants of health, according to James Brown, MD, a board certified family physician at Hamilton Community Health Network.

The social determinants of health (SDH) are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life, according to the World Health Organization (WHO). The Commission on Social Determinants of Health, set up by the WHO, published a report called ‘Closing the gap in a generation.’ The focus of the report is to understand from a social justice perspective how health disparities and health inequities can be changed and remedied.

“Social determinants of health affect people’s lives all over the world and specifically in Flint,” Brown said.

Brown explains there are several social determinants of health, including health literacy. Health literacy is what a person knows about their health.

People can educate themselves and gain information about their health in many ways;

  • by having a discussion with their physician, a nurse practitioner or a physician’s assistant,
  • by reading the pamphlets and brochures available on the shelves and kiosks at the doctor’s office often found in the reception area, in the exam rooms and in halls,
  • or by listening to the health and nutritional information broadcast on the televisions in the doctor’s office. This can be an opportunity to learn while waiting to see by the doctor.

Brown said on a visit to a person’s healthcare provider, patients should learn as much as they can about their conditions.

For example, Brown said simple carbohydrates like candy and cookies are broken down rapidly in the body and affects one’s sugar or glucose level. African Americans, especially women, are more likely to develop type 2 diabetes than their white counterparts, according to webmd.com.

According to healthline.com, insulin helps balance a person’s blood glucose levels. When there’s too much glucose in the bloodstream, insulin signals the body to store the excess in the liver. The stored glucose isn’t released until the blood glucose levels decrease, such as between meals or when the body is stressed or needs an extra boost of energy. Diabetes occurs when the body doesn’t use insulin properly or doesn’t make enough insulin.

Brown said it is important to know the full names of medications being taken. Brown suggests writing a list (using entire names) of the medications down, along with the dosage and dosage instructions (how many times a day to take the medications).

Keep this important information in your cell phone or in a notebook dedicated to your health, or attach it to the refrigerator. This is critical information in case of an emergency or when visiting a doctor for the first time.

According to Brown, simply knowing the color and/or shape of medications taken is not enough information, and will not support good health. By being more informed about your health, a patient can better advocate for themselves.

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Another social determinant of health is income level and socioeconomic status. Brown said when General Motors employed much of the city; many people enjoyed a better standard of living and comprehensive health insurance which led to better health care.

“With factories closing, throughout the Midwest, the tax base suffered, meaning there’s less money for municipalities to provide services and less money circulating in the local economy,” Brown said. “Everything is affected, including a person’s health.”

Brown’s philosophy is to be an advocate for the total patient, no matter their income or socioeconomic status. A doctor, who is alert to a patient’s barriers to good healthcare, may be able to advocate for that patient more effectively by directing services and solutions to assist the patient navigate around those income and economic social status barriers.

“The patient knows what they are feeling. Their symptoms, medical history and social issues are all part of my assessment in trying to help the patient achieve optimal medical health. As a physician, I handle their medical issues, while taking into consideration how social determinants of health may be impacting the patients’ health and what, if anything, can be done to alleviate some of those barriers to good health.”

“I incorporate a body, mind and spirit approach to patient care. The patient shares with me what they are feeling about different aspects of their health and life, and, in turn, I share professional, standard of care recommendations with patients in layman’s language as effective communication is essential. Listening is essential.”

“I believe in preventative care. Testing cholesterol levels and sugar levels are important, just as is assessing the emotional health of the patient. During this pandemic, I ask all my patients what measures are they taking to protect themselves and their families against COVID-19. How are they managing?”

Brown said he cares about whether his patients have a grocery store nearby or whether they are being fed spiritually. According to Brown, family medicine is about looking at the totality of the person and their life circle and helping them to be the best they can.

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