How can healthcare education effectively prepare healthcare professionals to recognise, address and mitigate health inequalities within diverse patient populations?
The 2008 WHO’s Commission on the Social Determinants of Health (SDH) advocated health inequalities were due to an “unequal distribution of health-damaging experiences” [1]. It emphasised these weren’t due to a “natural phenomenon” but rather consequent of the conditions in which people are born, grow and work [1]. These act on individual, household, community and national levels [2], with those experiencing multidimensional poverty having worse health outcomes and a higher risk of premature death [1].
This is a growing challenge amongst diverse patient populations, and healthcare education needs to equip students with the necessary knowledge about these “causes of the causes” [2].
This begins with the inclusion of SDH into curricula, the most effective method for embedding this knowledge being longitudinal learning – educational programmes integrated over extended periods [3]. However, theoretical education must be paired with hands-on experiences like community-based projects. These opportunities enable students to witness firsthand the vast impact of social and environmental factors on health. This will add an invaluable human dimension to students’ developing theoretical knowledge. Reflective practices, such as essays, further enhance this learning, by helping students process their experiences and consider how these insights will influence their future practice. This will cultivate a deeper commitment to addressing healthcare inequalities and inspire more holistic thinking.
Despite its importance, inclusion of SDH into curricula faces challenges, particularly resistance to change, due to stigma that the SDH are less clinically relevant compared to biomedical topics [4]. Addressing this, requires a multi-faceted approach starting with the education of the faculty, whose attitudes and teaching styles significantly influence students’ perceptions. A top-down approach, ensuring faculties are well-versed, and committed to SDH integration, will foster a culture which values health equity. Additionally incentivising SDH education, for example through inclusion in examinations, legitimises their place within the curriculum.
Another challenge is overcoming students’ feelings of ‘helplessness’ when facing systemic issues like poverty. Education must empower students with the knowledge of the variety of community services available to support diverse patient populations. Interdisciplinary teaching sessions can bring different healthcare students together, where they can teach one another about existing programmes. These can also act as collaborative forums where students can design new multidisciplinary approaches to reduce health inequalities.
Healthcare education needs to think beyond the immediate clinical setting and consider broader advocacy roles. Empowering students as agents of change, through encouraging engagement in policy discussions and thoughts about new community programmes. This will inspire students to stop seeing SDH as insurmountable barriers, but instead as areas where they can effect meaningful change.
In conclusion, preparing healthcare professionals to recognise, address and mitigate health inequalities is a multifaceted challenge that begins with education. Integrating SDH into curricula, complemented with practical experiences, reflective practices and interdisciplinary teaching, fosters a deeper understanding of the root of health inequalities and a commitment to change. Whilst this is imperative, education must consider how it delivers this teaching, re-phrasing the SDH as opportunities for impact, to empower students as agents of innovation and advocacy.
References:
1. Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet. 2008 Nov;372(9650):1661–9.
2. World Health Organization. Social Determinants of Health [Internet]. World Health Organization. 2024. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
3. Nour N, Onchonga D, Neville S, O’Donnell P, Mohamed Elhassan Abdalla. Integrating the social determinants of health into graduate medical education training: a scoping review. BMC medical education. 2024 May 23;24(1).
4. Lewis JH, Lage OG, Grant BK, Rajasekaran SK, Gemeda M, Like RC, et al. Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report. Advances in Medical Education and Practice. 2020 May;Volume 11:369–77.
