The social determinants of health are the crucial social, economic and political factors and forces that influence the health of individuals, communities and whole populations. In our current society, perhaps the most important social determinant is our financial status. Our income, wealth and financial literacy influence our ability to purchase necessities required for a healthy life, such as food, housing and medications. Financial status also influences how others in society perceive us, and how we see ourselves in a social hierarchy. Finally, financial status can also impact our ability to access health services and how we are treated within healthcare systems. Importantly, our financial status intersects with other key social determinants, including our sex and gender identity, our racial identity and our education level. In this body of work, I investigate several aspects of addressing financial insecurity as a key social determinant of health in primary care settings. In my first paper, I explore the acceptability and feasibility of implementing a routine approach to screening for poverty and intervening through providing resources to patients. In my second paper, I explore the potential of addressing financial strain through a peer-to-peer intervention hosted at a primary care clinic. In my third paper, I explore how patients react to routine screening of their income, and how the data collected from individuals compares to assigning income groups using a postal code. These studies provide a foundation for efforts to help primary care organizations to “move upstream”, by implementing routine data collection and intervening on financial insecurity as a key social determinant of health. Future research should focus on how to best implement different levels of interventions on financial insecurity in different settings, novel approaches to identify financial insecurity, and how this work could inform policy change that could impact whole populations.
Andrew D. Pinto (Fri,) studied this question.