The Congressional Social Determinants of Health (SDOH) Caucus is a bipartisan effort of lawmakers started in July of 2021 to improve approaches for addressing health disparities experienced by persons disproportionately impacted by SDOH and improve well-being. In this effort, the Caucus is seeking comments and feedback from the public on challenges and opportunities related to SDOH by September 21, 2021.  

SDOHs are the social conditions that can affect a person’s health and are not inherent to a person’s genetics or biological makeup.  Rather, they are the social conditions in the environment that people live in, go to school, work or spend their leisure time.

As HAPC professionals, we know that social conditions impact not only our ability to maintain healthy lives but also can have a devastating impact on the way our patients experience suffering and disease burden.  When social conditions lead to disparities in end-of-life care outcomes, these conditions can be described as social determinants of death.  Disparities in social determinants of death reveal that persons from BIPOC (Black, Indigenous and people of color) communities and those with lower socioeconomic status experience less utilization of hospice, a higher likelihood of difficulties in managing symptoms and experiencing pain, a higher likelihood of hospitalization in final stages of life, and a higher likelihood of discharge from hospice (Hughes and Vernon 2019; Jackson and Gracia 2014; Rine 2018). Barriers to accessing hospice include distrust and lack of access to health care services in general and also unfamiliarity with end-of-life services.

Access to Palliative Care services is also impacted by SDOH. While hospitals with fewer than 50 beds make up more than two-thirds of our nation’s hospitals, only 17% of them report having palliative care programs. Ninety percent of hospitals with palliative care are in urban areas. Telehealth can increase access, though there are disparities in access to high-speed broadband internet as well as access to and affordability of smartphones.

Hospice and Palliative Care social workers need to find ways to contribute to the conversation related to SDOH. The NASW Code of Ethics states that social workers should “engage in social and political action” to make sure that all persons have equal access. NASW standards for Social Work in Palliative and End-of-life Care explicitly state that social workers have an ethical obligation to participate in social and political action to create positive change.  This call for comments and feedback on SDOH offers an opportunity to meet this ethical obligation for our profession and for our patients. 

Please consider submitting a comment, and please identify yourself as an HAPC social worker so that the well-being of palliative care patients is not forgotten in this call to action.

Comments need to be submitted to this link by September 21, 2021.