Table 1.

Brainstorming Themes Regarding Social Determinants of Health and Primary Care, as Discussed at the 2017 Starfield Summit

Theme from Starfield Summit Participants' Discussion on SDHsRepresentative Statements from Group Discussion Reflecting Theme
Addressing SDHs is a responsibility of primary care.“SDHs frame the health problems of our patients.”
“In the United States, health care is used as a 'Trojan horse' for social services [because it is more acceptable].”
“Data are needed to understand which SHDs are priorities to be addressed by primary care providers and how best to do so.”
Innovations for addressing SDHs are outpacing the evidence.“Abundant emerging evidence supports the effect of SDHs on health outcomes/disparities, but less evidence exists for clinical interventions to mitigate SDHs.”
“Intermediate outcome metrics for SDH interventions must be developed and validated. Long-term mortality and intermediate health biomarkers may be inappropriate metrics of SDH interventions.”
“Public health and population health data should be better integrated at the point of care.”
Qualitative data analysis of patient stories should be used to identify and address SDHs.“If the patient is at the center of health care, we need to hear about the patient experience.”
“Patient stories can influence health care models and payment. Primary care should inform patients about the impact their stories can have.”
“The act of sharing a story can be therapeutic in itself.”
Relational leadership and community organizing are important, underutilized tools to address SDHs.“Coalitions start as 1 or 2 connections, and then they connect with others. Success depends on history and the process undertaken.”
“Social movements and relational approaches do not play to the technical expertise as health professionals. We can embrace that as an opportunity for those with whom we partner.”
“Academic medical faculty may feel less comfortable teaching about community organizing, but we can partner with community organizations to learn.”
CHIPs create needed links across the medical-social neighborhood.“CHIPs create intentional strategies and tactical plans.”
“In Oregon, everyone—hospitals, nonprofits, etc.—contributed to the CHIP. It was necessary to bring everyone together.”
“Metrics are universal, so [CHIPs] can be universal too. They can cross ideological divides, like the cost of health care, and encompass SDHs and workforce issues.”
Policy changes increasing payment and resources for addressing SDHs are necessary.“The fee-for-service payment model does not promote addressing SDHs.”
“Attempts to address SDHs without proper resources in place could do more harm than good.”
“Clinics need staff to connect patients with resources and to follow up to ensure coordination with these services.”
  • CHIP, community health improvement plan; SDH, social determinant of health.