Michelle Rupp: Joining us now is Angie walker from DeQueen. Angie, you’re with Dr. Walker’s family practice in DeQueen and we’ve got an interesting topic. I’m excited to dive into this topic with you today, social determinants of health. We’re going to put a spin on it because Christmas parties and holidays and family get-togethers are coming up that could be triggering for some. Let’s start from the beginning. What are we talking about when we say the phrase social determinants of health, what does that mean?

Angie Walker: It’s a barrier to your health. It can be lack of transportation, food insecurities, housing insecurities, utility issues, anything that puts a barrier between you and a healthy lifestyle.

MR: Now, can that happen at any age? Or are we specifically talking about children and adolescents?

AW: It can happen at any age. What studies have shown, is that when it impacts you at a childhood level, it seems to affect you throughout your life lifetime. You want to try to be the bridge during that childhood time period so that it doesn’t go on later in life.

MR: Children who have experienced these barriers, how does that manifest in them? What might we see in a classroom setting, for example?

AW: If you’re hungry, you can’t concentrate. If you don’t have utilities, how are you doing your homework? If you don’t have transportation, how are your parents getting you back and forth to doctor’s appointments, dental appointments? If you don’t have housing and you’re living, you know, from relative to relative to relative, that’s a distraction for a child.

MR: And that’s going to come out in a bunch of different ways. You know, maybe fighting on the playground, maybe some arguments in the classroom, acting out.

AW: …Or grades. You know, you can’t concentrate because you’re hungry, you can’t get your work done because you’re tired. 

MR: If someone’s watching this and they’re starting to connect some dots, and they’re thinking either, ‘oh my gosh, she’s talking about what I’ve experienced,’ or ‘I’ve got a child that I’m teaching that is starting to fit some of these patterns,’ what do you do?

AW: I’m just going to tell you what we focus on in our office. We try to make sure we’re screening our patients, and that’s at any age. We do an in-office food bank; we offer transportation to our patients as well. Anything where we can bridge a gap, the same thing is true for the school districts. A lot of them have the backpack program; they also have extra school clothes and things like that. They have a clothes closet.

A lot of people that are interacting with children are already trying to bridge those gaps. One of the things that we worry about during the holiday period is you’re out of school, so you don’t have access to the backpack program or to those, clothing, you know, assistance and stuff like that. And so that’s always a scary time for us is the time when school’s out. In our office, we try to focus on children during that time, making sure that we’re, even though you’re not here for a wellness visit, we’re still going to screen and make sure you’ve got food at the house. We’re going to make sure that you’ve got utilities, that your utilities are on because we’re getting into, you know, it’s cold. That’s a big deal. I think now more than ever as you get towards the holidays, but also, those holidays fall within colder months, you’re more hypersensitive to it.

MR: What goes into that screening.

AW: It’s going to be about a series of 10 to 15 questions and it’s just part of that whole overall wellness visit. We’re asking if you have worries today about food, are your utilities on, do you have transportation? Do you have a church family? Church bridges that gap for a lot of people as far as transportation and food and a lot of their drive-through food programs. It’s about 10 to 15 questions that are not overt, they’re just, you know, as you’re chatting, you’re asking. Then my group knows how to look at that screener on the other end of it where ‘oh, she just said that you know, she’s a little worried about food in the home.’ We don’t make a big deal out of it, we just make sure that we have a basket of food that we bring into that room, and that patient leaves with it that day. As a physician’s office, we do a resource guide and that resource guide makes sure it hits every social determinant of health, also, childcare services and those kinds of things so that if the patient, what we call “pops positive” for one of those social determinants, we’re going to make sure they have that resource guide in front of them. It’s going to help them make decisions about utilities, housing, any of those things that could be a barrier.

MR: What about success stories? Do you see many of those? Talk a little bit about that.

AW: We’ve had a couple in our office that we’re super proud of. We had a diabetic patient that could not get a number under control and the nurse thought, well, I’m going to do this screener and when she was talking to the patient, she identified that the patient didn’t have a refrigerator. It’s very hard to keep that medication stable if it’s not refrigerated. She was able to engage a couple of other resources that we had and even the insurance carrier to make sure the patient had a refrigerator. We had another patient that did not have running water. You know, they had had it at one time, but then something broke and they weren’t able to get it fixed and this one just happened to be one of the Medicare Advantage programs and we were able to get a hold of them and they sent someone out to repair that. There’s a lot of resources out there that can help you battle those social determinants of health. Still, you really don’t understand that until you start asking about them and screening for them and if you’re going to screen for them, make sure you have a resolution or you have something because just knowing is not enough. Once you have that information, you’ve got to do something about it.

MR: Yeah, it’s not an ‘Oh wow, okay, sorry’. No, that’s right. It’s going to be action. What about resilience? Does resilience play in on this?

AW: I say absolutely. Mankind is resilient. You have those individuals that social determinant of health doesn’t impact them, they kind of spark them, move them forward. They get past those things. But I think sometimes too, you don’t realize that as you move into adulthood, it does play a factor for you. It does play into how you live your life. You know, suddenly you’re doing things and you don’t remember why you’re doing them and then you’re like, oh, that impacted me at a younger age.

MR: What might be some takeaways because we are just a few weeks ahead of Christmas and for many people, this is a wonderful, joyous time. For many people, this is a very difficult time. And so, what are some takeaways that we can be mindful of and maybe kind of easing that because, and I keep going back to the child in the classroom, you know, other kids are talking about their Christmas list and what they hope they’re getting or what they think they’re getting. And then there’s at least that one child in the classroom that’s thinking, I hope I have electricity.

AW: Yeah, I think some takeaways are, number one, be kind, we’re all suffering, everyone’s tired, everyone’s had a rough two years. You know, we can start to see the other end of that. Number two, one of the things we try to do is, is to try to involve ourselves in as many of those projects that are going on that we can, you know Toys for Tots. There’s a lot of stuff going on in the school districts as far as you know, you know they’re getting ready to stuff those backpacks for two weeks. You know, they want to make sure that those kids have a meal that they can cook for themselves over that time. Reach out to those school food banks, you can reach out to those school clothes closets, you know, so there’s a ton of stuff, your local church, you know, your churches are going to your churches and your school districts are going to know a family in need. If they don’t know a family in need, a lot of times you can talk to your physician’s office and while they can’t provide you with a person’s name, they can certainly, you know, say ‘hey if you can drop off this, this and this, and I’ll make sure it gets to this patient’ and so they can bridge that gap as well. And so that’s one thing that we do as we’re moving into the holidays, we’re not thinking about gifts and those kinds of things. We’re trying to make sure we’re meeting just basic needs because we do know that there’s a population that is not getting a basic need met and so how can we take what we were going to spend on Christmas and partying and all that stuff and how can we make sure basic needs are getting met?

MR: That’s good. Angie Walker, thank you so much. You came up from DeQueen today. We love having you here in the studio. It’s been a good time. Thank you and thank you for joining us. We’ll see you back here next week for more AFMC TV.