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5.6 LESSON6. ADDRESSING INEQUITIES (social determinants of health)

The COVID19 pandemic has exposed disparities in the social determinants of health, resulting in noticeable inequities in COVID19 health outcomes among different population groups. This can be attributed, in part, to variations in the ability to comply with public health and social measures aimed at curbing viral transmission, such as practicing hand hygiene, wearing face masks, maintaining physical distance, and closing public spaces like schools and workplaces. The pandemic's broader consequences have disproportionately affected social determinants of health, further exacerbating existing health disparities. In addition, social determinants have significantly affected access to and uptake of vaccines throughout the country.44 

This has led to increased recognition of the impact of social determinants of health and health disparities on patient outcomes, highlighting the pressing necessity for policies and measures to address these disparities and has spurred efforts to improve shared decision making. Throughout the pandemic predictive models of the spread of the disease to inform containment measures were used throughout the country. 

In policy and healthcare decision making, it is essential to consider the impact of social determinants of health and patient preferences and needs. As models are utilized to guide unprecedented public health interventions, it becomes even more crucial to acknowledge what these models inform us of and, equally importantly, what they do not. For these models to be beneficial in making policy decisions of unprecedented magnitude, it is vital to engage in critical discussions regarding the forms of evidence that they may exclude and the potential unintended consequences of such exclusions.46 By taking into account the broader context of social determinants of health and patient preferences and needs, we can ensure that our policy and healthcare decisions are equitable and effective for all.

The pandemic has provided an impetus for healthcare providers and systems to take a more comprehensive approach to patient care and to partner with patients to address the social determinants of health that impact their lives. This approach should include shared decision making and patient centred care, aiming to better understand patients’ needs and preferences and to involve them in decisions about their care with models that are both culturally and linguistically appropriate. By recognizing the need to engage patients to address social determinants of health, health outcomes can be improved. 

Additionally, healthcare systems are increasingly adopting community based approaches to care delivery, which consider the social and economic factors that affect patients' health. These models prioritize the role of community health workers and other lay health workers in improving access to care and addressing social determinants of health.47

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