When it involves systemic lupus erythematosus (SLE) and social determinants of health (SDoH), it is obvious that these issues go hand in hand, especially for the Black community. Dr. Sam Lim, chief of rheumatology at Grady Health System, and his team investigated this link in a study presented at the American College of Rheumatology, and their findings were eye-opening.
“Nearly 80% of patients, the majority of whom were black women, tested positive for at least one social risk factor,” Dr Lim said.
This includes financial strain (as much as 72%), food insecurity (51%), and housing and utilities issues (35%). These aren’t just numbers; they represent real barriers to access to care and higher health outcomes.
BHM: Can you begin by summarizing the key findings from the study, with an emphasis on specific data applicable to the Black community?
Dr. Lim: Nearly 80% of patients, mostly Black women, tested positive for at the very least one social risk factor. Common challenges included financial strain (as much as 72%), food insecurity (as much as 51%), and housing and utilities (as much as 35%). Importantly, 91% of patients expressed comfort discussing social risk aspects, highlighting the value of incorporating SDoH screening into routine care.
BHM: Can you explain what social determinants of health (SDoH) are and why they’re necessary when considering health outcomes in the Black community?
Dr Lim: Social determinants of health discuss with the conditions in which a person is born, grows, lives, works and ages. These aspects, including income, education, housing, access to health care, and experiences of discrimination, account for 30-55% of health outcomes. In the Black community, antagonistic SDoH, akin to poverty and housing instability, are related to increased disease activity and poorer health outcomes. Systemic racism and discrimination further exacerbate these impacts by increasing stress and limiting access to resources.
BHM: How does SDoH specifically impact black SLE patients, and what did your study reveal about that impact?
Dr. Lim: Black individuals with SLE face antagonistic SDoH phenomena akin to poverty, food insecurity, and inadequate housing, which increase the severity of SLE and its related comorbidities.
Discrimination is strongly correlated with increased lupus disease activity and organ damage in black women.
Despite these challenges, patients were willing to interact with providers to eliminate these barriers. This highlights the need for systemic change to deal with the impact of SDoH on Black individuals with SLE.
BHM: How necessary is trust and cultural competency in conducting these screenings in the Black community?
Dr. Lim: Trust and cultural competence are key. Almost all patients were completely happy to reply these questions and appreciated the discussion about their social needs. Building trust requires acknowledging historical and ongoing inequities in health care and committing to culturally competent care.
When patients perceive their healthcare providers as empathetic and nonjudgmental, they usually tend to share the confidential information crucial to effectively address SDoH.
BHM: How do barriers akin to transportation, financial constraints, and limited healthcare resources impact Black patients with SLE, and what strategies might help address these issues?
Dr. Lim: Barriers akin to transportation difficulties, financial constraints, and limited health care resources often result in missed appointments, delays in diagnosis, and interruptions in treatment. Social initiatives and systemic changes are needed to remove these barriers. Mobile clinics, telehealth services, and financial assistance programs might help. Supporting health care navigation and cultural competence amongst healthcare providers can also be crucial. Dismantling these barriers requires a collaborative approach that mixes systemic health care reform, community-based solutions, and patient-centered support.
BHM: The study highlighted the importance of institutional leadership in eliminating health inequities. Why is SDoH a priority for healthcare institutions, especially for marginalized communities?
Dr. Lim: Healthcare institutions have a novel ability to discover, eliminate and mitigate structural and social barriers that impact patient outcomes. By prioritizing SDoH, institutions can improve individual health outcomes and support equity in the broader community. Institutional leadership sets the tone for cultural competence and trust-building, helping to rebuild trust and exhibit a commitment to equitable care. This is important in the treatment of complex diseases akin to SLE. Institutional efforts to deal with SDoH may additionally influence policy and funding priorities at the local, state, and national levels.
BHM: Given that the SDoH screening tool has been tested and found to cause minimal disruption to clinical workflow, what steps must be taken to make it standard practice in healthcare and why should it’s widely implemented?
Dr. Lim: Embedding a screening tool into electronic health record systems allows for seamless integration into clinical workflows. It is important to coach medical staff in the use of this tool and the importance of SDoH. Institutional leadership and financing mechanisms are also key to long-term sustainability. Reimbursement models and partnerships with community-based organizations can support the implementation of SDoH screening.
BHM: What are the best strategies for healthcare providers to interact patients in discussions about social determinants of health?
Dr. Lim: Healthcare providers must construct trust through committed listening, a non-judgmental approach, and consistent problem-solving.
Cultural competence is critical, and healthcare providers should respect the cultural, social, and personal contexts that shape patient experiences. Using inclusive language and open-ended questions helps create a friendly atmosphere.
Healthcare providers must also be equipped with tools to enable patients to access community resources and social services.
BHM: What long-term impacts do you anticipate incorporating SDoH screening into routine care, particularly for marginalized communities?
Dr. Lim: Addressing SDoH early can prevent exacerbations of chronic diseases, reduce hospitalizations, and improve quality of life.
Incorporating SDoH screening also can strengthen trust between patients and providers and make health care more proactive and preventive.
Over time, this might transform the way health care is delivered by shifting resources toward higher-level solutions that keep patients healthy.
Focusing on social determinants of health in lupus treatment shouldn’t be nearly checking boxes. It’s about understanding the challenges patients face in real life. Dr. Lim and his team’s research is a call to motion for healthcare providers to dig deeper and construct authentic connections with patients. By acknowledging these social aspects, we are able to create a more compassionate and equitable health care system that actually recognizes and supports every body.
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