Brooke Pantano, SPT ’23
This past month, a University of Pittsburgh study was published in the American Journal of Preventive Medicine that highlights the outcomes of Medicaid expansion implemented as part of the Affordable Care Act (ACA). The study found that over a 3 year period, expansions have led to increased detection of early stage cancer diagnoses and decreased late-stage cancer incidence, highlighting the importance of health care expansion for cancer detection and preventative services. In some states (PA being one of them), these expansions allow individuals to qualify for Medicaid services based on their income alone, allowing single adults like myself to now qualify for free or low cost health insurance. Previously, Medicaid eligibility was also determined by household size, disability, and other factors that left many people out of the picture.
Studies such as this repeatedly display the value that access to universal health care would bring to the entire population. But while advocating for the expansion of health care services is critical, it is only the tip of the iceberg when it comes to addressing public health. Factors in addition to health care, known collectively as the Social Determinants of Health (SDoH), address how the conditions that people live in impact health, functioning, and quality of life. Healthy People 2030, an initiative within the Department of Health and Human Services, groups the SDoH into the following categories – economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Categories like neighborhood and built environment focus on elements like air and water quality, rate of violent crimes, and building accessibility. Factors such as discrimination (in the context of race, gender identity, sexual orientation, disability, etc.), incarceration, and access to nutritious foods are addressed within social and community context.
When other aspects of patients’ lives are not met, whether that be food insecurity, lack of stable transportation, or literacy skills, our care is often not their first priority nor is it fully accessible. Failing to recognize the SDoH that may be impacting our patients can often lead to what we interpret as noncompliance, when in reality, it may be other external factors preventing adequate care. In physical therapy, we often emphasize the importance of movement and exercise when it comes to general morbidity and all-cause mortality. However, SDoH often prevent individuals from participating and reaping the benefits of movement and exercise, which in turn can actually contribute more to morbidity and mortality.
As PTs, our roles aren’t limited to just addressing musculoskeletal, neuromuscular, and cardiopulmonary deficits in patients. As healthcare providers, we have the voices, power, and responsibility to advocate for the overall health of our patients and communities. So how do we do it? We educate ourselves. We vote for legislation at the local, state, and federal level that supports our patients interests. We get familiar with and/or participate in pro-bono services and community health initiatives. We grow our lobbying power by increasing membership and participation in the American Physical Therapy Association (APTA). Through these efforts, we have the ability to change the trajectory of our profession and provide high-quality, accessible care to all of our patients.
Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [date graphic was accessed], from https://health.gov/healthypeople/objectives-and-data/social-determinants-health
Lauren Lin, Aparna Soni, Lindsay M. Sabik, Coleman Drake, Early- and Late-Stage Cancer Diagnosis Under 3 Years of Medicaid Expansion, American Journal of Preventive Medicine,
Volume 60, Issue 1, 2021, Pages 104-109, ISSN 0749-3797, https://doi.org/10.1016/j.amepre.2020.06.020.