I grew up in the Coachella Valley. Things were not always easy for me and my family, but I could also see that we didn’t have it as bad as those around us.
At the time, I did not understand the inequity that I was seeing among the different populations and how these injustices could affect our daily lives. I was introduced to the social determinants of health while studying at the University of California, San Diego. I realized that many in the Coachella Valley, especially in the eastern part, were greatly impacted by socioeconomic factors, by their health behaviors and by the environment in which they lived.
The notion that a person’s health is only impacted by the clinical care they receive is not a reasonable one. Currently, as a first-year medical student, I have had the privilege to learn from a variety of professionals that have once again reminded me why I am on this path and why I want to serve underserved populations.
Throughout the year, we have received various presentations about the inequity that is seen between different populations — injustices that I have also come across at the free clinics which are staffed by medical students like myself. At the clinics, I have had firsthand experience with patients whose health is affected by their race, socioeconomic status (SES) and the area they live in. As Dr. Nduati (University of California, Riverside (UCR) School of Medicine) pointed out in a lecture, “Social factors that drive health outcomes (SES, income, education) are not distributed equally throughout the population.”
The lack of support and increase in stress that exacerbates medical conditions in low-income populations is further supported by research by Cheney et al. This study shows that there are many unincorporated communities in the eastern Coachella Valley whose residents suffer from lack of care, stressful lives, low-income status and low-education status. Although Coachella Valley is only one example, there are many areas throughout California that lack basic health services. This can be inferred from the ratio of physicians to people living in these specific areas. Dr. Nduati’s lecture showed a population map in which we see that counties like Riverside, San Bernardino, and Imperial have fewer than 60 generalist physicians per 100,000 population. In comparison counties like San Diego, Orange, and Santa Barbara have more than 80 generalist physicians per 100,000 population. This map visually reflects the inequities in the number of physicians that are expected to provide care in underserved areas in California.
Under the supervision of Dr. Cheney, Dr. Zamora, and Dr. Debay, I have had the opportunity to go out into one of these communities and interact with patients, many of whom rely on us for their medical needs. Being able to get to know the individual and what they are going through really manifests the concepts that we have learned in the classroom. Moreover, these individuals have taught me how to be a better doctor in the future.
They have proven to me that listening and getting to know them as patients allows for a mutual feeling of trust, care and empathy. I saw this firsthand when a patient opened up to me and told me about her situation in her home — only after I had shared with her a little about me. I empathized with her, and she saw that I genuinely cared about her situation. Building these relationships and being able to relate to patients on a personal level allows me to help provide for their individual needs.
Having cultural humility and competency is a small part of addressing the social determinants of health, but as stated in the article Case Studies in Social Medicine — Attending to Structural Forces in Clinical Practice, to focus on this without addressing “the occupational and environmental hazards, access to health care, the affordability of medications … is to overestimate the role of individual choices in producing health and disease and treatment outcomes.” We must also view the person as a whole and how everything around them affects their health. We can not just assume that a person’s health is only related to the choices they make; instead, we have to look at the whole picture. This includes their occupation, the area they live in and the resources they have available to them.
These communities in Coachella Valley are merely an hour and a half from campus, yet they lack so much. The importance of closing the gap of inequity between communities is crucial, not only to see better health outcomes in the current population of adults but also to have even better outcomes for the future. This is something that is of great importance to me as a future pediatrician.
This year, I have also had the opportunity to work with pediatric patients at my LACE (longitudinal ambulatory care experience) site. LACE is a unique program that the UCR School of Medicine provides. At the beginning of our first year, we are matched with a physician; throughout our time at UCR, we attend clinic bimonthly. Here we get the experience of working with patients as well as the medical staff. Through this work, I have also been able to interact with both children and adolescents.
One patient that comes to mind is a baby that was brought in by his foster mom. Although he was young, I could tell that he had already been through a lot. He had yet to reach the developmental milestones that children his age normally meet; according to my preceptor, this is very common as a result of any trauma endure.
I frame this experience with a lesson from Dr. Scott Allen (UCR School of Medicine) who spoke to us about the traumatic living situations of the families in the detention centers. He emphasized the lack of pediatric care in these centers. Some of the documented injuries included: unrecognized severe dehydration, finger injuries from the prison doors and confinement of children. Physicians who studied the facilities expressed their concern for adverse health impacts on the children in the years to come. Unfortunately, these children are seeing and experiencing things that no child should have to go through, and it is shaping the person that they become in the future. The impact of social factors on adolescent health and the way it shapes us as adults is emphasized by Viner et al: “The strongest determinants of adolescent health are structural factors such as national wealth, income inequality, and access to education. Safe and supportive families, supportive schools … are crucial to help the young develop to their full potential.”
Being part of the new generation of physicians, it is important for us to learn about everything that affects our future patients. I am thankful to UCR for providing us with these public health courses that shine a light on this often-underexposed topic.
Ultimately, the social determinants of health, health disparities and childhood experiences shape us into the individuals we become as adults. Given that we do not get to choose the family or situation we are born into, it is an unfortunate reality that not everyone receives the treatment they deserve as human beings. In order to have better outcomes, the inequity seen between different populations must change; these changes will help nurture the future of tomorrow. Working with underserved populations will allow me to help bridge the gap that I routinely see.