AAMC’s Center for Health Justice responds to NCCIH request for information on determinants of health

On June 17, the AAMC Center for Health Justice (CHJ) responded to a information request (RFI) from the National Center for Complementary and Integrative Health (NCCIH) on defining a set of key determinants that deal with the “health of the whole person”, defined as factors that can influence health positively or negatively and which encompass the full continuum of biological, behavioral, social and environmental factors. These key determinants could then be used in research or patient care. While the RFI only requested the submission of determinants, the CHJ also submitted a letterproviding NCCIH with additional context for its response as well as recommendations on how comments to the RFI might be considered by NCCIH.

To inform the list of determinants submitted to the NCCHI, the CHJ invited its network of community partners, the AAMC Collaborating for Health Equity: Acting, Researching, Generating Evidence (CHARGE), as well as all AAMC employees to complete a short questionnaire on the social factors and determinants they believe have the greatest impact on health, including determinants that are overlooked or under-addressed in research or policy-making. There were several notable findings from the questionnaire:

Factors that influence the social determinants of health

60% of 67 respondents identified neighborhood and public safety as a key determinant. Education, economic stability and food security were cited as other key determinants (57%, 37% and 37% of respondents, respectively).

Commonly cited determinants that have a significant impact on health or disease progression

81% of respondents selected economic stability as a determinant having a significant impact on health, while 75% selected racism and discrimination and 69% selected neighborhood and environment.

Other determinants overlooked or under-researched in research or policy-making

Many respondents who provided determinants said that mental health (46%), social isolation (27%), police and incarceration (27%) and climate change (22%) were overlooked determinants or contracted out in research or policy development.

In its closing remarks, the CHJ highlighted the apparent variation in how respondents interpreted the meanings associated with certain factors and determinants and how these definitional challenges could produce new inequalities or exacerbate existing ones. The CHJ also recommended strong interagency coordination to ensure a “whole-of-government approach,” extending this initiative beyond NIH-NCCIH to other agencies doing this work, such as the Office of Management and Budget’s current efforts to revise his Standards for Maintaining, Collecting, and Reporting Federal Race and Ethnicity Data (refer to Washington Highlights, October 28, 2016). Ultimately, CHJ encouraged the use of community engagement as the foundation for the development of the NCCIH Search Strategy and Common Data Elements Measurement Tool to ensure it is easily accessible. , used and understood by all.

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