The Northwest AHEC Practice Support Team supports social, physical, and economic environments which promote attaining the full potential of health and well-being for all. This blog segment highlights impactful publications which promote improved health outcomes through Social Determinants of Health (SDOH) each month.

Our featured report this month discusses focusing on (SDOH) from the “groundwater” approach and lays out the metaphor of how health disparities have been addressed. 

The authors suggest that the focus has been primarily on “fixing the fish” as opposed to asking is there something wrong with the “groundwater” that has caused the fish to be injured. One of the primary takeaways is that racism and discriminatory practices, “the groundwater”, is the catalyst for persistent disproportionate health burdens and outcomes across race and ethnicity over time. And the way to reverse the effects is to focus on the groundwater as opposed to just trying to fix one issue or one group of people, “the injured fish”.

Finally, the article states the entity or entities that have the capacity and influence to be a major part of the groundwater solution are hospitals and academic medical centers. While at first this suggestion seems simple, the authors are careful to examine how powerful these institutions are in a community and the ways in which they play a critical role in addressing structural issues. The article also discusses the ways in which they say hospitals are “anchor institutions” that are well positioned to incorporate a groundwater approach beyond “fixing the fish” to target the underlying system shaping the health communities they serve.

Role of hospitals in addressing social determinants of health: A groundwater approach.  Dave G, Wolfe MK, Corbie-Smith G. (2021). Preventive Medicine Reports. 2021 Jan 8;21:101315. doi:10.1016/j.pmedr.2021.101315.eCollection 2021 Mar. PMID: 33505842