RISE looks at recent news regarding social determinants of health (SDoH), including the different impacts the global pandemic presents to children and adults.

A lack of commitment to children amid COVID-19 poses concerning risks

The rate of serious illness due to COVID-19 has remained low among children, but the pandemic has left them vulnerable nonetheless, particularly those who live in poverty. Schools in all states have closed in order to prevent virus spread, and it’s stripped the educational, nutritional, and social supports many children rely on every day, according to a viewpoint article published by JAMA Pediatrics. 

Although many school districts are engaging in distance learning, many students lack the necessary digital technology and internet access to participate. In some urban areas, as many as one-third of students are unable to participate in online classes, note authors Danielle G. Dooley, M.D., Asad Bandealy, M.D., both of the Child Health Advocacy Institute at Children’s National Hospital, and Megan Tschudy, M.D., department of pediatrics, Johns Hopkins School of Medicine. The loss of educational time will directly impact students’ reading level, grade retention, graduation rates, and high school dropout rates.

The lack of school resources is a significant concern as well, they wrote. More than 30 million children rely on school nutrition programs, and the emergency food assistance programs are only able to reach a fraction of the children the schools would be able to feed if they were open. Schools also provide access to caring adults, health centers, nursing services, and mental health programs for children who may not have access to such services elsewhere.

Legislation passed amid the pandemic has alleviated impacts, but there has yet to be a bill to directly target child health and well-being. The authors write that if the needs of children continue to be neglected, they will face consequences that can last a lifetime.

Patients forced to postpone care amid COVID-19, face negative impacts to mental health

Nearly half of adults have said they or someone in their household have postponed medical care due to the coronavirus outbreak, according to the recent KFF Health Tracking Poll. Eleven percent of those adults say their condition or their family member’s condition worsened because of postponing care. Of the 48 percent who say they or a family member have postponed care due to coronavirus, almost all say they will eventually seek the care that has been postponed, with 68 percent who expect to receive the care within the next three months.

The majority of people across age groups say their physical health has remained the same since the pandemic, but four in 10 say the worry and stress from coronavirus has had a negative impact on their mental health, with women (46 percent) and those who live in urban (46 percent) and suburban (38 percent) areas with the highest percentages. Among those living in households that have experienced income or job loss since the pandemic, 46 percent say the pandemic has had a negative impact on their mental health.

Pandemic has worsened existing food insecurities in adults

Food insecurity among adults has been a key SDoH even before the COVID-19 outbreak. Prior to the pandemic, one in seven adults between the ages of 50 and 80 struggled with access to enough food due to cost or other issues, and the percentage was even higher among those in pre-Medicare years and those who are African American or Latino, according to Michigan Medicine, citing results from the National Poll on Healthy Aging, which was conducted by the University of Michigan Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine. It’s likely the COVID-19 pandemic has worsened food insecurity among adults due to the disruption to food supply chains, employment, and social services.

The data from the poll suggests an opportunity to connect older adults with resources they may be unaware of that could improve their access to healthy meals. Federal programs such as Meals on Wheels and other community food services are increasing home delivery of meals. New programs at the federal and state levels have also been created to help improve food insecurity in older adults.

Health literacy plays important role in heart failure management

A recent analysis published by JACC: Heart Failure indicates an inadequate level of health literacy is associated with poor outcomes amid patients living with heart failure, Researchers examined 15 studies to determine whether patient knowledge of heart failure management, which requires the coordination of several outcomes-related measurements including weight, blood pressure, glycemic index, medication and diet adherence, and exercise and weight loss on occasion, affects their health outcomes.

The data showed a high prevalence of inadequate health literacy, with only two of the studies showing an increase in health literacy among patients who were originally considered to have inadequate health literacy levels.

Researchers suggest the lack of health literacy could be due to SDoH, as patients without adequate understanding of their illness face additional barriers to care such as not seeking the appropriate health care services needed, they don’t know how to discuss their condition with their physician, or the educational materials provided exceed their reading ability.

“Identifying health literacy as a factor that affects health outcomes and measuring its effect on patients with heart failure is essential to allocate more resources for, and research on, interventions to improve health literacy," said study author Lila J. Finney Rutten, Ph.D., professor of health services research in the Department of Health Sciences at Mayo Clinic in Rochester, Minn., in an announcement.

Health literacy, food insecurity, and other key SDoH will be hot topics at RISE’s National Summit on Social Determinants of Health, which will be held virtually on June 9-11. The first full day of the virtual conference, Wednesday June 10, will feature a spotlight on one health plan’s SDoH progress and its program advancements in literacy, food security programming, and more.