Incorporating the Social and Structural Determinants of Health Into Clinical Practice: Addressing Health Equity in...

Seeking heath equity means striving to give everyone a fair opportunity to be as healthy as possible by working to eliminate health disparities and determinants that adversely affect certain groups. An alternative framework is to define health equity by quality of outcomes. Numerous family medicine organizations have argued that health equity is central to the practice of medicine, adding convenience, cultural humility, structural competency, community engagement, and collaboration to the core tenets of primary care. Many family medicine educators have embraced a focus on health equity within practices as foundational to training future physicians. Aspects of the health care system that perpetuate inequity include fee-for-service payment models (which create untenable expenses for patients and pressure on clinicians to increase volume) and capitation models (which can lead to the underprovision of care for patients). Practicing care that is trauma- and violence-informed, culturally safe, and contextually tailored predicts better outcomes for patients and can help reduce moral injury for the clinician. Family physicians are uniquely positioned to work with patients, communities, and partners to create a more equitable health care system.