Addressing the Social Determinants of Health Within the Patient-Centered Medical Home

Lessons From Pediatrics

Socioeconomic disparities in health continue to exist, despite advances in medicine.1 Since the classic Whitehall studies, it has been well known that the social context in which an individual lives and works influences health.2- 3 Mitigating the harmful consequences of social factors that contribute to health disparities has largely been left to the public health and policy communities, whereas clinical medicine has traditionally focused on identifying and reducing biological risk factors for an individual patient. The patient-centered medical home (PCMH), however, offers an important opportunity to promote population health through systematically addressing the social determinants of health.

Pediatrics first developed the concept of the medical home4 and continues to evolve clinical practice aimed at addressing social determinants because of children's exquisite vulnerability to the deleterious effects of the social and physical environment, especially the aggregation of social factors associated with poverty. Many programs that affect social risk have been demonstrated to be effective in pediatric practice; PCMHs under the accountable care organization model can accelerate the delivery of such innovative services that include new financial models designed to provide incentives for the adaptation to adult populations. Adaptation of such programs within the PCMH can be implemented in a variety of ways that will provide important data about what types of services best improve population health.

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