RISE looks at recent headlines concerning social determinants of health (SDoH).
Maternal mortality rates on rise across the world, UN data finds
Progress made in maternal mortality in recent years is on the decline in most parts of the world, according to a new report published by the World Health Organization (WHO).
The report, which examined maternal mortality rates at a global, regional, and country level between 2000 and 2020, estimates there were 287,000 maternal deaths around the world in 2020, a slight decrease from the 309,000 maternal deaths in 2016. According to the research team, the rate of maternal deaths per live births in 2020 equates to a woman dying from pregnancy or childbirth related issues every two minutes. Most of those deaths are preventable or treatable. If the current trends continue, researchers estimate more than one million more maternal deaths worldwide by 2030.
Though maternal mortality rates improved globally between 2000 and 2015, dropping an average of 2.7 percent each year, progress has stalled or even declined in recent years. Maternal deaths increased from 2016 to 2020 by 17 percent in Europe and Northern America and by 15 percent in Latin America and the Caribbean.
“Everybody, regardless of income, education, race and ethnicity, deserves access to safe, quality and respectful birthing conditions,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus in the report. “This report is not only a call for world leaders to take action to end maternal deaths, but also to invest in the health of women and children so that they go beyond surviving to thriving.”
ONC releases SDoH data collection toolkit
The Office of the National Coordinator for Health Information Technology (ONC) has released a Social Determinants of Health Information Exchange Toolkit in an effort to help communities working to advance health equity by leveraging SDoH data sharing.
The toolkit consists of 11 foundational elements to facilitate the data sharing across communities and stakeholders:
- Community readiness and stewardship: Assess the community’s ability and willingness to participate in data exchange based on its current needs, assets, initiatives, opportunities, and challenges. Participation requires shared contributions related to co-design, evaluation, and decision-making.
- Mission and purpose: Initiatives should incorporate the value propositions of stakeholder groups, including the vision, scope of services, and expected benefits.
- Values and principles: Participation standards should include ethical decision-making to further health equity.
- Policy: Consider federal, state, and local policy to advance SDoH data exchange capabilities, as well as collaboration with other relevant efforts in the community, region, or state.
- Legal: Data exchange should follow a framework of processes, operations, and rights and obligations that encourage compliance with federal, state, local, and tribal laws.
- Measurement and evaluation: Monitor all performance metrics, outcomes, program effectiveness, and quality management.
- Financing: Fund opportunities for investments, ongoing costs, and incentives for community participation.
- Implementation services: Inclusive of technical services (e.g., defining requirements, standards specifications, and integration with existing infrastructure and services) and programmatic services (e.g., defining use cases, workflow design/redesign), as well as support for adoption and utilization by individuals and the community.
- Technical infrastructure and data standards: Alignment of hardware, software, data, processes, and standards to support scalable and interoperable data and IT systems.
- User support and learning network: The network should include an assessment of community challenges and needs, education, communication, training, technical assistance, peer-to-peer learning, and identification of practices and lessons learned.
- Governance: Follow decision-making processes and groups for institutional, administrative, and data governance.
"The nature of this work continues to grow and evolve, and challenges and opportunities experienced in the process will vary by community and context,” wrote ONC authors. “Implementers of SDOH information exchange initiatives can use the Toolkit as they think through these challenges and opportunities. Community-led SDOH information exchange initiatives, based in standards to facilitate interoperability, can play an important role in addressing health equity and improving health outcomes.”
Study: SDoH a root cause of breast cancer racial disparities
Black women with breast cancer experience the greatest racial disparity in survival outcomes, and, according to a recent study conducted by researchers at the University of Illinois Chicago, SDoH play a critical role in those disparities. For the study, researchers analyzed the data of 60,137 women ages 18 or older who had a breast tumor diagnosed between 2004 and 2015. Based on their findings, SDoH are as equally as impactful on breast cancer disparities as tumor biology.
They found SDoH, particularly neighborhood disadvantage and insurance status, contributed to 19 percent of the mortality disparity. Tumor biology characteristics contributed to 20 percent of the mortality disparity.
“Adverse social determinants of health are well-known root causes of the racial disparity in breast cancer survival. This study added to our understanding of this public health problem by demonstrating conclusively that disproportionately aggressive tumor biology in Black women not only contributes to disparate outcomes but appears to be as important as social disadvantage,” said lead author Kent Hoskins, M.D., the Eileen Lindsay Heidrick Professor of Oncology in the College of Medicine and associate director of translational research in the University of Illinois Cancer Center at UIC, in a statement. “The study also suggested that social factors may actually be driving some of the racial difference in tumor biology.”