Ellen Fink-Samnick, chair of RISE's SDoH Community, reflects on the state of the industry in the wake of the Supreme Court's decision to overturn Roe v. Wade.
In preparing to write this quarter’s newsletter column for RISE’s SDoH community, I pondered the state of social determinants of health. I was excited to share a review of the latest industry news, studies, and reports on health equity, including:
- The CDC report on lack of availability to COVID treatment in the areas of highest need
- Increased data validating the impact of, redlining on health outcomes, and especially across chronic illness
- Ten million dollars in HHS grant funding for rural health communities to manage the surging fentanyl and opioid overdoses
- From PCORI, $63 million to reduce maternal health inequities and $50 million for research on management of multiple chronic conditions, which also heavily impact those dealing with SDoH
- Advocacy of the Gravity Project in advancing further ICD-10-CM Z codes; the FY23 ICD-10-CM release in October will see codes for transportation insecurity, financial insecurity, material hardship, as well as treatment plan non-adherence, and financial hardship
Yet, as I started to craft this column on Friday, a breaking news notification ran along the top of my computer screen. I saw it was about the SCOTUS decision in the Dobbs v. Jackson case and clicked to read more; Roe v. Wade had been overturned and my heart sank. There would be mass impact of this decision across systems and sectors. The media news blitz was immediate.
My primary concern was for our most vulnerable and marginalized populations. They already suffer rampant access to care obstacles. Women of color are less likely to have early access to maternal health care, contraceptive care, and other reproductive health services, which puts them at a higher risk for poor maternal health outcomes. The Turnaway Study released earlier this year revealed grim realities for women denied an abortion: they are four times as likely to end up living in poverty, stay with abusive partners, suffer from poor physical and mental health, and have decreased aspirations.
Many of you may know that I’m a data fiend, so I’ll let the facts do the talking. Moving forward, we can expect:
- Increased inaccessibility of reproductive services for women and families across states.
- Less options for providers and women suffering from ectopic pregnancy, pregnancy loss, or other complications, particularly in states with the most restrictive abortion policies
- Increased anxiety, fear, and hesitancy for individuals to seek or provide care in states where abortion is illegal, 16 states at the time of this writing and expected to rise
- Thousands of unplanned births and the potential for increased maternal morbidity and mortality
- Increased mental health challenges for persons dealing with unwanted pregnancies
- Higher rates of suicidal ideation, gestures, and action for victims of rape, sexual assault, or interpersonal violence who carry a pregnancy to full-term
- Forty-five percent of pregnancies are unplanned but for teenagers that rate increases to 75 percent
- There will be a ripple effect to college-aged students; many will be forced to raise children on college campuses or give up hopes of earning a degree
I am full of many emotions. Yet, at the same time, I find comfort in knowing that our community members will do what they do best, define strategies that mitigate the gaps in care. There will be legislative advocacy and appeals, grant funding, and community partnerships. Organizations, associations, and credentialing entities are publishing their opposing position statements. Safeguards are being put in place to protect all populations across the diversity, equity, inclusion, and cultural landscape, including the LGTBQIA community, persons with disabilities, immigrants, and all disenfranchised groups. New programs to leverage public health will evolve, as will other imperatives to build health and mental health equity.
This is not our first fight, #SDoHWarrior, nor will it be our last; we shall get through this latest assault on public health together.
About the author
Ellen Fink-Samnick, chair of RISE's SDoH Community, is an award-winning industry entrepreneur who empowers health care's interprofessional workforce. She is a subject matter expert on health equity, ethics, professional case management practice, interprofessional teams, and trauma-informed leadership. Her latest books include, The Essential Guide to Interprofessional Ethics for Healthcare Case Management, The Social Determinants of Health: Case Management's Next Frontier, End of Life Care for Case Management, and upcoming Social Determinants of Mental Health: Advancing Wholistic Practice Excellence.
Fink-Samnick is a licensed clinical social worker, board-certified case manager, certified clinical trauma professional, and certified rehabilitation provider. Her academic appointments include the University of Buffalo School of Social Work, and George Mason University’s Departments of Social Work and Global Community Health. She is a clinical supervision trainer and instructor for the National Association of Social Workers of Virginia, moderator of Ellen’s Ethical LensTM on LinkedIn and author of the blog, Ellen’s Interprofessional Insights. She is a consultant for the Case Management Institute, moderator of their Case Managers Community, and a doctor of behavioral health candidate at Cummings Graduate Institute of Behavioral Health Studies.
She has served as a commissioner of the Commission for Case Manager Certification and chair of their Ethics and Professional Conduct Committee, as well as a past member of the Board of Directors for the Case Management Society of America. currently serves on the Gravity Project’s Intervention Council and Coalition for Social Work and Health. Fink-Samnick is vice-chair of the American Association of Doctors in Behavioral Health, and chair of their Regulations Committee. She is also an editorial board member for the Professional Case Management Journal, and Case Management Monthly.