Beyond the Medical Model: Social Determinants of Health


Social Determinants of Health

Dr. Bob Weissinger DO, ARMO


What if I told you that most of health has nothing to do with doctors, hospitals, clinics or prescriptions.

Would it surprise you that 80 percent of our health status comes from outside the healthcare system? Things like nutritious food, housing, transportation, safe neighborhoods, supportive family and friends.

Think about it: How is good health possible if we lack any of these? Without wholesome food, someone will be far likelier to suffer from obesity and chronic conditions like diabetes. They also are likely to be inactive, opening the door to other chronic conditions like high blood pressure and heart disease.

If you lack transportation, you will have no way to get to the grocery store.  You may miss medical appointments, so important health issues will go unaddressed. You will likely be homebound or very limited in your social interactions. The isolation will take a toll on your mental and physical health. It is estimated that the effect of loneliness is equivalent to smoking two packs of cigarettes a day.

Or consider how physical health is affected by one’s mental and emotional state. A patient who suffers depression or anxiety may neglect their physical needs. A depressed person often has a poor diet, overeating or binging on junk food. Often they don’t get enough sleep, which causes further deterioration in health.

"Whole person" Health Care

CareMore was founded on a “whole person” model of health care. That means our doctors and nurses look beyond physical symptoms. We try to find the underlying causes of disease, which often are outside our bodily systems and beyond the scope of physical medicine. Often those causes are poor nutrition, unsanitary housing, and the other factors described above.

Example: The patient came in with multiple symptoms: Type 2 diabetes, high blood pressure, overweight. He was 76 years old. When I asked about his last meal, he confided that he doesn’t cook and since his wife died, he lived on junk food from the Dollar General store.

This patient has immediate physical symptoms we need to treat, like his diabetes and blood pressure. We accomplish this with the standard medical exam and prescription drugs. But we also suggest changes in lifestyle – eating better, getting exercise, making social connections to relieve depression and isolation. For improving health and extending life, these are as important as the medical interventions.

Part of the challenge is that doctors are trained almost entirely on the medical model. We look for physical symptoms and are trained to treat the physical causes of disease. Traditional medicine is oriented toward the “medical model” and we overlook the factors (80 percent!)  that affect overall health.

Another challenge is financial: Doctors (and everyone in the healthcare system) typically are paid for services performed. There is a complex list of “billing codes” that cover every medical condition and procedure. Since these codes are all medical in nature, there is little incentive for doctors to consider the patient’s non-medical needs.

CareMore's Approach

CareMore’s whole-person approach recognizes that health depends on many factors beyond medical. In some markets, like Iowa, we are paid a fixed amount to keep our patients healthy rather than performing procedures. So we have a strong incentive to know our patients and learn about all the issues affecting their health. I’ve made many house calls where I learn about the patient’s environment and can help make it more safe and healthy.

This approach to keeping patients healthy is called “value-based care."