Social determinants of health has been defined by the World Health Organization as the conditions in which people are born, grow, live, work, and age. These determinants can include factors such as housing, transportation, education, employment, and access to care. Social Determinants of Health: A Primer for the Practicing Surgeon provides a comprehensive, state-of-the art, definitive reference for the surgical community on this important topic, serving as an invaluable resource for surgeons, physicians, fellows, and residents.


Cover image
Title page
Table of Contents
Copyright
List of Contributors
Foreword
Preface
Chapter 1. Social Determinants of Health in Surgery Overview
Introduction
Access to Care
Poverty and Insurance
Food and Housing Insecurity
Systemic Racism and Allostatic Load
Education
Representation in Medicine
Section I. Theoretical Frameworks for Social Determinants of Health
Chapter 2. Internalizing Social Determinants of Health: The Ecosocial and Weathering Theories
An Introduction to Social Epidemiology
Ecosocial Theory
Discrimination: An Embodiment Pathway
Incorporating the Ecosocial Theory into Surgical Research
Weathering Hypothesis
Mechanisms Behind the Weathering Hypothesis
Application of the Weathering Hypothesis
Weathering in Surgical Research
Chapter 3. Allostatic Load Measurement Issues in Cancer Patients and Other Populations
Introduction
Allostatic Load Theory and Conceptual Development
Allostatic Load in Cancer Populations
Measurement Issues in Allostatic Load
Case Example: Transdisciplinary Collaborative Center in Precision Medicine and Minority Men's Health
Conclusions and Future Directions
Chapter 4. The Conserved Transcriptional Response to Adversity: Prepared for Social Determinants of Health in Surgery
Introduction
Discovery of the Conserved Transcriptional Response to Adversity
Health Implications
Social Determinants of Health
Interventions
Measurement
Prospects
Section II. Social Determinants of Health in Surgery
Chapter 5. Finances as a Social Determinant of Health in Surgery
Introduction
A Brief Overview of Health Economics and the Complexity of Cost
The Patient Impact: Financial Toxicity
Long-Term Financial Impacts: Employment Disruption and Bankruptcy
What is High-Value Surgical Care and Why Does it Matter?
Building High-Value Surgery
The Future of Value-Based Surgical Care
Conclusions
Chapter 6. Neighborhood as a Social Determinant of Health in Surgery
Introduction
Commonly Used Measures of Neighborhoods
Neighborhood Designations Specific to Healthcare
Common Indexes to Measures Neighborhoods
How Might Neighborhoods Influence Surgical Outcomes?
Neighborhoods and Surgical Outcomes
Developing Areas of Neighborhoods and Surgical Outcomes
Chapter 7. Addressing the Social Determinants of Health to Enhance Clinical Trial Participation
Introduction
Current Data and Literature on Clinical Trial Participation
Barriers to Participation in Clinical Trials Underlying the Social Determinants of Health
Pathways and Mechanisms Through the Social Determinants of Health for Augmenting Recruitment and Retention in Clinical Trial Participation
Conclusion
Chapter 8. Race, Ancestry, and Social Determinants of Health in Surgery
Overview
Disparities in Surgical Management of Cancer Related to Race and SDOH
Germline Genetic Aspects of Race Related to Ancestry, SDOH, and Breast Cancer Burden
Conclusions
Chapter 9. Community Engagement as a Social Determinant of Health in Surgery
Identification of Social Determinants of Health
Government Response to Addressing Social Determinants of Health
Importance of Healthcare Provider Screening of Social Determinants of Health
Role of the Surgical Healthcare Provider in Community Engagement
Improving Representation in Clinical Trials
Role of Patient Advocacy in Community Engagement
Future Directions
Chapter 10. Insurance as a Social Determinant of Health in Surgery
Social Determinants of Health and Insurance Status
Insurance Basics and Recent Policy Advances
Discussion
Chapter 11. Health Literacy
What is Health Literacy?
Health Literacy as a Social Determinant of Health
Prevalence of Health Literacy
Health Literacy and the Practice of Surgery
Health Literacy Instruments
Limited Health Literacy Cost
Potential Challenges and Strategies to Address Health Literacy
Conclusions and Future Directions
Chapter 12. Psychological Stress and the Surgical Stressor
Introduction
Stressors and Stress Responses
Illness as a Stressor
Hospitalization and the Surgery Stressor
Preoperative Responses in Association with Outcomes
Stress Reduction to Reduce Anticipatory Stress and Improve Surgical Outcomes
Section III. Research
Chapter 13. Framing Theoretically Informed Social Determinants of Health Research Questions
Background
Theoretical Frameworks
Research on Social Determinants of Health
A Step-by-Step Guide on Framing Theoretically Informed Research Questions on SDH
Conclusion
Chapter 14. Social Determinants of Health: Study Designs and Outcomes
Introduction
Identifying the Research Question
Select the Study Population
Study Design
Select the Outcomes
Interpretation and Dissemination
Conclusion
Chapter 15. Interventions for Redressing Disparities Related to Social Determinants of Health in Surgery
Background
Data Collection
Patient Interventions
Provider Interventions
Systemic Interventions
Frameworks for Implementation of Equity-Focused Interventions
Next Steps
Chapter 16. Future Directions
Glossary of key terms
Index