Social determinants: Why are they so difficult to address?

“He who knows only his own side of the case knows little of that.”
John Stuart Mill, On Liberty. 1869

By Greg Gruener

At a lecture I recently attended with our students, the guest speaker’s topic was on health disparities and the data presented was, as most of us in the healthcare field know, pretty conclusive.  I have to admit that I knew and had seen this same information in prior lectures, articles, and had gone over it in small group discussions.  I also knew that health disparities existed because of various social determinants.  While the subsequent discussion moved along, I was left at the reflective starting line since I finally grasped the fact that being caused by social determinants, health disparities could only be completely addressed by changing those same determinants.  This is not news for most people in healthcare as their organizations and schools, unlike business, law, etc., have been charged (and are accredited) with addressing those determinants.  So, despite being immersed in the data, why had it taken me so long to have this aha moment?  Here is my explanation for a cognitive lapse, as informed by Donald Rumsfeld…

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