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Place as a social determinant of health

This week I traveled to Los Angeles to participate in the Putting Care at the Center conference held by the National Center for Complex Health and Social Needs. Here I found 500 compassionate speakers and attendees each deeply concerned about people in our society that suffer from multiple issues simultaneously, such as poverty, poor health care, homelessness, joblessness, mental illness, and other maladies. Sadly, it is frequent that misery manifests itself in a spectrum of ways. A common theme running through the conference was that the traditional biomedical ways of treating patients can be inadequate. For example, is sending someone home with a wheelchair going to work if their sidewalk is so cracked and uneven that they cannot  leave their home? Clearly, the problem is multi-pronged and without distinct edges, which makes it tempting to collapse into a sense of overwhelming helplessness. One story really struck me– people are now not dying from AIDS because of the availability of drugs that combat this illness– but they are dying from hopelessness that leads them to cease taking their medications from other social problems they are experiencing. What can we do in the face of such hurdles?

It was clear to these conference participants, who you could justifiably call the leaders of the emerging field of Complex Care, that physical place and housing are a vital part of the answer as a social determinant of health*. As the breadth of thinking required to effectively help people with complex needs begins to gel, the need for empirical research on effective supportive housing and other physical places people inhabit will surely increase as well– as will practical ways we can design that puts these empirical ideas into action.

The complexities of poverty, disinvestment in public places, crime, race, healthcare inequity, and violence are not going away. However, one panelist at the conference quoted the Outward Bound program which said, “If you can’t get out of it, than get more into it”.  I would say that pretty much sums up the need to understand and make clear the contribution place can make to people who are faced with significant life stressors.

*A Public Health Framework for Reducing Human Inequities. By the Bay Area Regional Health Inequities Initiative, http://barhii.org/

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