The following content is created in partnership with Stanford Medicine Children's Health. It does not reflect the work or opinions of the NBC Bay Area editorial staff. Click here to learn more about the pediatric cardiology services at Stanford Medicine Children's Health.
For centuries, an individual’s health has been examined based on present symptoms and overall physical well-being. However, the social determinants of health have been historically overlooked within the clinic setting. As health becomes increasingly understood as a holistic endeavor and social determinants of health are increasingly studied, more institutions like the the Single Ventricle Program at Stanford Medicine Children’s Health are looking beyond the doctor’s office to address how factors like income, education, food insecurity, and housing impact a patient’s health–a meaningful step towards reducing health disparities and removing obstacles to heart care for the most vulnerable.
Social Determinants Today
While healthcare access is undoubtedly pivotal, it’s just one facet of a multitude of factors that interrelate and compound to create tremendous hurdles for children and families. It is imperative to recognize that social factors are connected in ways that can profoundly impact the efficacy of care received at clinics; even when children receive excellent care, outcomes may be compromised by challenging circumstances in their home environment or elsewhere.
Zip codes, financial resources, education, nutrition, housing, transportation access, early childhood development, and structural conflict—these are just some of the many factors that impact access to quality health services and health outcomes. These social determinants of health are especially laid bare when considering their effects on the 2.4 million children and adults living with congenital heart defects.
“I would say these are the factors [that affect health] beyond clinical care. The environment where we live, where we grow, where we’re born, where we work, where we go to school—that impacts our health and our access to quality care. As you can imagine, specifically for children and adults who have a chronic health condition, it matters what their income level is, it matters where they live,” said Elizabeth Ramos, licensed clinical social worker with Stanford Medicine Children’s Health.
Studies have shown that 18 percent of Americans live more than 10 miles from the nearest hospital, which might not seem like much, but when combined with social factors like employment, economic status, and zip code, a mere 10 miles can turn into a substantial burden. For individuals who don’t have a car or can’t afford public transportation to get to the nearest healthcare institution, finding accessible and necessary medical attention becomes a much bigger hurdle.
Ramos continues, “Someone living in a city versus a rural area and the access to an immediate hospital or community health clinic that offers the specialty services they need access to, that's also going to impact their health overall.”
Accessibility, Affordability, and Medical Conditions
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Sharon Chen, MD and Director of the Single Ventricle Program at Stanford Children’s Health, explained single ventricle heart defects in children: “A child is born with these defects. They cause babies to be blue [because] they don't have enough oxygen. In terms of what this means for the child, without treatment, these defects are typically fatal and most will die in infancy. Treatment does require heart surgery, typically more than one and usually at least three open heart surgeries before they reach early childhood. Even with these surgeries, [they] don't fix or cure the heart, it will still affect all organs, so that's why these kids need lifelong cardiac care."
An infant born with a congenital heart condition requires consistent access to quality care and ongoing support as they grow—and for parents who live far from the nearest medical center with limited resources for travel, let alone medical bills, every single day can be an uphill battle.
Realities like these exist throughout the state and beyond, putting the lives of infants, children, and even adults at risk. That’s why a holistic approach, one that focuses on the medical, as well as the mental and socioeconomic realities of each family, is imperative. For families navigating medical conditions worsened through varying social health determinants, initiatives like the one led by the Single Ventricle Program team at Stanford Children’s Health are beyond essential—they are lifesaving.
Dr. Chen relayed the positive impact of what happens when social determinants are considered when providing care to patients. “Over the last 18+ months, we’ve screened 90 percent of our families, and in 21 percent of cases we have identified various needs,” she explained. “Social determinants are known to impact health outcomes. The screening has really improved how we care for our patients and families. I think our sense is it's a lot more than that, and that's why when we started our screening process, we screened across the board on all various factors.”
In many cases, Dr. Chen stressed, the care from teams addressing the social determinants of health is critical, if not more important, than the clinical care offered—the care provided by the doctor is only as good as the support system and guidance that helps patients and families follow through on a care plan. That’s why the multidisciplinary team at the Betty Irene Moore Children’s Heart Center at Stanford Children’s includes a wide range of experts from pediatric cardiology and neurodevelopmental psychology to school advocacy, social services, and everything in between to improve health outcomes and help children live a fuller life.
The Future of Healthcare
The CDC recently estimated there are roughly 40,000 babies born every year with some sort of congenital heart defect. Despite this, marginalized communities are seldom considered in the totality of these statistics due to socioeconomic status and other factors that prevent access to healthcare institutions in the first place.
The correlation between social and health disparities is no longer theoretical, but rather unmistakable, and according to Ramos and Dr. Chen, a holistic approach that considers the social determinants of health is the way forward. Dr. Chen relayed, “Our program is quite unique in being a much more comprehensive program—we follow kids from infancy through to adulthood. We’re presenting this in a way that's research-oriented so that we can hopefully convince others that this is important to do.”
The Single Ventricle Program at Stanford Children’s is one of the largest programs on the west coast entirely dedicated to providing lifelong support to pediatric patients with single ventricle hearts. The Single Ventricle Program is housed within the renowned Betty Irene Moore Children’s Heart Center at Stanford Children’s, a center that’s committed to providing tailored and highly specialized heart care services to patients from infancy through adulthood. Click here to learn more.
