Mental health: the conditions in which people grow, live, work and age matter

On July 6, 2022, The Daily Star published an article by Nahaly Nafisa Khan titled “The root of our unhappiness: When the personal becomes political”. The eloquently written article delves into socio-economic turmoil to explain the Global Emotions Report 2022, which ranks Bangladesh seventh “among the world’s angst, saddest and most stressed nations”. . The author traced the origin of these problems to poverty, unemployment, lack of access to healthcare, social stigma around mental and behavioral health issues, loneliness, domestic violence, and more.

I couldn’t agree more. As a health care consultant designing and implementing solutions around these issues in Florida on behalf of the state government, I am thrilled to share my own experience.

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Social determinants of health (SDH) is a relatively new concept that is gaining momentum in the West. The World Health Organization (WHO) has defined SDOH as “the conditions in which people are born, grow, live, work and age”. The definition includes basic human needs such as food, shelter, employment, education, health care, etc.

An increasingly common trend in healthcare systems in the West is the use of SDOH. They have become major drivers of healthcare in the United States (US) in recent years. A research article published in the American Journal of Preventive Medicine showed that 80% of health care costs in the United States are spent on traditional health care, even though it only affects 20% of health outcomes. . On the other hand, 80% of health outcomes depend on unrelated health issues such as food, housing, employment, education, social isolation, and domestic and community violence. Many other studies have also concluded that there is a strong correlation between health care and unmet social needs. In fact, traditional health care has proven to be just the tip of the iceberg for an individual’s health and well-being.

In the United States, social programs have been a focus for many years, but recently and increasingly federal and state governments have turned their attention to addressing social issues through SDOH. The goal is to achieve better population health outcomes by meeting citizens’ needs for food, housing, employment, transportation, and more. The approach costs less to keep the population healthy.

I myself manage two SDOH projects for the Florida State Government. So far, only a few states have launched various forms of SDOH solutions, others are in various stages of implementation, while most do not even have an SDOH-oriented plan. Those who are behind have extensive social service programs to help the needy, and sooner or later they will be on the SDOH train too.

Recognizing the value of social services, Florida worked on a project to design and implement a statewide technology solution that will empower all service providers (medical, social, behavioral and mental ) the ability to scan their members for basic needs. For example, the program will allow a doctor to ask a patient a few simple questions – for example, if they have enough food at home, a safe place to live, or if they are suffering from domestic violence, etc. . If a need is identified, the patient will be formally referred to the specific service provider(s). The attending physician will be able to verify whether or not the person has received the service(s) and ensure that it takes place. Of course, the patient/member must consent to receive the service. The solution will allow US states to analyze data and identify needed services in specific communities. Thus, various state programs at the local level will be able to point the finger at people with needs.

The main cause of most social problems is poverty, which leads to a cascade of problems such as stress and mental illness. Social needs have a direct impact on a person’s overall health. Existing SDOH data has proven that the provision of social services significantly improved coordination of patient care, reduced anxiety and anger, increased happiness, and therefore reduced health care costs and less crime.

If basic needs are not met, we fail in our society. Health and social care organizations should shift their focus from traditional health care to the diverse social and behavioral needs that exist in our communities.

In Bangladesh, most families who have the capacity are inclined to save or build wealth, often neglecting their mental and physical problems. Many families are simply unaware of the importance of self-care, while others cannot afford a healthy life. Mental health issues are almost completely ignored or suppressed to avoid perceived social embarrassment. But a healthy society is difficult to build without an awareness of these issues, even if resources are available. Therefore, Bangladesh should start addressing social issues more prominently so that proper health care can be obtained.

ATM Uddin is a program manager at the Florida Agency for Health Care Administration.

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