More recently there appears to be a paradigm shift in how health care systems and access is viewed. Health care delivery plays a relatively minor role in its impact to premature death. What governs individual behavior of the patient is a result of SDH, which are a product of:
- Barriers to appropriate health care
- Economic instability
- Unsafe environment
- Poor health literacy and education
- Limited social and community support
- Food scarcity
- Social discrimination and language barriers
These are just a few of the factors that part represent and challenge patient care and health inequities. Genetics is relatively a minimal risk factor to disease condition. We cannot just say that Blacks have a greater risk of heart disease, diabetes, hypertension etc. We need to ascertain the social context of our diverse populations in order to address incidence of chronic disease and its effects. It cannot be just genetics of the immigrant, the refugee, the homeless, or impoverished population that lead to the greater morbidity and mortality.
As a pediatrician practicing in the central valley, I see the consequence of social complexity in pediatric care delivery, daily. In a recent 2017 report by Center for Regional Change and Pan Valley Institute, California San Joaquin Valley, children are “living under stress”. They are not only born under duress but face lifelong barricades to better health, physical and mental. The occurrence of child poverty level in counties of the SJV are profound. The graph exhibits poverty levels of 28 to 38 % in the valley:
The Context of Care 