影响病人健康的因素.docx

Beyond Hospital Walls: Teaching Students About Social Determinants of HealthAAMC Reporter: September 2012 —By Barbara A. Gabriel, special to the ReporterMost physicians know there are multiple factors that affect their patients’ health. If diabetic patients cannot afford healthy food, do not have safe places to exercise, or do not have support from family and friends, it will be harder to help them manage their condition. The idea that these social determinants influence health is not new. At several medical schools and teaching hospitals, faculty are integrating the social determinants of health into the curricula, taking students beyond hospital walls.“In medical school, it’s very easy to think that what we do in medicine is what matters the most in health care, that the action is in the clinic and hospital,” said Jeroan Allison, M.D., professor and vice chair of quantitative health sciences and associate vice provost for health disparities research at the University of Massachusetts Medical School. “But that’s not true. The context of patients’ lives is the most powerful determinant of health.”The concept that social determinants—such as socioeconomic status, ethnicity, poverty, and education level—shape health is not new, although its acceptance in medical education is relatively recent. “This is something that has changed only during the past three years,” said Paula Braveman, M.D., M.P.H., professor of family and community medicine and director of the Center on Social Disparities in Health at the University of California, San Francisco, School of Medicine (UCSF). “It still isn’t featured very prominently in the curricula of medical schools. But it looks like there are the beginnings of awareness, a movement in that direction,” Braveman said.When Braveman taught a course she developed about the social determinants of health 20 years ago, she was a pioneer. “About 20 percent of my students really liked it, about 20 percent really hated it, and the rest wondered