Last Updated: Nov 18, 2021
Rishi Jain, MD—Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia
Jenna Spears, MD—Internal Medicine, Pennsylvania Hospital, Philadelphia
Why are you so passionate about social determinants of health?
I am a GI medical oncologist. Fifty percent of my time is dedicated to nutrition research. Food insecurity is a major issue that many of our patients face. It contributes to many chronic diseases such as obesity, diabetes, and cancer. I spent three years in Bronx, New York, where food insecurity is a big problem. I also did a fellowship at Fox Chase Cancer Center and Temple Main. The patient population in that area also faces inadequate access to food (i.e. food deserts). This compromises patient outcomes.
With cancer, unhealthy diet patterns can increase the risk of cancer. In fact, obesity, which is closely related to unhealthy dietary habits, has been linked to more than 10 different types of cancers. Poor nutrition also increases the risk of worsening cancer outcomes.
As doctors, we want the very best for our patients. But sometimes we get so busy that exploring patients’ social determinants of health doesn’t get the attention it needs and deserves. We often instruct patients to eat healthier, or exercise more, without realizing the complex barriers to health they are facing. Addressing these barriers can make a huge difference for people. Food and transportation insecurity are significant barriers to health for some patients. This impacts how they get to and pay for appointments, access medications, where they can source food from, and what they eat. These barriers hinder our ability to help our patients improve their health.
Physicians should be aware of social determinants of health—think about them, identify those patients that are struggling with barriers to health, and find community resources to connect them to. Lastly, be creative, just because something doesn’t already exist, doesn’t mean it cannot.
What are you doing to address social determinants of health in your community?
One of the challenges of diet and nutrition research is understanding what people are actually eating. Current strategies include asking your patient to keep a log of what they’ve eaten for a day or a few days, which is really only a small glimpse into their overall dietary patterns. I am utilizing a tool called a computerized food frequency questionnaire for a variety of ongoing studies. It’s a picture-based tool that allows patients to click through pictures of what kinds of foods they eat, their portion sizes, etc., and it asks them how frequently they eat those specific foods. It takes about 30 minutes to complete and gives immediate feedback on how the person is eating, both macro and micronutrients, how healthy the person’s diet is, and even how inflammatory their diet is.
In my clinic population, I’ve been trying to establish a role for this technology, which is distinct across different populations. For cancer survivors, it’s a teachable moment—We can use this technology and help patients improve their diet, which could potentially reduce the risk of their cancer coming back while reducing their risk for other chronic diseases such as diabetes or heart disease. For the advanced cancer patient, this technology may play a role in helping us to identify which food categories the person is deficient in and improve their nutritional intake, feedback on how the person is eating, both macro and micronutrients, how healthy the person’s diet is, and even how inflammatory their diet is.
At the J. Edwin Wood Clinic, I work with a primarily underserved population. Many of my patients have food and/or transportation insecurities that impact their overall health and their access to care. Some patients are motivated to take charge of their health, but do not have the resources to do so. Though I would watch these patients make progress in improving their overall health, there was always that last hurdle they couldn’t overcome, which was often related to their diet. I started paying more attention to social determinants of health, and my patients would share stories of not being able to afford healthy food or not being able to access the healthy options they wanted due to mobility or transportation constraints. Their stories were both frustrating and motivating to me, and I knew that there had to be more I could do.
I went to my clinic directors Dr. Edward Wu and Dr. Alex Glaser and shared my frustrations and idea to start a program that could help. Through a lot of hard work, we secured funding and established a food delivery program – the Overcoming Barriers to Healthcare Program. Through this program, selected patients receive monthly deliveries of organic produce to their homes. I realized early on that it was important that the food be delivered to patients, since many of our patients with food insecurity also have transportation insecurity.
It has been great to watch the program grow and hear the amazing responses from patients. We check in with the patients monthly to see how they are doing, how their weight and blood pressure have been, and how they are liking the food. The program is only a little over a year old, but from what we can see, their numbers look better. Even more rewarding to me than the improved objective outcomes are that patients report subjective improvements in their health. Patients report that they have more energy, grade their health better, and have even reported that their mental health has improved. I have always believed in the importance of preventative medicine, and it has been really gratifying to empower patients and watch the positive impact it can have on their lives. This year we’re expanding the program to include more patients.
Establishing the program came with challenges, but it has been my most rewarding endeavor to date, and I am so proud of what we have accomplished.
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