Social Medicine Grand Rounds: A Collaborative Education Hub to Promote Action on Social Determinants of Health Across Community Sectors in Rural Alaska

Background: The connection between social stratification and health inequalities in the United States suggests the need for medical education and practice to address social determinants of health as a key condition for achieving health equity. This reading of the project of social medicine—to wed health care delivery to a pragmatic and operationalized equity agenda—is particularly relevant to tribal health systems, where patient populations bear a disparate burden of injury and disease, where social and historical forces play a large role in the generation and maintenance of these health disparities, and where social and economic forces constrain the availability, accessibility, and efficacy of health care. Objectives: This paper describes the conceptual framework and educational materials from a social medicine grand rounds program in an Alaskan arctic tribal health system, aimed at building clinical, organizational, and community capacity to address social determinants of health. Led by the Maniilaq Association Division of Social Medicine with partners at Harvard Medical School and Massachusetts General Hospital, social medicine grand rounds bring together hospital and village clinic-based care teams, social and tribal service workers, and community members to study and apply social medicine perspectives to health care delivery across 12 circumpolar Alaska Native villages. The model utilizes a case-based curriculum to drive clinical-community collaboration and critical analysis of health care delivery challenges focused on four broad priority areas established by tribal leadership: maternal and child health, chronic disease, mental health, and infectious disease. Methods: The social medicine grand rounds program was piloted in April 2017 and will be formally launched in November 2017. Researchers will utilize a mixed methods approach, pairing analysis of electronic health record data with participant interviews and surveys to investigate changes in provider practice patterns relating to action on social determinants of health, community and cross-sector partnerships, and revisions to health system policies and protocols over one year of programming. Pre-mid-post surveys collected before the program begins, at the six-month mark, and after a year of programming will assess participants’ knowledge, readiness, and action to address social determinants of health. A social needs assessment protocol administered in the outpatient clinic will evaluate patients’ met and unmet needs, and a discrete range of health outcomes will be tracked using patient registries in the electronic health record. Discussion: We hypothesize that by maneuvering social determinants of health into the sphere of moral concern of health workers; by underscoring the clinical relevance and utility of social theory and analysis; by strengthening community partnerships linking primary care to social and tribal services; and by building a practical skill set among health workers to include social and structural interventions as part of the core clinical repertoire, social medicine education may help to mitigate the impacts of social stratification on health outcomes in Northwest Alaska. Ultimately, such projects can play a minor role in redressing structures of inequality that both produce and are propagated by poor health. Conclusion: Social medicine grand rounds examine how social, historical, and structural forces are embodied as illness and injury in individuals, as well as how these forces shape medical efficacy, illness experience, and standard of care. The model serves to build inter-professional communities of practice for learning, deliberation, and action on social determinants of health in Northwest Alaska, and to build and leverage shared clinical, education, and training infrastructure with academic partners to expand the reach of the program and reduce health inequities. Keywords: social medicine, Alaska Native, health equity, social determinants of health. OBJECTIVES: This paper describes the conceptual framework and educational materials from a social medicine grand rounds program in an Alaskan arctic tribal health system, aimed at building clinical, organizational, and community capacity to address social determinants of health. Led by the Maniilaq Association Division of Social Medicine with partners at Harvard Medical School and Massachusetts General Hospital, social medicine grand rounds bring together hospital and village clinic-based care teams, social and tribal service workers, and community members to study and apply social medicine perspectives to health care delivery across 12 circumpolar Alaska Native villages. The model utilizes a case-based curriculum to drive clinical-community collaboration and critical analysis of health care delivery challenges focused on four priority areas established by tribal leadership: maternal and child health, chronic disease, mental health, and infectious disease. METHODS: The social medicine grand rounds program was piloted in April 2017 and will be formally launched in November 2017. Researchers will utilize a mixed methods approach, pairing analysis of electronic health record data with participant interviews and pre-post survey data to investigate changes in provider practice patterns relating to social determinants of health, community and cross-sector partnerships, and revisions to health system policies and protocols over one year of programming. Pre-mid-post surveys collected before the program begins, at the six-month mark, and after a year of programming will assess participants’ knowledge, readiness, and action to address social determinants of health. A social needs assessment protocol administered in the outpatient clinic will evaluate patients’ met and unmet needs, and a discrete range of health outcomes will be tracked using patient registries in the electronic health record. DISCUSSION: We hypothesize that by maneuvering social determinants of health into the sphere of moral concern of health workers; by underscoring the clinical relevance and utility of social theory and analysis; by strengthening community partnerships linking primary care to social and tribal services; and by building a practical skill set among health workers to include social and structural interventions as part of the core clinical repertoire, grand rounds may contribute to the mitigation of the impacts of social stratification on health outcomes in Northwest Alaska. CONCLUSION: Social medicine grand rounds examine how social, historical, and structural forces are embodied as illness and injury in individuals, as well as how these forces shape medical efficacy, illness experience, and standard of care. The model serves to build inter-professional communities of practice for learning, deliberation, and action on social determinants of health in Northwest Alaska, and to build and leverage shared clinical, education, and training infrastructure with academic partners to expand the reach of the program and reduce health inequities.

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