Chronic conditions are driven by social factors outside a doctor’s control: GP

Doug Hendrie

8/08/2018 3:41:07 PM

A prominent GP has called for attention to poverty and low-paid work as a key driver of chronic health conditions.

Dr Tim Senior has a particular interest in social determinants of health.
Dr Tim Senior has a particular interest in social determinants of health.

In an article for the British Journal of General Practice, Dr Tim Senior argues that a focus on lifestyle choices obscures the larger drivers of chronic conditions that lie in a patient’s social environment.  
After a consultation, he wrote, GPs send the patient back to the environment they came from.
‘For quite a few of our patients these environments contain the circumstances in which chronic diseases thrive. We send them back to stressful jobs, or, even more stressful, lack of jobs. There may be no let-up at home, with the effects of long hours, low income, or poor housing all causing stress for families,’ he wrote.  
‘The seeds of chronic disease take hold in these difficult circumstances, and germinate. For some people, the only relief they get comes in the form of cigarettes, alcohol, or comfort food, which is like fertiliser for chronic diseases.’
 Dr Senior told newsGP the article came from a sense of frustration.
‘It’s like working with one hand behind your back. Instead of managing people’s health, you’re writing forms for housing,' he said.

'It’s not what we’re trained for, but it’s crucial to their health. And on healthy nutrition – people say, "Yeah, I’d love to, but I can’t afford to." So framing it as "choices" obscures the fact that people are constrained in their choices and often by money.' 
In the article, Dr Senior argues that the constraints on people’s ability to make choices are very important, but harder to see than the choices to smoke or eat unhealthily.
‘It’s so easy for policymakers … to imagine that everyone has the same degree of choice they do. People should ‘take responsibility’ and make decisions that benefit them, buying healthy food and stopping smoking. Then doctors can get on with prescribing the right medications, people can make the decision to follow our advice, and chronic disease is vanquished,’ Dr Senior writes.
He observes that many people live in areas where fast food outlets and cheaper, unhealthy processed foods in supermarkets are more common, while insecure gig-economy work means workers have less power. Similarly, air pollution is more likely in poorer areas.
‘[W]e do what we can, with a hypoglycaemic agent here, a statin there, and hoping that antidepressants and psychology will get people through their social circumstances.
‘Ultimately the circumstances that enable chronic diseases to thrive are found outside our consulting rooms and hospital wards. Chronic diseases thrive where there is a lack of money and a lack of power,’ he concludes.
The Australian Institute of Health and Welfare states in its 2018 Australia’s Health report that many of the key drivers of health are due to living and working conditions.
‘Evidence supports the close relationship between people’s health and the living and working conditions which form their social environment. Factors such as socioeconomic position, conditions of employment, power and social support – known collectively as the social determinants of health – act together to strengthen or undermine the health of individuals and communities,’ the report states. 
‘In 2015, the all-cause mortality rate for people in the lowest socioeconomic group was 1.5 times as high as for people in the highest socioeconomic group …

This is reflected in life expectancy gaps. In 2011, Australian males and females in the lowest socioeconomic group lived, on average, 5.7 and 3.3 years less than males and females in the highest socioeconomic group.’

chronic conditions chronic diseases poverty social determinants

newsGP weekly poll What is your chief concern with role substitution?

newsGP weekly poll What is your chief concern with role substitution?



Login to comment

Other side of coin   10/08/2018 10:57:43 AM

"Excess" brings its own evil too. Length of life is not the ultimate criteria. Low socioeconomic conditions contribute to many health related issues, so does higher socioeconomic conditions. It will be great if no one in our country is economically unaffording of basic amenities and necessities of a respectable, healthy, content and peaceful life; but assuming that it will eliminate or significantly improve mental and/or physical health en masse?! Not sure about that.
On a lighter note; If all get healthy, I'll have to retrain and find some other job.

Jim kafiris   11/08/2018 12:39:05 PM

Last time I checked, Australia has a total debt of 800 billion approximately. The average household debt ratio has now hit 200%. Yet we are currently per capita earning the greatest income in history. Do you think the problem has nothing to do with money, but human nature itself in most cases. These are issues that have never been solved throughout the existence of humanity. At the end of the day every person is responsible for themselves as an individual unit. Depending on others to come to your rescue has never survived the test of time.