Using the “Five A’s” to Support Social Factors in Healthcare

By | February 19, 2020
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It is understood that social factors influence health and wellness. Currently, Healthcare systems grapple with the question of how to address issues.

A recent report from the consensus committee of the National Academies of Sciences, Engineering, and Medicine provides recommendations to guide practice, societal, and policy discussions in this area. They recommend five A’s specifically, in the health care setting, that address social needs and can offer more equitable outcomes.

The first concept, Awareness, defines social risks and assets of specific patients and populations. Thereby requiring us to screen for such needs and simultaneously understand the availability of interventions. So, it is important that we also invest our energy in all discovered gaps. Presently, there are screening tools available for asking such questions. However, many argue that if there isn’t a means to address, I am better off not asking. Unfortunately, this attitude undermines this idea of Awareness.

The next is Adjustment. These activities focus on altering clinical care to accommodate identified social barriers. As caregivers, we adjust our treatments on a physiologic basis. The same concept applies to the psychosocial axis. We can no longer say that a patient is non-compliant when, in fact, we do not address the underlying barriers. For success, we must be accountable for the total healthcare of those we serve, not just the identification of existing illness and treatment. Hence, this requires us to think differently, thus Adjustment.

The third is Assistance. We must focus on activities that reduce social risk by connecting those in need with all the available services. Therefore, this requires us to identify such assets in our communities and help support them as they support us. A food voucher might be just as important, if not more, than a prescription.

Up next is Alignment. These are activities undertaken by health systems to understand existing social care assets in a community, support and lead the organization to facilitate synergies, and invest in deploying them to affect outcomes.

Lastly is Advocacy. Health systems must collaborate with social care organizations to promote policies that facilitate the creation and redeployment of assets or resources that address root cause issues. These are societal issues, not just care delivery concerns.

Unquestionably, these are not effortless to accomplish. However, only through steadfast purpose and collaboration will we be successful at creating a healthier society. These five A’s give us a helpful framework from which to organize our thinking and activities.