Social Determinants of Health Are Being Highlighted More in Pharmacy Practice

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, Assistant Professor of Clinical Pharmacy, University of California, San Diego, provides an articulate and thought-provoking look at barriers to care, important facets of social determinants of health, and discrimination that makes people feel like they cannot seek help from their pharmacist at APhA.

PT Staff: How have social determinants of health (SDOH) shifted during, and since, the COVID-19 pandemic?

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP: So that is a great question. And then when I think about just the SDOH and COVID-19, I don't even know that I would say they necessarily have shifted, I think that they become more are highlighted. And we just showcase them more. But I think what we are really seeing in terms of SDOH are just access- how it is that access really impacts—especially communities of that are minoritized or marginalized their ability to receive the COVID-19, therapeutics, or even just the other treatment modalities for COVID-19.

But then I think when we think about access, we have to think about, well, what are major contributors to that. And I think in terms of SDOH, just the way that we think about that has maybe shifted. So for me, now, education has become really a focal point for me in terms of SDOH. So just when there is limited health literacy, then of course, we see limited, you know, uptake of these resources. So that coincides with the access because, if the access is there, if folks don't understand why they're receiving it, then irrespective of that we're going to see low uptake. But then also, when we think about education, from the perspective of, “How does it impact jobs and occupations that folks have?” Well, if you have less education, you're less likely to get a job, if you're less likely to get a job that has insurance or other things that accompany that [then] this, once again, is going to impact access. So, I think more so it’s shifted in a way in which we are looking at intersectionality. And just seeing the intersections and how different things work together to contribute to just lower uptake rates of COVID-19, vaccines, and therapeutics.

PT Staff: What are some overlooked examples of barriers to care?

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP: Absolutely. So I think that education is definitely one of those barriers to care. But even when we think about education, I think about it in terms of agency. I think agency is a really big barrier. Even when you think about folks that do eventually get vaccinated, it's like, “Oh-well I got vaccinated because my job told me, you know. I had to.” So now, when they're faced with other vaccines, it’s going to be, “Well, if I'm not told that I have to get them, then I'm not going to get them,” because folks didn't have that agency or that ability to make a choice to receive it.

And I think that education, you know, is not mono-dimensional. we have to think about it, you know, in education being that aspect of health literacy— health literacy allowing for people to have agency, allowing for people to have that self-decision making as to whether it is they want to receive those vaccines.

Also, we talked about access. But I think more importantly, when we think about the May 11 Emergency Act that's in place to ensure that people can receive these vaccines and therapeutics for free, well, if those things are repealed, now we're in that place of [it being] an added barrier; people that maybe would have gotten vaccines before won't get it because now they'll have to pay for it. Or they won't be able to have access to these treatments, irrespective of it being in the community and available to them. So that's that difference between equality and equity— they won't be able to receive them because they won't be able to afford them. And then we end up at that occupation aspects. So, I think we continue to see these determinants of health that we've outlined previously. But I think just more exacerbated when we think about the continual barriers throughout the COVID-19 pandemic.

PT Staff: What taboos could be preventing patients with adversity from turning to the pharmacist?

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP: I think that is a phenomenal question. I think it's so many taboos that are there. But I think more importantly, it's discrimination—It's the stigmatization. And we must think about the fact that this has been in place for decades upon decades. So with that, you know, that passed-down type of thought about the healthcare process and the healthcare infrastructures and institutions- so pharmacy being as a part of that.

Even a study just came out from California about veterans. They said something like, “Well, you know, we try to mask, anything that will be seen as a deficiency because we don't want to be discriminated against when we go and receive care from our provider.” Just the fact that people have to think about these things, when they go and receive care, you know, just shows the adversities that are here. And with discrimination, no one wants to feel like they can't, they shouldn't, get the things that they're asking for; that they can't receive the things that they're asking for that when they go in somewhere. They don't have someone that connects to their intimate experience.

So I think a lot of times that's where the adversity comes from. But then I think it's also just that lack of agency, being able to make your own choice and choose to receive care and not feeling as though it'll be forced upon you. I think that pharmacists are in a very, very unique type of situation, because we're really able to connect with our patients, which I think is amazing. But I think that we really need to really dive into that more like we have that ability, really leverage that and be able to show the patients can come to us, you can talk to us. We're welcoming, we want to hear from you! And I think that that's just the uniqueness that pharmacy brings to diversity. But I think the discrimination and stigmatization are really at that top place. When we think about marginalized communities and just why it is, we don't see an uptake in care there.

PT Staff: Diversity, equity, and inclusion (DEI) is largely supported in pharmacy practice, but are there educational initiatives or resources that you think could strengthen the discipline?

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP: Right, absolutely, I think that I'm so happy to see the direction that pharmacy is going in terms of DEI and just uplifting the work of those that are doing it and really showcasing it and really placing a big place of importance there. I think that we have a host of primary literature that focuses on how it is that we can increase DEI initiatives. I think that the APhA journal. So Journal of the American Pharmacists Associaton (JAPhA) has a ton of articles, and actually different sections dedicated to health equity. APhA also has a phenomenal website, vaccine competency, there's right there on the APhA website. And it includes a resource to help increase uptake amongst marginalized communities and just communities at large. I think it's an amazing resource that I continue to use to make sure that I can adequately talk about vaccine uptake with the community members, but they also have handouts that you can give that increase education. So, they're once again really focusing on our access and those limitations.

And then American Journal of Health-System Pharmacy (AJHP) has a ton of resources surrounding DEI, and they are providing some publications on these topics for free, you know, for people to have open access and be able to read them so that they can enhance their education. The American Journal of Pharmaceutical Education (AJPE) has articles there. I think the Rx-HEART article, written led by Dr. La Keisha Butler, PharmD, is phenomenal to read and to think about how can I integrate these topics within my didactic portions of the curriculum that you may have for pharmacy programs because that's where the education starts, right? For these future pharmacists. So, I think there are so many resources, so much primary literature, really, um, a lot of things that we can pull from to think about how what's our role in increasing DEI and how can we contribute.