Kate Collings, Maryland
Primary care clinicians understand that addressing lifestyle-related chronic disease health disparities in minority and low-income communities is an important opportunity to alleviate unnecessary suffering. The disparate health outcomes associated with underlying comorbidities during the coronavirus pandemic have highlighted the urgency of this issue.
However, when it comes to providing evidence-based therapeutic lifestyle behavioral interventions to these populations, there is a misconception that lifestyle medicine is only for the wealthy. Such misconceptions unnecessarily widen health disparities, because the truth is that everyone has the right to access lifestyle medicine. Fortunately, there are many successful examples of providing these services to patients who lack resources. We can all contribute to reducing health disparities by accessing increasingly abundant lifestyle medicine resources.
Every patient’s lived experience is unique and a wide range of potential challenges exist in achieving lifestyle behavior change. Lack of access to nutritious food and transportation, lack of safe green space, unstable housing, and low health literacy are examples of social determinants of health (SDOH) that influence lifestyle choices . Ignoring these disorders is a disservice to the patient and will almost certainly lead to treatment failure. The requirement to document SDOH was a huge first step.
The next step is to have a conversation with all patients about how even small lifestyle changes can have a big impact. Clinicians avoid conversations about lifestyle changes with patients affected by harmful SDOH, assuming that social impairment automatically means the patient is neither willing nor able to attempt behavior modification. Very often. Rather, it is an opportunity for clinicians, particularly those certified in lifestyle medicine, to meet patients where they are, work with them to identify solutions, and refer them to community-based organizations with supportive resources. It becomes.
small steps towards big change
Not all lifestyle behavioral interventions need to be programmatic or time-intensive. Clinicians can guide patients toward simple but concrete actions that can make a difference in their health over time. Small steps like eating a can of beans or two bags of frozen leafy greens each week are a good start toward adjusting your eating patterns. The American College of Lifestyle Medicine (ACLM) offers a whole-food, plant-based eating guide to share with your patients.
You can increase your physical activity by standing, sitting, or balancing on one leg in your living room. Establishing deep breathing and sleep routines are also lifestyle behavior changes that don’t come with a price tag.
It is true that early adopters of lifestyle medicine often had difficulty implementing it in communities that lacked resources. These practitioners were forced to operate on a cash-based basis, making the cost of treatment prohibitive for many patients. However, since 2017, specialist certification has become available, and lifestyle medicine is being integrated into medical schools and residency programs. Many of these board-certified clinicians now work in large health systems and bill in the usual way. There are also frameworks, such as the community-based lifestyle medicine model, that show how to effectively treat patients affected by harmful SDOH.
For example, patients who are at risk of malnutrition due to illnesses such as chronic kidney disease, cancer, or congestive heart failure can receive medically tailored meals through a partnership between UC San Diego and Mama’s Kitchen. You can see a registered dietitian. In Pennsylvania’s Lehigh Valley, where one in 10 of the nearly 700,000 residents faces food insecurity, the Kerin Foundation delivers fresh food through the Eat Real Food Mobile Market, offering whole-food and plant-based food. cooking classes, interactive elementary school programs focused on health, and more. Lifestyle choices and therapeutic lifestyle change programs at local locations. Three months after launching a new mobile market site in Allentown, 1,200 families received $15 weekly food stamps through the program. Lifestyle medicine clinicians serve urban and rural areas in independent practices, large health systems, and community-based practices.
To improve access to lifestyle medicine in under-resourced areas, we need more clinicians trained and certified in lifestyle medicine. The Health Equity Achieved through Lifestyle Medicine (HEAL) Initiative supports a diverse workforce in lifestyle medicine by providing scholarships to clinicians who are underrepresented in the medical community. Physicians are on the Frontline Federally Qualified We are committed to training and certifying at least one physician within each of our 1,400 federally qualified health centers. Lines that provide care to the most underserved populations.
A meaningful first step for clinicians to address health disparities is to screen patients and document SDOH. The American Academy of Family Physians offers useful tools to screen patients, identify community-based resources, and help patients create a plan of action to overcome health risks and improve outcomes. Masu. In a promising trend to better support SDOH efforts in clinical care, the 2024 Medicare Physician Fee Schedule Final Rule includes new provisions to support this effort.
Not all patients are ready or willing to start a lifestyle disease treatment plan. Still, they will all be grateful for the opportunity to make their own decisions. If we are focused on reducing health disparities, lifestyle medicine and behavioral change should be a theme in our clinical encounters with all patients.
