Perspective from the Field on Underserved Populations - What it Means and Why it Matters

As a society, we are continually concerned on how to support and nurture our youth to prepare them as the next generation of educated, caring and successful adults.  Both public opinion and evidence-based research suggests that the proxy for failure to achieve these objectives can often be an unplanned pregnancy. In addition to the usual medical, educational and religious strategies implemented to reduce unintended childbearing and rearing among teens, attention is now focusing on the environment as well. More and more, research is proving that one’s overall environment can not only enhance health in general, but can also reduce behavioral risk, such as teen pregnancy, specifically.

This concept, the Social Determinants of Health, suggests that health is also determined in part by access to social and economic opportunities: resources and supports available in homes, neighborhoods, and communities; quality of schooling; safety of workplaces; cleanliness of water, food, and air; and nature of social interactions and relationships. Such an approach underscores the role of community in improving our children’s future and reducing a variety of risks, including sexual.

Applying the Social Determinants of Health in communities to address factors that contribute to teen pregnancy is useful for several reasons. First, it provides a strategic and logical way to place community capital, such as health care services, and second, it establishes a benchmark to measure whether the chosen intervention reduces the targeted disparity and improves wellness of the specific neighborhood. Finally, such a strategy can also stimulate conversations on what infrastructure or social determinants actually exists in underserved communities. The installation of comprehensive “youth-friendly clinics”, for example, can identify, and quantify health system gaps for teens thereby providing the support to move in additional clinical resources.

This approach, while empirically evidenced-based is not without challenges. Some of them include:

* A disconnect between public policy and best practices: As many public interventions are supported with tax dollars, they are often dependent on consensus developed through the political process. Not to be ignored are vocal constituents who may have a concern specific to the elected official’s district. Especially vulnerable are those indicators that involve reproductive and perinatal care.

* Jurisdictional budget constraints:  In some cases, the evidence is accepted but the tax-based resources are not available. Social and medical services for inner city youth, while important, have difficulty competing with traditional expenditures such as higher education, roads or federally mandated issues. Reducing health disparities may not be a high enough priority in the budgeting process to receive sufficient funds to implement effective local interventions.

* Intervention guidelines that become service barriers: There are instances where communities understand the cost effectiveness of public support for health parity. However, the intervention’s effectiveness is minimized by eligibility guidelines which may not be sensitive to the nuances of the community problem or the solution. These procedural requirements can become effective barriers to the receipt of youth-friendly services for which the allocated funding and policy support were intended to rectify.

Nevertheless, community members can look toward Social Determinants of Health as a viable approach to the continued reduction of teen pregnancy. This strategy provides concrete ways to reduce risk in vulnerable and underserved communities. However, accomplishing this takes city/county/state leadership to strike a path using the data which are clear and compelling.

By: Peggy B. Smith, MA, PhD, Professor, Baylor College of Medicine and Director Teen Health Clinics and Texas Campaign Board Member