Even with new medical developments and more effective treatment options on the horizon, underserved communities are experiencing an uptick in stroke fatalities. Could social determinants of health be the cause?

When it comes to stroke prevention and reducing stroke fatalities, significant progress has been made to address the biological factors at play. However, after years of progress, the prevalence of strokes is actually on the rise within poorer minority communities.

Nancy Tkacs, adjunct professor of nursing at the USC Suzanne Dworak-Peck School of Social Work, has long taken a holistic approach to healthcare issues such as this one. Tkacs’ consideration of both the biological and social determinants of health may hold the key to more effective stroke treatment.

In honor of American Stroke Awareness Month, Tkacs considers the social, economic and racial factors affecting stroke risk and accessibility to health care in the United States, and what we can do to close these gaps.

USC Suzanne Dworak-Peck School of Social Work: Why is it important for healthcare providers to consider both biological and social determinants of health?

Nancy Tkacs: In recent decades, great strides have been made in biological research that have resulted in remarkable medical progress and health improvements. Yet today we aren’t seeing the same pace of advancement in terms of overall health outcomes.

This is because, while treatment has become more sophisticated, it has also become more expensive—and in the changing climate of the U.S. health care system, where more and more Americans find themselves uninsured or underinsured, the cost of care is often prohibitive. Coupled with the socioeconomic setbacks that beset certain communities, this has created great disparities in access to lifesaving treatments.

Thus, it has become necessary to take a more holistic approach to health care. Rather than diagnosing and treating a patient’s symptoms in a vacuum, health care providers must consider the external factors that can prevent a person from receiving the best care possible.

USC: How does this approach apply to the treatment of patients who have suffered, or are at risk of suffering, a stroke?

NT: Stroke fatalities have been declining since the 1960s, but within the last two decades, some regions, like the southern United States, are seeing a reversal of this trend. In order to understand this shift, it’s necessary to take a broader view of patient health that considers the effects of social determinants of health.

Traditionally, diagnosing a patient’s likelihood of suffering a stroke has involved an evaluation of a few major risk factors—the most common being diabetes, hypertension, and smoking. Others include high blood pressure, high cholesterol, obesity, an unhealthy diet and a lack of physical activity.

A patient who displays one or more of these risk factors certainly has a higher chance of suffering a stroke, but these factors should not be considered in isolation. Often, things like obesity, an unhealthy diet, and high cholesterol are exacerbated by the circumstances under which a person lives and works. For example, many poorer communities are located in what’s referred to as “food deserts”—areas with a low density of grocery stores or sources of healthy foods. Poverty can also make it much more difficult for individuals to maintain a healthy lifestyle, not to mention restricting access to quality health care from an economic standpoint.

USC: How does the USC nursing program account for these complex risk factors and ensure that students are trained to provide the most comprehensive care possible?

NT: Our nursing students study the social and biological determinants of health from the very start of their program. For instance, in one introductory-level class, we examine the unequal geographical distribution of obesity and diabetes in the U.S.

In general, those with a firsthand understanding of the challenges that low-income communities face can be the most effective advocates for health in areas where the rate of stroke-related deaths is particularly high. Increasingly, we are considering unique cultural- and family-centered approaches to promoting health.

The notion of a multifaceted approach to health is ingrained in our curriculum: we rely on the biological knowledge that serves as the foundation of health care, but we also examine new evidence-based research on social determinants of health. The core concepts of our new curriculum, which we’re developing based on this recently emerging area of science, are rooted in this integrated approach.