The Invisible Pandemic: Domestic Violence and Social Determinants of Health

In the aftermath of the COVID-19 pandemic, South Shore Medical Center (SSMC) has been looking at the way we deliver care for people who are experiencing issues that are often difficult to discuss, even in the confines of a confidential exam room.

With worldwide attention to social distancing and staying home when possible, experts in the United States prepared for an increase in the usage of domestic violence hotlines.

As many faced financial hardship, food insecurity, job loss, and other social determinants of health, the concern was that previous outlets and safe spaces were no longer readily available to those who needed them.

Rather than the anticipated surge in hotline usage, research published in the New England Journal of Medicine found that in some regions of the United States, calls dropped by 50%.

What is a Social Determinant of Health?

Social determinants of health (SDOH) are conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.

These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.

The World Health Organization (WHO) states that SDOH are responsible for health inequities and can be broken into five categories:

  1. Healthcare Access and Quality – access to primary care, access to health insurance
  2. Education Access and Quality – early childhood education and development, high school graduation
  3. Social and Community Context – community cohesion, discrimination, incarceration
  4. Economic Stability – poverty, employment, food security
  5. Neighborhood and Built Environment – adequate housing, access to transportation, neighborhood violence

Domestic violence affects people of all races, genders, sexual orientations, socioeconomic classes, and religious affiliations.

Though it's widely underreported due to feelings of shame, fear of retaliation, economic dependence, and privacy concerns, as many as one in four women and one in nine men are victims of domestic violence.

The effects of domestic violence can result in a wide array of issues, ranging from broken bones to Post Traumatic Stress Disorder.

In order to best support survivors, we worked with local experts to educate providers on how to identify the signs of domestic violence, how to respond with a trauma-informed approach, and what local resources are available to serve survivors.

By formulating new workflows, confidentiality procedures, and learning more about evidence-based treatments, we found that assessing domestic violence in conjunction with other SDOH would help bring about meaningful conversations and interventions.

Connecting patients with the resources they need

Using the Tool for Health & Resilience in Vulnerable Environments (THRIVE), developed by Boston Medical Center, SSMC screens patients for SDOH with the goal of connecting people with programming that fits their unique need. 

For example, someone with a substance use disorder may be referred to our Office Based Addiction Team or the Bridge Program. If someone identifies difficulty with health insurance, we may refer to our Financial Counseling Department.

This year, we have added a domestic violence screening question to our THRIVE in an effort to reduce stigma and to provide the very resources needed by those who are experiencing violence.

SSMC is committed to the ongoing health and wellness of our community and remains steadfast in our pledge to deliver world-class care.

By normalizing these difficult conversations and bringing more awareness to domestic violence, SSMC aims to bring visibility to those who feel unseen. You are not alone. We are ready to help. 

Please do not hesitate to reach out to your provider if you feel you need support or want to learn more about this important work. We are here with you and here for you, As One.

If you're seeking assistance with food, housing, medical care, or other needs, please visit our Community Resource Directory.