My community in the western Denver suburb of Lakewood has a wide variety of

incomes, ethnicities, education levels, and types of neighborhoods. The primary

The patient population of the ambulatory care clinic where I work provides care to a
predominantly Hispanic clientele, with 25% of patients insured by Medicaid and 15% by
Medicare. Because of the scarcity of affordable housing, many patients are unhoused or
“couch surf.” Lack of safe housing often affects already vulnerable populations; it also
impacts their ability to access essential services and sanitation and worsens
pre-existing conditions (Mwoka et al., 2021). I work closely with the social work team to
provide resources such as motel or Section 8 vouchers, food bank locations, and
mental health care for unhoused patients.

Denver is known as a sanctuary city for migrants and has a robust Hispanic community.
Many of these residents do not speak English and face prejudice and discrimination to
obtain affordable housing, healthcare, education, and employment. Discrimination
increases health disparities among ethnicities and contributes to adverse outcomes
(Togioka et al., 2024). It also contributes to economic inequality in job hiring and
income-earning potential, with a language barrier and education gap exacerbating
prejudice (Lisnek et al., 2024). My clinic attempts to counter racism by welcoming
Medicaid insurance, ensuring translation devices are readily available, and offering a
significant discount for self-pay clients.

Many community members do not have access to or cannot afford nutritious foods.
Nutrition is influenced by economic stability, culture, and education; an unhealthy diet
directly contributes to poor health outcomes and a higher likelihood of chronic illnesses
like diabetes, cardiovascular disease, certain cancers, and obesity (Bishal Gyawali et
al., 2024). Individuals without transportation may be unable to access food even if
eligible for food banks or SNAP assistance. Polluted air or water is not a significant
concern in the area. My clinic works closely with Intelliride (a Medicaid transportation
service), subsidized meal delivery services, and food banks to combat food insecurity.
As previously mentioned, many members of my community have a significant language
barrier, directly affecting health literacy skills. Lower-income patients tend not to seek
health information as often as more financially secure patients. Health communication
must consider both the patient’s native language and his level of material understanding
(Chu et al., 2021). Epic electronic health record has a designated charting area to
address the social determinants of health, care gap needs, and their potential impact on
the patient’s health. My clinic screens all patients when establishing care and then
annually to ensure that we proactively treat the whole patient.

References

Bishal Gyawali, George Frederick Mkoma, & Harsch, S. (2024). Social Determinants

Influencing Nutrition Behaviors and Cardiometabolic Health in Indigenous

Populations: A Scoping Review of the Literature. Nutrients, 16(16), 2750–2750.

https://doi.org/10.3390/nu16162750

Chu, J. N., Sarkar, U., Rivadeneira, N. A., Hiatt, R. A., & Khoong, E. C. (2021). Impact

of language preference and health literacy on health information-seeking

experiences among a low-income, multilingual cohort. Patient Education and

Counseling, 105(5). https://doi.org/10.1016/j.pec.2021.08.028

Lisnek, J. A., Caluori, N., Brown-Iannuzzi, J. L., & Oishi, S. (2024). Investigating How

High Perceived Economic Inequality Exacerbates Intergroup Competition,

Zero-Sum Beliefs, and Perceived Intergroup Prejudice. Personality and Social

Psychology Bulletin. https://doi.org/10.1177/01461672241234787

Mwoka, M., Biermann, O., Ettman, C. K., Abdalla, S. M., Ambuko, J., Pearson, M.,

Rashid, S. F., Zeinali, Z., Galea, S., Valladares, L. M., & Mberu, B. (2021).

Housing as a Social Determinant of Health: Evidence from Singapore, the UK,

and Kenya: the 3-D Commission. Journal of Urban Health, 98(S1), 15–30.

https://doi.org/10.1007/s11524-021-00557-8
Togioka, B. M., Duvivier, D., & Young, E. (2024). Diversity and discrimination in

healthcare. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK568721/

United States Census Bureau. (2024). QuickFacts: Lakewood city, Colorado. Census

Bureau QuickFacts; United States Census Bureau.

https://www.census.gov/quickfacts/fact/table/lakewoodcitycolorado/PST045224

Keterah-
Thank you for your very well-organized post! Poor nutrition has a profound impact on
health. Food insecurity is tied to many factors, including low socioeconomic status,
immigrant status, disability, limited access to supermarkets, lower education level, and
lack of transportation (Jiao, 2024). Another way to screen for this social determinant of
health is to use the Hunger Vital Sign food security screener. This two question tool
determines risk if patients answered often or sometimes true to the questions:
“Within the past 12 months, we worried whether our food would run out before
we got money to buy more.”
“Within the past 12 months, the food we bought just didn’t last, and we didn’t
have money to get more” (Calloway et al., 2024).

When food insecurity is identified, providers can provide resources to food pantries,
federal programs like SNAP, WIC, or school lunches, nutrition education, and
community classes.

References

Calloway, E. E., Coakley, K. E., Carpenter, L. R., Gargano, T., & Yaroch, A. L. (2024).

Benefits of using both the Hunger Vital Sign and brief nutrition security screener

in health-related social needs screening. Translational Behavioral Medicine,

14(8). https://doi.org/10.1093/tbm/ibae037

Jiao, L. (2024). Social Determinants of Health, Diet, and Health Outcome. Nutrients,

16(21), 3642. https://doi.org/10.3390/nu16213642

Thank you for your post! It sounds like your community offers many educational
opportunities; libraries can be a wealth of information and a gathering center. Health
literacy empowers patients to have greater control over their health care by ensuring
they make well-informed decisions. High literacy is also tied to healthier habits,
treatment and medication compliance, and early recognition of disease states (Coughlin
et al., 2020).

Healthcare organizations, especially primary care centers, can also directly impact
health literacy. Studies find that many healthcare professionals lack knowledge of the
definition of health literacy and its effects, assessment of patients’ learning needs, and
the use of clear communication (Gibson et al., 2022). Clinic strategies include creating a
welcoming environment, using printed information, easy-to-use portals,
basic/nonmedical language and clear speech, and asking and encouraging questions
(van der Scheer-Horst et al., 2023).

References

Coughlin, S. S., Vernon, M., Hatzigeorgiou, C., & George, V. (2020). Health Literacy,

Social Determinants of Health, and Disease Prevention and Control. Journal of

Environment and Health Sciences, 6(1), 3061.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7889072/

Gibson, C., Smith, D., & Morrison, A. K. (2022). Improving health literacy knowledge,

behaviors, and confidence with interactive training. HLRP: Health Literacy

Research and Practice, 6(2). https://doi.org/10.3928/24748307-20220420-01

van der Scheer-Horst, E., Rutten, G., Stortenbeker, I., Borkent, J., Swormink, W. K.,

Das, E., Staal, J. B., & van Lankveld, W. (2023). Limited Health Literacy in

Primary Care Physiotherapy: does a physiotherapist use techniques to improve

communication? Patient Education and Counseling, 109, 107624.

https://doi.org/10.1016/j.pec.2023.107624