Guest Column: Social determinants of health in small towns

By Julie Drake

RBC Director of Public Health

Julie Drake

RBC |  Every time I turn around I am reading and hearing about Social Determinants of Health (SDoH).  It is the latest research buzzword, emphasis for funders and focus for reducing healthcare costs and improving outcomes. 

SDoH is the theory that brings into better focus the “nurture” component of the nature v. nurture debate over human success. I have seen for years the impact culture has on health. Culture is the old term, social determinants the new. 

Try this quick geography task. Look up the following communities:  San Acacio, Colo.; Guffey, Colo.; Robertson, Wyo.; Yoder, Wyo.; Herndon, Kans., Norcatur, Kans. What do each of these communities have in common?  All have fewer than 200 people and have, virtually no healthcare resources.  All are places where I have worked. Most people would guess that sick people in these communities do poorly and suffer.  Actually, many times they thrived, albeit not easily. 

I learned about self-reliance quickly in these communities.  I remember confidently telling an elderly lady, who was using a walker for the first time, to pull up all her throw rugs for safety.  She politely smiled and said “pull up a corner and see if you think it will be safer.”  I did and found a dirt floor. Teaching another lady to safely balance  a .22 rifle on a walker so she could still enjoy hunting squirrels was another challenge. Helping build a ramp into a horse trailer so parents of a severely disabled child had a way to haul a 500 pound power wheelchair with them when they traveled. Politely refusing a burned sugar and onion drink when I showed up at a patient’s house with laryngitis. Marveling at the stitches a retired veterinarian put in an uninsured man’s arm wound. These people were taking health, wellbeing and safety into their own hands because there was no other option. 

People in Rangely and Meeker are no different and could undoubtedly add to the lists of creative home treatments.  We are proud of our isolation, self-reliance, ingenuity and will to survive. Our rural culture is unique. This serves us well most of the time, but at other times it fails us miserably and leads to harmful self-treatment or fixes. Opioid and drug use, suicide and alcoholism remains high in our county. Not a fun topic, but one that needs discussed. Next week’s column might be an eye opener for many.