Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Social determinants of health

Optometrists are an important part of the American health care system. We are recognized as physicians by Medicare, and as primary care providers in the Resource-Based Relative Value System for payment and our services are included in the essential elements of the Affordable Care Act.

Our roots and traditions, however, have been based on isolated private practice models that have provided “standalone” vision services that have not considered the overall health of the patient and certainly not the health environment of the communities in which we live.

We are not alone in our outdated care delivery system. Most traditional health care providers, many of our hospitals and urgent care centers are also victims of our 20th century traditions and provide care in isolated care models. Our outdated system continues to focus on the treatment of disease and injury rather than prevention, wellness and health education. This is why America rates so low in world population health studies that look at the wellness factors of our society.

Both the World Health Organization and the American Public Health Association have studied population health and identified a number of factors that affect the health and longevity of different places and cultures. Beyond the health care services provided by doctors and clinics, a number of other factors contribute to the health of each society. These can be summarized by five key factors:

--neighborhood and built environment;

--economic stability;


--social and community context; and

--health and health care.

If we can get past the fireworks of repealing, replacing, revising and repairing our health care laws, our federal government has actually launched some important work through the Office of Disease Prevention and Health Promotion. They have developed the “Healthy People” program that looks at American health issues for each decade. We are currently in the Healthy People 2020 program and working on the development of Healthy People 2030.

As primary care health care providers, we optometrists need to take a more active role in promoting public health information in our practices as well as the communities where we live, work and play. As leaders and role models we can affect the social determinants of health.

Here are a couple of tips to help you take a large role in improving the health of our nation

In your office:

--measure your patients’ vital signs at each office visit;

--review the vital signs along with family history, signs and symptoms and the results of your eye examination to develop a comprehensive management plan for each patient;

--promote healthily lifestyles that include diet, exercise and regular health care check-ups with posters and literature throughout your office; and

--be a member of the American Public Health Association and participate in their programs to promote health education and wellness.

In your community:

--be a resource for public health issues;

--support community efforts to improve health and wellness of your neighbors;

--be a well-informed leader on population health and the social determinants of health and how they affect your community; and

--be a vocal advocate for the public health agenda.

Being a health care provider is more than just being an excellent clinician and providing good health care. The eye and vision are not isolated systems that exist in a vacuum. They can only perform optimally as part of a healthy person that is part of a healthy community in a healthy society. We must all assume a broader role and look at the bigger picture if we are to improve the nation’s health.