Social Determinants of Health: Implications for Voice Disorders and Their Treatment

Abstract

Purpose: Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations. Conclusions: This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.

Measurements of the effect of interventions on heathly voices: a scope review

“…In speech-language-hearing (SLH) therapy, the recent planning of the American Speech-Language-Hearing Association (ASHA) recommends that the profession increase its emphasis on preventive and occupational medicine by 2030 to improve the quality of life in healthy populations, addressing communication health determinants and the healthy lifestyle related to human communication (5) . As for the field of voice, specifically, people with no voice complaints related to dysphonia seek SLH care to improve their voice and communication and improve their social and occupational participation (6,7) . Great heterogeneity was recently observed in the design of studies aiming to verify the characteristics and effects of SLH intervention in vocally healthy individuals (6) .…”

Medidas de efeito das intervenções em vozes saudáveis: uma revisão de escopo

“…Na Fonoaudiologia, o planejamento recente da American Speech-Language-Hearing Association (ASHA) recomendou que até 2030 a profissão ampliasse a sua ênfase na medicina preventiva e no trabalho, para melhorar a qualidade de vida em populações saudáveis, atuando sobre os determinantes da saúde da comunicação e sobre o estilo de vida saudável relacionado à comunicação humana (5) . Especificamente na área de voz, constata-se que pessoas sem queixa vocal relacionada à disfonia têm procurado o cuidado fonoaudiológico para melhorar a voz e comunicação, com objetivo de ampliar a sua participação social e no mundo do trabalho (6,7) . Recentemente, observou-se que há grande heterogeneidade em relação aos delineamentos de estudos cujo objetivo era verificar as características e os efeitos da intervenção fonoaudiológica em indivíduos com vozes saudáveis (6) .…”