Stephen R. Covey, author of The 7 Habits of Highly Effective People, said: "I am not a product of my circumstances. I am a product of my decisions." While that notion can be explained logically, many people find themselves struggling — for no other reason than their circumstances.
In healthcare, situations known as social determinants of health (SDoH) can be a significant barrier to care.
What Are Social Determinants of Health?
The World Health Organization (WHO) defines social determinants of health as, "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." SDoH are often grouped into the following five categories:
- Healthcare: access to care, health insurance, health literacy
- Economic Stability: poverty, unemployment, housing, food insecurity
- Education: level of education completed, language, literacy
- Social and Community Life: discrimination, incarceration, workplace hazards
- Neighborhood: housing quality, access to transportation, crime/violence, access to healthy food, water quality
All five groups contribute to one's overall health. For example, if a family lives below the poverty line, they also likely live in a neighborhood with little access to quality food and water. Their kids often go to schools with crowded classrooms. As a result, overall health literacy typically suffers.
The resulting impact on health is severe. In fact, the National Academy of Medicine estimates that medical care or "clinical factors" account for only 10 to 20% of "modifiable contributors to healthy outcomes." The other 80 to 90% is made up of SDoH.
There is significant research to supports this, too. A study out of the New York University School of Medicine found that life expectancy for Chicago residents can vary by more than 30 years, depending on where they live in the city's parameters.
Social Determinants of Aging
Recent research has found that aging is a contributing factor to SDoH. MedCity News writer, Karl Ulfers, calls it the social determinants of aging (SDoA) and says this includes housekeeping, technology support, food insecurity, environmental safety and social engagement.
The geriatric population is living longer but with more chronic illnesses. Caregivers are in short supply, resulting in issues like isolation and lack of healthcare access.
A Key Nursing Skill: Relationship Building
To effectively address SDoH in respect to healthcare settings, nursing leadership must advocate for solutions. However, real change often starts with nurses who are "in the trenches" and on the front lines of the healthcare system.
As the first line of care, nurses have a unique opportunity to build trust and positive relationships with patients. Having an authentic, transparent connection with patients allows nurses to better uncover which SDoH might be at play — and what sort of interventions might be needed. In this way, the role of the nurse has evolved. They are no longer simply taking and recording "data" (blood pressure, temperature, etc.). Instead, nurses are active participants in optimizing their patients' health on every level.
Beyond Hospital Walls
Nurse advocacy doesn't exist only within the walls of a hospital or clinic. Michael Cirigliano II believes that nurses hold the power to make change happen — both as professionals and community citizens. He urges nurses to work with community-based agencies on initiatives at the local level and even push for policy change at the state and federal levels.
"Looking outside of the healthcare system, nurses can amplify their voices and advocate for SDoH interventions. When it comes to addressing a patient's social needs, like food insecurity to lack of transportation or employment, it's clear that the U.S. healthcare system cannot cover all of the bases. That's where collaboration and communication beyond the healthcare realm play a critical role — and luckily, nurses are highly skilled in both areas," states Cirigliano.
An Emphasis on Education
Cirigliano's statements may seem like a tall order, but current nursing education programs actively prepare them to recognize and mitigate SDoH. Registered nurses earning their Bachelor of Science in Nursing (BSN) degree are often required to take specific classes, like the Population and Community Health Nursing course in the Registered Nurse (RN) to BSN online program at the University of North Carolina-Wilmington.
Another course in the program titled Gerontological Nursing and the End of Life Care covers issues specific to the aging population, including Ulfers' social determinants of aging. The Health Assessment for Registered Nurses course explores the ways environment, life choices, literacy and genomics impact holistic health.
Achieving Health Equity
There's no overnight solution for improving the impact of SDoH. However, every effort made now — especially among frontline nurses in both the classroom and the field — is one step closer to achieving health equity.
Learn more about the University of North Carolina-Wilmington's RN to BSN online program.
Covey, Stephen R. 2018. An Effective Life: Inspirational Philosophy from Dr. Covey’s Life. Blackstone.
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