1. Davis, Sandra

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As deputy director for the National League for Nursing (NLN)/Walden University College of Nursing Institute for Social Determinants of Health and Social Change, I am excited to introduce our readers to this groundbreaking initiative. This article highlights the institute's timely and critical need and provides important information about the institute's vision, mission, and implementation



The World Health Organization defines social determinants of health (SDH) 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 (World Health Organization, 2008). These forces and systems include political and economic policies and systems, social policies and norms, and societal institutions.


It has been known for centuries that social, environmental, economic, and structural factors influence health, health care delivery, and health outcomes (Du Bois, 1899). Increasingly over the past 20 to 30 years, serious attention has been given to health inequities, the unfair and avoidable differences in health between groups of people that stem from social and structural determinants of health and result in health disparities (Braveman & Gottlieb, 2014; National Academies of Sciences, Engineering, and Medicine, 2016; Smedley et al., 2003). In the United States, the COVID-19 pandemic highlighted stark underlying inequities and disparities in health and health care across segments of the population, with highest rates of risk, infection, and death for communities of color (Manatt Health, 2020). Furthermore, it underscored the urgent need for the education of a health professions workforce equipped to engage in transformative social change and eliminate the unfair and avoidable differences in health, health care delivery, and health outcomes.



The Future of Nursing 2020-2030 report stresses the role of nursing education in ensuring that nurses are prepared to address SDH and achieve health equity (National Academies of Sciences, Engineering, and Medicine, 2021). However, SDH are not well integrated into undergraduate and graduate nursing education (Tilden et al., 2018). As a result, the emerging nursing workforce may not be prepared to assess SDH, their impact, and the broader structural influences on health, social justice, and health equity (NLN, 2019).


The collaboration between the NLN and Walden University College of Nursing reflects contemporary thinking about the role nursing education must play not just in teaching SDH but also in equipping nurses with the knowledge and skills to understand and change the broader systems and structures. The institute will develop and cultivate interprofessional leaders with a deep understanding of the how and why from a systems approach that incorporates organizational, systemic, and sociopolitical contexts. This is often missing in teaching about SDH. When leaders understand how and why things came to be the way they are and who benefits and who does not, they are able to employ a social justice and health equity lens that incorporates an understanding of the historical injustices and the contemporary factors that perpetuate these injustices (Sharma et al., 2018). Leaders prepared in this way can develop the competencies to integrate fully the SHD and social change into programs and curricula. In addition, they engage in research and other scholarly activities leading to solutions with broad dissemination.



The NLN formed a partnership with Walden University College of Nursing and created the Institute for Social Determinants of Health and Social Change to prepare educators and practitioners of the health care interprofessional team to provide safe and quality care based on a social change model. Walden University's mission, to "provide a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they may effect positive social change," and its vision, "where graduates can apply the rich knowledge to the immediate solutions of critical societal challenges, thereby advancing the greater global good," complement the NLN mission (Walden University, 2021).


The NLN mission, to promote "excellence in nursing education to build a strong and diverse nursing workforce to advance the health of the nation and the global community," is guided by four dynamic and integrated core values that permeate the organization and are reflected in its work: caring, integrity, diversity, and excellence (NLN, 2021). The NLN further believes that health is inextricably linked to the social, economic, environmental, political, and cultural forces that shape the world around us, and SDH should be integrated throughout graduate and undergraduate nursing courses and not isolated in community-based courses (NLN, 2019).



The Walden University College of Nursing/NLN Institute for Social Determinants of Health and Social Change is housed in the NLN Center for Transformational Leadership under the leadership of chief program officer Dr. Janice Brewington. Over the next five years, the institute will


1. prepare nurse educators and other interprofessional colleagues to develop leadership competencies and integrate social change in their programs, addressing SDH in their programs and/or curricula;


2. prepare nurse educators and other interprofessional colleagues to become leaders of social change; and


3. explore opportunities to engage in research and scholarly activities related to SDH and social change.



The cornerstone of the institute is the yearlong NLN/Walden University College of Nursing Leadership Academy for Social Determinants of Health and Social Change for competitively selected health professionals. The program consists of focused activities that will instill a visceral and conceptual understanding of health inequities and disparities through social and structural determinants of health. These activities will include experiential exercises, such as role-playing, webinars, live interactive group calls, an intensive leadership retreat, individual leadership projects, and the annual NLN Education Summit. The institute started to accept applications for the academy in December 2021.


The institute will culminate in a two-day Interprofessional Conference on Social Determinants of Health and Social Change that will highlight the institute's accomplishments and present research and innovations in SDH and social change. Participants will be health professionals across nursing and other health professions including, but not limited to, education and practice, public health, social work, and mental health.


A goal of Healthy People 2030 specifically related to SDH is to create social, physical, and economic environments that promote attaining the full potential for health and well-being for all (US Department of Health and Human Services, n.d.-a, n.d.-b). The NLN and Walden University recognize that health and well-being can be experienced more equitably through innovative contemporary thinking, bold action, and a commitment to developing catalysts for change through leaders who engage in transformative social change.




Braveman P., Gottlieb L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 9-31. [Context Link]


Du Bois W. E. B. (1899). The Philadelphia Negro: A social study. University of Pennsylvania Press. [Context Link]


Manatt Health. (2020, November). State strategies for overcoming barriers to advance health equity. Princeton University.[Context Link]


National Academies of Sciences, Engineering, and Medicine. (2016). A framework for educating health professionals to address the social determinants of health. National Academies Press. [Context Link]


National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. National Academies Press. 10.17226/25982 [Context Link]


National League for Nursing. (2019). A vision for integration of the social determinants of health into nursing education curricula [NLN vision series].[Context Link]


National League for Nursing. (2021). About.[Context Link]


Sharma M., Pinto A. S., Kumagai A. K. (2018). Teaching the social determinants of health: A path to equity or a road to nowhere?Academic Medicine, 3(1), 25-30. [Context Link]


Smedley B. D., Stith A. Y., Nelson A. R.Institute of Medicine (U.S.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press. [Context Link]


Tilden V. P., Cox K. S., Moore J. E., Naylor M. D. (2018). Strategic partnerships to address adverse social determinants of health: Redefining health care. Nursing Outlook, 66(3), 233-236. [Context Link]


US Department of Health and Human Services. (n.d.-a). Healthy People 2030.[Context Link]


US Department of Health and Human Services. (n.d.-b). Healthy People 2030: Social determinants of health.[Context Link]


Walden University. (2021). Vision, mission, and goals.[Context Link]


World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health [Final report].[Context Link]