As a surgical intensive care nurse, I spent most of my career caring for patients at the height of their illness acuity. On the other end of the spectrum are the primary care and public health nurses who focus their efforts on illness prevention and managing chronic conditions. As clinicians, we are all trained to assess aspects that impact our patients’ health such as family history, exercise, diet, medication adherence, smoking, alcohol and drug use. While nurses take a more holistic approach to patient care, we also have a tendency to focus on our patient’s immediate medical issues, often overlooking the broader external factors that ultimately have significant long-term consequences. The individual patient circumstances that are gaining greater awareness in practice due to their effects on “health disparities, health outcomes, and overall quality of health” are called social determinants of health (SDOH) (Persaud, 2018).
What are social determinants of health?
The World Health Organization (WHO, 2019) defines SDOH as the conditions in which people are “born, grow, work, live, and age, and the wider set of forces and systems” (economic, social policies, and political systems) that shape the conditions of daily life. These SDOH affect a person’s health, functioning, and quality of life outcomes and directly result in health inequities which could be avoided if all individuals are provided with equal access to social and/or economic resources (Kneipp et al., 2018).
The Office of Disease Prevention and Health Promotion (ODPHP), a US government agency, launched the Healthy People campaign to provide science-based, national objectives to improve the health of all Americans. As part of the Healthy People 2020 strategic mission, the organization strives to develop public awareness and understanding of the determinants of health, disease, and disability (ODPHP, 2019a). Healthy People 2020 (ODPHP, 2019b) and the Centers for Disease Control and Prevention (CDC, 2017) categorize the SDOH into five essential areas which include several key interrelated issues:
- Economic stability
- Social and community context
- Health and health care
- Neighborhood and built environment
Resources that improve quality of life, such as “safe and affordable housing, access to education, public safety, healthy food, local emergency/health services, and environments free of life-threatening toxins,” can improve population health outcomes (ODPHP, 2019b).
How can nurses influence SDOH?
There is a growing need to increase the skills of nurses to assess SDOH. Strategies that nurses and nurse leaders can implement to address SDOH issues include (Olshansky, 2017; Persaud, 2018):
- Incorporate SDOH curriculum into all clinical courses, ensuring students routinely assess for SDOH in clinical rotations.
- Strengthen interdisciplinary collaboration with social work, public health, city planning, occupational health, police, and fire fighters to ensure care is delivered effectively at the community level.
- Include SDOH in administrative policies.
- Stay current on proposed legislation and their potential effects on SDOH.
- Advocate for the use of documentation tools that utilize SDOH measures.
- Integrate SDOH into the standard assessment and electronic health records.
- Develop orientation programs and annual competency-based continuing education for new nurses that includes:
- Overview of SDOH
- Description of the community being served by the organization
- List of community resources that are available
- Foster opportunities for staff to share ideas.
- Conduct nursing research devoted to SDOH.
has compiled several tools and resources to help practitioners tackle social determinants of health. Nurses, as a profession, are well-equipped to take a leadership role in this underserved area. Have you addressed SDOH in your practice? Please share in the comments below.
Centers for Disease Control and Prevention. (2017). Social Determinants of Health: Know What Affects Health. Retrieved from https://www.cdc.gov/socialdeterminants/index.htm
Kneipp, S.M., Schwartz, T.A., Drevdahl, D.J., Canales, M.K., Santacroce, S., Santos, H.P., & Anderson, R. (2018). Trends in health disparities, health inequity, and social determinants of health research – A 17-year analysis of NINR, NCI, NHLBI, and NIMHD funding, Nursing Research, 67(3), 231-241. doi: 10.1097/NNR.0000000000000278.
Office of Disease Prevention and Health Promotion. (2019a). About Healthy People. Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People
Office of Disease Prevention and Health Promotion. (2019b). Social Determinants of Health. Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
Olshansky, E.F. (2017). Social determinants of health: The role of nursing. American Journal of Nursing, 117(12), 11. doi: 10.1097/01.NAJ.0000527463.16094.39.
Persaud, S. (2018). Addressing social determinants of health through advocacy, Nursing Administration Quarterly, 42(2), 123-128. doi: 10.1097/NAQ.0000000000000277
World Health Organization. (2019). Social Determinants of Health. Retrieve from https://www.who.int/social_determinants/en/