There’s a growing consensus in the healthcare industry that healthcare delivery requires more than just clinical considerations. Healthcare challenges no longer exist in a vacuum of their own but are rather intertwined with a mix of non-medical issues.
In many instances, people tend to focus only on the medical factors surrounding an issue, blindsided to the underlying social factors. The need to embrace a more comprehensive approach to healthcare delivery grows more salient by the day.
Every day, research continues to shed light on how big of an impact some seemingly unimportant factors, like ZIP code, housing stability and childhood education could have in maintaining a healthy life. In Chicago, alone, for instance, studies show that life expectancy can vary as much as 30 years or more across different neighborhoods within the city.
It’s becoming clearer that individuals no longer have as much power over their health as previously thought, and social factors beyond their immediate control can seriously impact their access to healthcare.
In this dossier, we explore how the distribution of social determinants impacts healthcare delivery and the moral and ethical responsibilities that this foists on healthcare workers.
What are the social determinants of health?
Social determinants of health (SDOH) describe the conditions in which people live, including their work, lifestyle, education, skills, attitude, and beliefs. These SDOH span from community-level factors affecting a community at large, such as programs and policies, income levels, discrimination and access to opportunities, to survival and social needs, such as housing stability, food security, access to education and then access to healthcare delivery, such as quality of care and treatment for chronic illnesses.
Most experts agree on the following rough categorization of SDOH:
Race and ethnicity
This encompasses issues relating to the dominance or suppression of races and ethnic groups, including:
- Racism
- Stereotyping
- Immigration status
- Microaggression
Wealth and income
Wealth and income distribution also influence the predisposition of people to diseases, sickness episodes, mortality and lifestyle habits, like smoking, etc. For instance, people from low-income backgrounds are more vulnerable to issues, like heart problems, diabetes, stroke and other chronic conditions.
Access to quality care
Healthcare inequity is a raging problem in many communities, with access to healthcare delivery unevenly distributed among neighborhoods or social or income classes. Studies show that equitable healthcare delivery could go a long way in preventing caseloads of ailment episodes, unnecessary disabilities and deaths.
Academic background
A person’s education reflects many other social factors and is therefore heavily linked to healthcare outcomes. Studies show that the more advanced a person’s education is, the less likely it is that they will develop conditions, such as heart disease, diabetes, liver disease and cancer. High levels of education are often associated with higher income and higher socioeconomic status, representing a greater capacity for healthy living.
Housing stability
The kind of accommodation a person occupies, their location and their housing stability can also influence their ability to live healthily. Homelessness and housing instability can cause greater exposure to such illnesses as tuberculosis, HIV, mental illness, etc. Also, people in rural areas often lack easy access to quality healthcare facilities.
Food security
Food-related problems, such as diabetes, birth defects, cognitive issues and high hospitalization rates, are often prevalent in communities grappling with food insecurity. One study points out that diabetes has a prevalence rate of 14.7% in American Indian communities, 11.7% in Black communities and 12.5% among Latino communities, but just 7.5% among White communities.
Environmental factors
People living in areas with relatively higher levels of pollution tend to be more exposed to health issues. Environmental issues, such as access to clean water, air pollution, harmful agricultural chemicals, etc., are often prevalent in low-income communities, exacerbating issues with inequitable healthcare delivery.
Shaping the influence of SDOH on healthcare delivery as a nurse
As the first line of defense against health issues in a community, nurses can wield a huge influence on how SDOH affects access to healthcare. Through direct and indirect means, they can promote social justice and health equity. Their intervention can draw positive attention to these sociocultural challenges and help forge lasting solutions.
Whether you work in a community health center, a large public healthcare organization or a private clinic, here are tips to help you better address social determinants of health (SDOH) in your line of work:
Establish SDOH from the onset
SDOH assessments should form a vital part of your initial conversations with patients. Here’s a checklist of issues to discuss:
- Employment
- Food security
- Eating patterns
- Housing stability
- Early childhood education and development
- Enrollment in higher education
- Language and literacy
- Educational, economic and job opportunities
- Access to physical and mental healthcare
- Housing
- Clean drinking water
- Public safety
- Social support
- Civic participation
- Discrimination
- Incarceration
- Social cohesion
- Health literacy
- Neighborhood and built environment
- Crime and violence
- Environmental conditions
- Quality of housing
Engage on the community level
Gain insights into community-wide issues affecting your patients. Think of ways to help your patients get assistance for these issues. Engage with social service agencies on your patient’s behalf and also advocate for better access to healthcare on the community level.
Engage in public advocacy
As a nurse, you need to have a firm understanding of how programs and policies affect the well-being of members of your community. Nursing programs these days, like Baylor nursing online, explore the issue of public advocacy extensively. Baylor’s nursing program brings students abreast with relevant policies and practices and also equips them to become policy influencers in their own way.
Collaborate across sectors and disciplines
As a nurse, you can use your soft communication and persuasion skills to get people from other disciplines and sectors on board with plans for more equitable healthcare delivery. For instance, you can nurture a good rapport with players in the food industry, transportation industry and housing industry to help drive better health outcomes for your patients.
Be the bridge builder for better access to healthcare in your community
The responsibilities of nurses these days extend beyond the medical sphere activities, encompassing the social and individual issues affecting a patient.
To save more lives and promote healthy living, nurses today need to do their best in fostering inclusion, equity and diversity in healthcare delivery.
