Social determinants of health: What nurses need to know

Social Illustration
Credit: Stocksy

As a nurse, you have likely seen the same person get readmitted to your facility over and over again, or perhaps you have wondered what led to a certain patient’s illness. What did the person do or fail to do to stay healthy?

For all the money the United States spends on health care (we are at about $3 trillion a year), we should be the health­iest people in the world. Yet on some of the most impor­tant indica­tors, such as life expectancy, we’re not even in the top 20 devel­oped countries. Surely we have been overlooking something.

Nurses are well positioned to help their facil­i­ties meet the Triple Aim – reduce costs, improve outcomes and improve patient experi­ence of care. But to more success­fully reform the health care system, it’s crucial to under­stand – and artic­u­late to others – what are the most impor­tant contrib­u­tors to a person’s health, why some people are healthier than others, and how we can ensure health equity for every­body and address health disparities.

Factors that determine health #

Most people do not think about health in terms of social factors. In fact, research has found that most Ameri­cans tend to view their health as something largely under their control and for which they have to take personal responsibility.

The real answer is more complex. We know that condi­tions in which people are born, grow, live, work and age, known as the social deter­mi­nants of health, combine together to affect the health of individ­uals and communities.

These circum­stances are shaped by the distri­b­u­tion of money, power and resources at global, national and local levels. We know that a person’s level of educa­tion, employ­ment and income is the single-biggest predictor of their health status – more so than healthy behav­iors, access to and utiliza­tion of clinical care, and their physical environment.

On the same note, these social deter­mi­nants are mostly respon­sible for health inequities – the unfair and avoid­able differ­ences in health status seen within and between countries.

Under­standing that the context of people’s lives deter­mines their health proves that blaming individ­uals for having poor health or crediting them for good health won’t move our needle on outcomes on the national scale.

What nurses should know #

Acknowl­edging that health starts in our homes, schools and commu­ni­ties is the first step toward building a culture of health. So what can nurses in acute care or non-commu­nity positions do? Asking your patients the right questions about some social factors that affect their lives can shape more effec­tive inter­ven­tions. Do they have access to:

  • Educa­tional, economic and job opportunities
  • Physical and mental health care
  • Housing
  • Clean drinking water
  • Fresh food
  • Trans­porta­tion
  • Public safety
  • Social support
  • Other factors?

As the advocate for your patient, you have the oppor­tu­nity to be their link to better health. Are you aware of social service agencies around you? Can you connect your patient to a service they need?

Look beyond your patients. Are you aware of the social inequal­i­ties people are experi­encing in your commu­nity? How do programs, practices and policies in the area affect the health of individ­uals, families and commu­ni­ties? Are there agencies that are working to tackle broad social issues? Do they need board members or committee members? Lend your exper­tise! As a nurse, you are solution-oriented, equipped with valuable knowl­edge and able to offer great insight.

You will find great resources on the Healthy People 2020 website. Educate your colleagues about how social factors lead to health disparities.

Let’s help others stop thinking of health as something we get in a hospital or clinic, but instead as something that starts in our homes, in our schools and workplaces, and in our playgrounds and parks. Our oppor­tu­ni­ties for health start long before we need medical care. Let’s ensure all Ameri­cans are as healthy as they can be.

This article was submitted by leaders of Washington Nursing Action Coalition’s Leader­ship workgroup:

Sofia Aragon, JD, BSN, RN, Washington Center for Nursing Execu­tive Director and Washington Nursing Action Coali­tion (WNAC) Co-Lead

Katie Eilers, MPH, MSN, RN, WNAC Leader­ship workgroup co-lead

Dorene Hersh, RN, MN, WNAC Leader­ship workgroup co-lead

Sarah Wicken­hagen, DNP, FNP, ARNP, WNAC Leader­ship workgroup co-lead

Kathy Mertens, MN, MPH, RN, WNAC Leader­ship workgroup member