Social Determinants of Health (SDOH) (Nursing)

00:01 Today we're going to talk about the Social Determinants of Health.

00:05 Oftentimes, in health care when we consider the reasons that people get sick, we focus on their individual behaviors, or think about the type of clinical care that they have access to.

00:14 But the reality is that these two things only make up about 50% of the reasons that people get sick.

00:20 So what makes up the other 50%? Well, it's the social, economic, and environmental factors that surround the person.

00:28 This is what we call the social determinants of health.

00:33 The social and economic factors that surround an individual or a population account for 40% of the reasons that they get sick.

00:40 These include education, employment, income, family and social supports, as well as community safety.

00:48 The physical environment accounts for another 10% of the reasons that people get sick, and this includes air and water quality, as well as the quality of housing and transportation.

01:00 Again, these are what we call the social determinants of health.

01:04 Officially, the social determinants of health are defined as the conditions in the places where people live, learn, work and play that affect a wide range of health and quality of life risks and outcomes.

01:16 Some more examples of these include safe housing, racism, discrimination, an individual may face, educational opportunities, job opportunities, the availability of nutritious foods, water and air quality, as well as health literacy.

01:33 The social determinants of health are so important that healthy people 2030 included an objective specific to the social determinants of health.

01:42 They identified five areas that are important for public health nurses, and all nurses really to consider.

01:48 Those are economic stability, educational access and quality, health care access and quality, neighborhood and built environment, and social and community context.

01:58 So let's take some time to look at each of these individually, starting first with economic stability.

02:05 We know that individuals and populations living below the federal poverty line have worse health outcomes than those who are living above the federal poverty line.

02:14 And that's really just because there's an inability to afford the basic necessities that impact health.

02:20 Some of those basic necessities are access to health care, access to nutritious foods and access to safe housing.

02:28 So what can public health nurses do to address economic stability? Well, we can support employment programs.

02:36 We could support community based career counseling programs.

02:40 We can assure availability of high quality childcare options, and we can advocate for public policies that support economic stability, such as increasing the minimum wage.

02:51 But how do we know what's needed in a community? We have to start with our assessment.

02:55 Remember, that is the first part of the nursing process.

02:58 So once we do a community assessment, we're able to understand the unique needs of a community and then identify the specific strategy that will help address those needs.

03:09 So let's move on now to education access and quality.

03:13 Here are some examples of conditions that impact education access and quality.

03:18 Children who come from low income families or families who are living below the federal poverty line are less likely to have access to high quality education than others.

03:28 Sometimes children with disabilities don't always have access to the services that they need in order to obtain the education that others obtain.

03:37 And children who are experiencing discrimination or bullying are more challenged in the school setting to obtain educational success.

03:47 So again, what can public health nurses do to address education access and quality? Well, we can advocate for educational assistance for children who are living with disabilities.

03:57 Those may be physical disabilities, intellectual disabilities, or learning disabilities.

04:02 We can implement programs that address chronic conditions in schools.

04:06 We know that healthy students are better learners, and public health nurses are well positioned to address those chronic conditions within a school setting.

04:15 Maybe it's putting together a program to address asthma or diabetes.

04:19 Either way, we're working to ensure that our students are healthy and therefore are ready to learn.

04:25 We can develop programs that address issues such as bullying or discrimination within the schools.

04:30 And we can support alternative learning opportunities such as homeschooling or evening school for those who need it.

04:38 Let's move on now to health care access and quality.

04:42 There are several groups of people whose health is threatened by poor access to high quality health care.

04:48 In the United States, about 10% of our population does not have health insurance, and there are many more who are underinsured.

04:55 Because of this, people often delay or sometimes even for go health care services that they desperately need.

05:02 This is particularly true with preventative services such as annual visits, or recommended screenings that would often be performed in a primary care setting.

05:12 So, what can public health nurses do to address health care access and quality? Well, we can educate individuals and communities about affordable health insurance options.

05:23 In fact, some community based organizations have entire offices that are dedicated to doing just this.

05:28 They'll work with individuals that work with families to help them find affordable health insurance options that fit their needs.

05:36 We can also support access to health care through telehealth services in areas with limited access to in person health care.

05:43 This was particularly important during the COVID 19 pandemic.

05:47 At the time, I worked in a school based health center and our students weren't in school so they didn't have access to the care that they typically would.

05:54 So we pivoted and we started providing our services through telehealth.

05:58 This was particularly important for mental health services.

06:01 By providing telehealth services, our students had access to health care that they wouldn't have otherwise had during the pandemic.

06:10 Let's talk about the neighborhood and built environment.

06:13 Here are some examples of how the built environment can impact our health.

06:18 It can impact our health through neighborhood violence.

06:21 And when you live in a neighborhood that is impacted by violence, not only are you at risk for being a victim of that violence, but it also impacts your daily life in other ways.

06:30 For example, you might not feel safe going to the park for physical activity.

06:35 You might not feel safe, say walk into a grocery store where you buy healthy foods.

06:40 The built environment also includes air and water quality.

06:44 So we consider pollutants.

06:46 This is especially important for communities that are surrounded by industrial areas.

06:51 We also need to be aware of the occupational health hazards that residents in the community face.

06:57 This could be anything from, say a person who's working in a beauty salon who's exposed to chemicals all day, or a construction worker who has a lot of physical strain put on their body through their work.

07:11 So what can we as public health nurses do to address these neighborhood and built environment factors? Well, we can develop and implement violence prevention programs, and this can look wildly different based on the community that you're working in.

07:24 This could be developing programs that build relationships between residents and police officers.

07:30 It could be implementing after school programs to provide a safe space for children after school hours.

07:37 We could also advocate for environmental health policies, and address occupational health concerns.

07:42 We could do that through either working with the employer, or by educating the employee about the risks that they face during their job.

07:51 And finally, we have social and community context.

07:54 This is really looking at the entire community as a whole.

07:58 We consider the safety of the neighborhood.

08:01 We consider discrimination that residents might face, their challenges affording the things they need.

08:06 And maybe most importantly here, social supports.

08:09 We know that people who have support of their family, their friends, of their community have better health outcomes than those who lack those social supports.

08:19 So as public health nurses, we also have a role here.

08:22 We can facilitate community support groups.

08:25 In fact, I just recently saw a flyer at my local grocery store that was advertising a support group for grandparents who are parenting their grandchildren.

08:33 Now what a wonderful way to build support within a community.

08:38 We can also plan community wide events.

08:40 Examples could be community health fairs, or maybe even a park cleanup day.

08:46 So again, what I want you to remember is that when you think of the causes of illness, don't focus so much on those individual behaviors or that clinical care.

08:55 Really think about the social determinants of health, those social, economic and environmental factors that make people sick.

09:03 So in closing, it's really the social determinants of health that drive health outcomes.

09:09 As public health nurses, it's important for us to understand the social determinants of health so that we can develop programs that address the specific needs of those that we care for in the community.