The Social Determinants of Health (SDOH) are the conditions in the environment, not including genetic or biological factors, that affect a wide range of health and quality of life outcomes (Schoon & Porta, 2024). They are organized into five broad categories: Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, Social and Community Context, and Economic Stability (US DHHS, 2021). Disparate impacts are seen in several areas but notably for racial minorities. Schoon and Porta (2024) discuss the effects of both overt and covert racism in all SDOH areas: poverty that leads to less safe neighborhoods, chronic stress leading to chronic mental and physical health conditions, higher maternal and infant mortality rates, and poorer access to health care.
Public health nurses (PHNs) participate in and carry out case management, health teaching, community outreach, and advocate for clients at the individual, community, and systems level (Schoon & Porta, 2024). Interestingly, the University of Kansas includes actions not traditionally thought of as nursing actions, such as registering voters, petitioning and boycotting, and even use of social media for outreach (University of Kansas, 2020). A simple advocacy action could be availing oneself of the public health/SDOH continuing education opportunities available on the CDC website, which include emergency preparedness and health equity training. (CDC, 2022). In my current ambulatory care nursing practice, I apply a good deal of health teaching to patients with low health literacy, and a level of informal case management, as I coordinate between specialty silos in a large organization even between specialty providers in my own department. Simply helping to navigate the system is often the largest help to patients.
Of the three specialty areas discussed by Eardley and Schoon (2022), school nursing holds the greatest interest for me; however, correctional nursing might stand out as a specialty where the SDOH and their disparities are notable. I spent 15 years in EMS, and my service area included both a juvenile detention center and a Minnesota Department of Corrections facility. The intersection of poverty, unsafe homes and neighborhoods, lack of access to health care, and lack of educational opportunities, simply could not have been more evident. Although hearing these patients’ stories in any depth was not a standard part of the care I provided, on the occasion I did hear them, Incarceration often seemed inevitable and even expected; they didn’t hope for any better out of their life. From the outside, it seemed like they never had a chance, especially for the adolescents. While my exposure was limited, it often seemed to me that chronic conditions often developed or worsened as well; prison is not a place to stay safe or get healthy, despite the work of good people.
It is hard to imaging changing a system like this one. I don’t think it would be feasible to bear much change in the areas of Economic Stability and Built Environment. If I look specifically at racism under the guise of Social and Community Context, I can examine my own biases for any discrimination or assumption in my own care of clients, and I can call it out in the community or systemically. Tying in to Health Care Access and Quality, I can provide high-quality services and educate clients on their conditions (i.e. health literacy, Schoon & Porta, 2024). If preventative care is not offered, I can advocate for that, and for oral health as well (US DHHS, 2021). Other ideas that come to mind is advocating for physical fitness resources or better nutrition options for clients. Lastly, in the area of Education Access and Quality, I can encourage clients to avail themselves of educational or library opportunities, and collaborate with the departments that provide these resources – this would contribute to psychological health for clients as well, and Economic Stability on release (i.e. high school graduation, language and literacy, Schoon & Porta, 2024). The above could also be accomplished through writing letters, lobbying, grant writing, as outlined by the University of Kansas (2020). The Minnesota Department of Corrections website states, Medical Services provided on site include physician services, physician’s assistant, dentist, lab, X-ray, psychiatric and psychological services, dietician, and basic nursing” (MDC, 2023). My advocacy would include collaboration with all these partners in care.
College of Nursing and Health Sciences F 23 – Evidence-Based Discussion Forum 1: Social Determinants of Health
GOAL: Students explore the impact of the social determinants of health that result in health inequities among at-risk and marginalized populations in order to identify social justice and advocacy actions they might take to mitigate health inequities.
OBJECTIVES:
Describe the social determinants of health.
Identify the impact of the social determinants of health on at-risk and marginalized populations and resulting health inequities.
Identify social justice and advocacy actions that could be taken by the nursing profession in collaboration with others to reduce or eliminate the health inequities that are a result of one or more social determinants of health.
Propose actions you might take to become more aware of the impact of social determinants of health if you are working in one of the PHN/CHN specialty roles.
DIRECTIONS:
READ AND VIEW
Read Schoon & Porta, (2024). Chapter 13, Evidence of Commitment to Social Justice, pp. 285-296.
Review Healthy People 2030 Social Determinants of Health content at Social Determinants of Health – Healthy People 2030 | health.gov. Read about the five domains of the SDOH and some of the related evidence (research) and efforts to address the SDOH in different communities.
See D2L Module 2/Week 2 Social Determinants of Health Expanded folder.
Review the Social Determinants of Health (Schoon) power point presented in Week 1 class.
Review one or more of the additional CDC SDOH websites:
SDOH Public Health Actions
Public Health Professionals Gateway
Equitably Addressing Social Determinants of Health and Chronic Disease.
Review University of Kansas. (2020). Community Toolbox – Addressing Social Determinants of Health and Development at
Discussed one or more social justice and advocacy actions that could be taken by the nursing profession in collaboration with others to reduce or eliminate the health inequities that result from specific social determinants of health with citations from textbook, one or more of the additional SDOH websites, and the Community Toolbox.
Identify a PHN/CHN specialty role and the at-risk population served by nurses in that PHN/CHN specialty role. Describe at least two SDOH that affect the health status of that at-risk population and the impact of these SDOH on the health status of that population. Make sure you have reviewed the power point by Eardley & Schoon on PHN/CHN specialty roles.
Discuss one or more social justice and advocacy actions that could be taken by you if you were practicing in the specialty role you identified to reduce the negative impact of the SDOH on your clients/patients. How would you work collaboratively with others to reduce or eliminate the health inequities experienced by that at-risk population? Cite Chapter 13 in your textbook and the Community Toolbox.
Peer Review Response Postings
Respond to two classmates who have selected a different PHN/CHN specialty role.
Compare one or more points from your initial discussion with the initial discussion of two of your peers.
Compare how the social determinants of health affected the health of the at-risk populations your peers discussed with how the social determinants of health impacted the population you discussed.
Compare the social justice and advocacy actions you identified for your at-risk population with the advocacy and social justice advocacy actions of your peers.
Cite sources of information and include a Reference List in APA format.
NURS 459 EBDF Social Determinants of Health Grading Rubric
Student: Instructor: Grade: ____/15
Criteria
Grade
Initial Post Described the social determinants of health and impact they have on different at-risk and marginalized populations with citations from textbook, Healthy People 2030 and/or Community Toolbox. (2 pts.)Discuss important points your learned from one or more of the following websites: SDOH Public Health Actions, Public Health Professionals Gateway, Equitably Addressing Social Determinants of Health and Chronic Disease. How could you use this information in your own nursing practice or in your community? (2 pts.)Discussed one or more social justice and advocacy actions that could be taken by the nursing profession in collaboration with others to reduce or eliminate the health inequities that result from specific social determinants of health with citations from two of the following: textbook, Healthy People 2020, and/or Community Toolbox. (2 pts.)Identify the PHN/CHN specialty role and the at-risk population served. Cite Eardley & Schoon’s power point. Describe at least 2 SDOH that affect that at-risk population’s health. (1 pt.)Describe what and what social justice and advocacy actions you could take if you were practicing in that PHN/CHN specialty role to reduce the impact of the SDOH on the at-risk population’s health status. Cite Chapter 13 in textbook to support your actions. (2 pt.)
/9 pts.
Peer Responses – Respond to each peer individually.
/4 pts.
APA & Writing Style Citations and References are included and in correct APA format with 2 mistakes or less in both initial and peer responses. (1 pt.)Discussion demonstrates critical thinking, and is organized with correct spelling and grammar. (1 pt.)