Katie Feldner
College of Nursing PhD Student
University of Utah
Social Determinants of
Health
There is a shift in acknowledging social determinants and
how they influence overall health. Social determinants of health (SDOH) reflect
the environment and conditions in which people are born, live and die.
Determinants can have positive or negative consequences depending on the forces
which have shaped one’s daily life (Healthy
People 2030).
In context, SDOH are influenced by income and
occupation, lifestyle, social behavior, community characteristics, housing and
neighborhoods, discrimination and inequality, and economic situations, which
are defined as determinants, social factors or needs. These factors once regarded as a secondary affliction to
negative health outcomes are now being recognized as primary causative factors of
chronic illnesses (Cockerham et al. , 2017).
The History of Social Factors and
Health
Social factors that affect health
outcomes can be linked all the way back to the 14th century with the
black plague. The black plague was a global epidemic caused by Yersinia Pestis;
bacterium that was transmitted from rodents to humans. The epidemic killed over
25 million people in Asia and Europe and those of lowest socioeconomic status
were predominantly affected (Cockerham et al., , 2017). Social factors,
however, are not limited to infectious disease. Cardiovascular, diabetes,
stroke, cancer, kidney, and pulmonary diseases serve as direct causes of
chronic diseases influenced by “ More than 21-chronic diseases, 12 types of
cancer, six types of cardiovascular disease, diabetes, and obstructive
pulmonary disease (Cockerham et al., , 2017, p. 2, para 2). The use of tobacco
products for example, has been correlated with social influence. A person who
spends time with family, friends, or a spouse who actively smokes is more
likely to adopt this behavior.
Western Medicine “The Quick Fix”
Traditionally, the U.S. health
care system has focused on treating an illness caused by a specific disease,
not the person. This is also known as the “quick fix”. While treating an acute illness is important,
adopting a holistic approach requires a different mindset. It requires clinicians
to get to know their patients environmental, social, cultural, circumstances
and to think about how this contributes to their overall well-being (Grubin,
2015).
Clinicians as Catalysts for Change
Clinicians play an active role in
addressing SODH because they
are at the frontlines of health care and important catalysts for change. They
are well-positioned to support their patients in dealing with social needs and “
To raise awareness of the human cost and suffering as a result of poverty, discrimination, violence and social
exclusion. To advocate for better living conditions, reduce health inequities,
and increase awareness in systems to care for those in need” (Andermann, 2016, p.4 para 6).
Addressing Social Factors
Social needs should be approached in a compassionate
and caring way. Evidence suggests patients are more forthcoming about their
concerns when therapeutic communication is utilized. A trusting relationship
yields a more accurate diagnosis and timely interventions. Once a social need
diagnosis is made it is imperative to connect the patient with supportive
resources beyond the health care system (Andermann, 2016).
Addressing SODH is also a collaborative
effort with communities. Public health sectors are aware resources available in
the community and can aid in facilitating community based interventions. Clinical– community relationships foster
relationships that can have meaningful outcomes for people with social needs (e.g.,
offering low-cost daycare and early childhood education opportunities, introducing
violence prevention programs in schools, increasing the number of parks and
green spaces, banning soda-vending machines, creating bicycle lanes or
introducing farmer’s markets to combat food deserts). The earlier clinicians engage in a
partnership with public health, the more impactful health promotion and disease
prevention are (Andermann, 2016).
Current Barriers and Potential Facilitators
|
Barriers |
Facilitators |
|
Patient Discrimination |
Identify a safe space for
communication Establish trust Foster a therapeutic relationship |
|
Avoid Bias |
Adopting a holistic approach to health
care Adopt cultural inclusivity Role model positive behavior |
|
Time |
Empower systems to consider active vs.
reactive approaches to health Anticipatory care is central to
disease prevention |
|
Deficient Knowledge in Resources |
Become an active member in community Partner with Public Health officials Obtain a list of resources for referrals Advocate for ongoing training |
|
Resistance |
Influence Policy Change Be an Activist |
References:
Andermann, A., & CLEAR Collaboration (2016). Taking
action on the social determinants of health in clinical practice: a framework
for health professionals. CMAJ : Canadian Medical Association journal =
journal de l'Association medicale canadienne, 188(17-18),
E474–E483. https://doi.org/10.1503/cmaj.160177
Grubin, D. (2015). Defining
Challenges: How Disease-Based, Doctor-Centered Medicine Is Failing Us. Retrieved
on April 25th, 2022, from: https://rxfilm.org/problems/how-diseased-based-doctor-centered-medicine-is-failing-us/
Cockerham, W. C., Hamby, B. W.,
& Oates, G. R. (2017). The Social Determinants of Chronic Disease. American
journal of preventive medicine, 52(1S1), S5–S12. https://doi.org/10.1016/j.amepre.2016.09.010
Healthy People 2030, U.S. Department
of Health and Human Services, Office of Disease Prevention and Health
Promotion. Retrieved on March 31, 2022, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health
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