Question

One of the topics for next week is The Social Determinants of Health Model. You will see a handout about it under the readings for next week. First how would you describe social determinants of health? Why is this model important for us to understand? Provide two examples from the readings or films that are explained or could be better understood from the perspective of the Social Determinants of Health.

Answer 1

Social Determinants of Health

Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighbourhood) have been referred to as "place". In addition to the more material attributes of "place", the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy food, local emergency/health services, and environments free of life-threatening toxins.

Healthy People 2020 Approach to Social Determinants of Health

A "place-based" organizing framework, reflecting five (5) key areas of social determinants of health (SDOH), was developed by Healthy People 2020. These five key areas (determinants) include:

1. Economic Stability.

2. Education.

3. Social and Community Context.

4. Health and Health Care.

5. Neighbourhood and Built Environment.

Each of these five determinant areas reflects a number of key issues that make up the underlying factors in the arena of SDOH.

1. Economic Stability: Employment, Food Insecurity, Housing Instability, and Poverty.

2. Education: Early Childhood Education and Development, Enrollment in Higher Education, High School Graduation, and Language and Literacy.

3. Social and Community Context: Civic Participation, Discrimination, Incarceration, and Social Cohesion.

4. Health and Health Care: Access to Health Care, Access to Primary Care, and Health Literacy.

5. Neighbourhood and Built Environment: Access to Foods that Support Healthy Eating Patterns, Crime and Violence, Environmental Conditions, and Quality of Housing.

This organizing framework has been used to establish an initial set of objectives for the topic area as to identify existing Healthy People objectives (i.e., in other topic areas) that are complementary and highly relevant to social determinants. It is anticipated that additional objectives will continue to be developed throughout the decade.

Why emphasize social determinants?

1) Social determinants of health have a direct impact on health.

2) Social determinants predict the greatest proportion of health status variance (health inequity).

3) Social determinants of health structure health behaviours.

4) Social determinants of health interect with each other to produce health.

The Importance of Considering the Social Determinants of Health :

Social determinants have a major impact on health outcomes - especially for the most vulnerable populations. Factors such as a patient's education, income level and environment must be considered when providing treatment and care.

It is essential for primary care providers - such as nurse practitioners educated in FNP programs - to consider social determinants of health to enable more holistic, comprehensive healthcare for the patients and families they serve.

Examples of social determinants include:

1. Availability of resources to meet daily needs (e.g., safe housing and local food markets).

2. Access to educational, economic, and job opportunities.

3. Access to health care services.

4. Quality of education and job training.

5. Availability of community-based resources in support of community living and opportunities for recreational and leisure-ime activities.

6. Transportation options.

7. Public safety.

8. Social support.

9. Social norms and attitudes (e.g., discrimination, racism, and distrust of government).

10. Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community).

11. Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it).

12. Language/Literacy.

13. Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media).

14. Culture.