Social determinants of health: What nurses need to know

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.