The Social Determinants of Health: IACN Weighs In

Generally, it is accepted that there are two overarching factors that influence a person’s health: genetics and environment. Together, genetics and environment both play a role in a third way to think about health: lifestyle. Whether a person exercises, eats healthy, or participates in risky behaviors are all lifestyle choices that result from both genetics and environment. 

While these are all common ways to think about the factors involved in health, in an editorial recently published in The Journal of Nursing Education, Dr. Teri A. Murray, PhD, APHN-BC, RN, FAAN proposes we examine another: social determinants of health. We at the Illinois Association of Colleges of Nursing spoke with some of our members to get their insights on this interesting and important topic. 

SOCIAL DETERMINANTS OF HEALTH — WHAT ARE THEY?   

Social determinants of health are aspects of one’s environment that can have an influence on lifestyle and, therefore, overall health. In the editorial “The Future of Nursing 2020–2030: Educating the Workforce,” the Dr. Murray defines social determinants of health as “disparities (that) are often rooted in the environmental contexts and conditions in which people live, most often shaped by structural realities such as the distribution of wealth, power, social mores and cultural norms, economic, and political forces.” 

“Concrete examples of this would include socioeconomic status, accessibility to healthcare, and cultural considerations,” said Dr. Pam Ferguson, PhD, CNE, RN-BC, Dean of Nursing at Methodist College

Dr. Tina Decker, DNP, RN, CNS, Chair of Nursing at Trinity Christian College added that “access to food, safe housing, and income” are also important to consider. 

COMBATING NEGATIVE SOCIAL DETERMINANTS OF HEALTH  

Much like how the negative effects of genetics, environment, and lifestyle can be combated, so too can the negative health effects of an individual’s social situation. In the aforementioned editorial, the Dr. Murray suggests that a health in all policies approach is one way to do this. According to the Centers for Disease Control and Prevention, a Health in all Policies approach is “a collaborative approach that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people.” 

This approach encourages policy makers to consider health in all areas, including “housing, education, food security, transportation, and health services” (Farrer, Marinetti, Cavaco, & Costongs, 2015). 

While all of these different aspects should be considered, there is one that stands out from the rest.

“Most importantly, making quality healthcare available is absolutely key to this approach,” said Dr. P. Lea Monahan, PhD, RN, Director of Nursing and faculty at Western Illinois University

WHAT CAN NURSES DO?   

For a long time, nurses faced challenges impacting patient health outside of the acute care setting—especially with regards to social determinants of health. However, this is quickly changing. Many colleges in Illinois are developing curriculum to address both the overall culture of health, as well as the social determinants of health. 

“At my previous University, Rutgers, the State University of New Jersey, we introduced students to the RWJ website and The National Association of County Health Officials (NACCHO) toolbox which provides online learning modules in public health issues from a social determinants lens. At Northern Illinois School of Nursing, we’re developing academic/clinical partnerships that provide students the opportunity to learn about community health needs and how the social determinants of health influence health outcomes. We also have students experience interdisciplinary case studies with public health, occupational therapy, physical therapy and nutritional science ,” said Dr. Susan Caplan, PhD, MSN, APRN-BC, FAAN, Chair at the Northern Illinois University School of Nursing

Dr. Tiffany Greer, PhD, MSN, RN, Director of Nursing Programs at Olivet Nazarene University said that her university program opts for an all-encompassing approach. 

“We try to thread these concepts through the curriculum, not just in the Community Health course. We also focus on discussing these concepts with students in clinical settings, not just in the classroom. This includes having students follow a case manager, social worker, and/or home health nurse so they can see what patients have to face going home from acute care and why it is difficult for them to maintain their health.” 

At Illinois State University, nursing faculty are working together with community organizations to build a new model of healthcare, with the goal of elevating nurses to work at the top of their license while impacting patient care outside of the hospital. 

“Our CAUSE initiative aims to increase the number of nurses working in primary care and prevent hospital readmission. Under the model, nurses work at the center of a coordinated care team that includes professionals from a variety of disciplines, including social work, nutrition, audiology, exercise science and others. Collectively, the team works to manage chronic illness, mental health, and substance issues,” explains Dr. Judy Neubrander, EdD, FNP-BC, Dean of Mennonite College of Nursing at Illinois State University.

CHANGING HEALTHCARE  

While all of these are important ways to address the negative effects of social determinants of health, alone, they do not go far enough. In order to implement a health in all policies approach, nurses, as the largest and most trusted profession in healthcare, need to be active in their communities to advocate for this change. Fortunately, many Illinois universities are leading this charge. 

“Our college shares information regarding legislative issues, reaches out to all political offices, and supports state and local nursing organizations that are critical in the political arena,” Dr. Ferguson explains. 

Dr. Greer added, “Olivet encourages nurses to interact with policy-makers to learn how they can affect change.”

“It is obvious to all of us that healthcare is changing. Nurses must come to the table and help lead that change. Nursing has the answers to many of today’s healthcare challenges,” explains Dr. Neubrander. 

Overall, it is through this cultural shift that nurses–in Illinois and elsewhere–will be a catalyst for ensuring that people’s health needs are being addressed in all aspects of life.