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Social Determinants of Health"Social determinants of health are the economic and social conditions that influence the health of individuals, communities and jurisdictions as a whole." - (Raphael, 2004)
BackgroundWhile there are many contributors such as genetics, lifestyle choices and medical treatments that determine s health outcomes, the primary contributors to health outcomes are the conditions in which individuals live, work and play. These conditions, also known as the social determinants of health, are heavily shaped by money, power and resources which are influenced by economic policies and systems, social policies, political systems and development agendas. People whose basic needs are met are able to pursue opportunities which enhance the quality of their lives,and these individuals typically enjoy better health. Those who face poverty and systemic barriers have fewer life choices, face increased physiological and psychological stress and consequently generally have poorer health.
While is it well known that the social determinants of health greatly impact the health of British Columbians, priorities and interventions related to health continue to be heavily centred on screening for biomedical risk factors, changing one's lifestyle and prescribing medications , without addressing the systemic issues that are the root cause of poor health outcomes. By addressing the social determinants of health, it becomes clear that health outcomes of individuals heavily depend on one's physical, social, political and economic environment. Registered nurses (RNs) and nurse practitioners (NPs) play a significant role in addressing the social determinants of health at the micro, marco and meso levels. Further, RNs and NPs have the responsibility of advocating for, and supporting healthy public policy and principles of social justice, understanding the determinants of health, and the origins of health disparities and inequities, as outlined by the College of Registered Nurses of British Columbia. Recognizing the broad array of determinants and working towards reducing inequities requires inter-sectoral collaboration between governments, businesses, civil and health actors.
The fourteen social determinants of health as outlined by the Canadian Public Health Agency include:
- Income and Income Distribution
- Unemployment and Job Security
- Employment and Working Conditions
- Early Childhood Development
- Food Insecurity
- Social Exclusion
- Social Safety Network
- Health Services
- Aboriginal Status
All fourteen social determinants of health have been proven to have a stronger effect on the health outcomes of individuals than behaviour and lifestyle.
- RNs and NPs play an important role in advocating for British Columbians' health because they recognize the downstream impacts of poor determinants in their communities, schools, ERs and on the street. Many of the individuals who present with health issues in the ER have landed there as a result of lack of housing, poor nutrition, unemployment or poverty.
- RNs and NPs understand the impact social determinants have on the individuals and groups they work with and include these factors in their assessments. At a broader level, by advancing progressive policies that address the social determinants of health, nursing can improve the health outcomes of British Columbians.
- RNs and NPs have both a professional and ethical responsibility to promote health equity through action on the social determinants of health.
- Reducing health inequities, with a goal of eliminating them, must be a priority in all domains of nursing practice.
- ARNBC supports the concept of 'health in all policies', an approach to policymaking that considers the health impacts in areas such as finance, education, housing, employment and transport. It assists leaders and policymakers to 'integrate considerations of health, well-being and equity during the development, implementation and evaluation of such policies and services.
- Government must re-examine how cuts to social service organizations and funding organizations that support those suffering from socioeconomic disadvantages have negatively impacted these populations, and take immediate steps to develop new frameworks and resources, with support from the healthcare community.
- Government and all sectors need to recognize and work to achieve the principles outlined in the WHO's Commission on the Social Determinants of Health:
- Improve the conditions of daily life.
- Tackle the inequitable distribution of power, money and resources.
- Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health and raise public awareness of the social determinants of health.
Questions for Nurses
- Better Health: An Analysis of Public Policy and Programming Focusing on the Determinants of Health and Health Outcomes that are Effective in Achieving the Healthiest Populations
- CNA - Social Determinants of Health and Nursing: A summary of the issues
- Video - Michael Marmot, chair of the WHO Commission of Social Determinants of Health
- Health Inequities and Social Determinants of Aboriginal Peoples' Health
- Pathways to Improving Well-being for Indigenous Peoples: How Living Conditions Decide Health
- Population and Public Health Ethics: Cases from Research, Policy, and Practice
- Social Determinants of health: The Canadian Facts