February 2019

Polic y Brief

Social Determinant of Health: How is

Your Health Impacted?
The purpose of this policy brief is to evaluate the way health
OVERVIEW:
is impacted based on where people live, learn, work and play.
Essential Public Health 2

Primary Care Assessments 2 SUMMARY

Healthy People 2020 3 The overall health of a person
Analysis of Options 3
is largely impacted by the social and
economic opportunites avaliable to
Recommendations 3
them. It begins with our home and
References 4 where it is located, the cleanliness of
water, food and air, as well as the
quality of our schooling.
Studies have suggested that
Social Determinants of Health (SDoH)
influence health outcomes more than
medical care (DeVoe et al., 2016).
SDoH impact every person, but
healthcare providers must be mindful
that SDoH are indivudiualiezed to
every person. By establishing policies
to positively influence social and
economic conditions and those that
support changes in individual
behavior, we can improve health for
large numbers of people that can be
sustained over time (Healthy People
2020, 2019).

BACKGROUND

 The poverty rate for the United States was 12.3 percent, down 0.4 percent
from 2016.
 According to the U.S. Department of Education, 32 million adults can’t read; 14
percent of the population.
 The U.S. Department of Housing and Urban Development estimates 554,000
homeless people in the United States on any given night.
 High school graduation rates are at an all-time high of 84 percent with four out
of five high school student earning a diploma within four years.
 Page 2 Polic y Brief: Social Determinants of Health

Essential Public Health Services

ADDRESSING SOCIAL DETERMINANTS OF HEALTH INEQUALITIES

1. Monitor health and solve health 8. Assure competent

status to identify problems. public and
and solve personal health
5. Develop policies
community health care workforce.
and plans that
problems.
support individual 9. Evaluate
2. Diagnose and and community effectiveness,
investigate health health efforts. accessibility and
problems and quality of personal
6. Enforce laws and
With greater hazards in the
community.
regulations that
and population-
based health
awareness of key 3. Inform, educate,
protect health and
ensure safety
services.
public health and empower
7. Link people to
10. Research for new
practices people about
health issues.
needed personal
insites and
innovative
incorporating SDoH 4. Mobilize
services and
ensure the
solutions to health
problems.
considerations, community provision of health
(CDC,2019)
partnerships and care when
practitioners can action to identify otherwise
transform and unavaliable

strengthen their
ability to advance
health equality
How can proper assessments be completed?
(CDC, 2019). Babbel, Mackenzie, Hastings & Watt (2019) suggest that general
practitioners working in primary care and public health need to
recognize their role in mitigating health inequalities among the general
population. When appropriate assessments are developed and
targeted to focus on the fundamental causes of poor health, the
provider gains a more cohesive and accurate picture of the patient.
 Polic y Brief: Social Determinants of Health Page 3

Healthy People 2020

Healthy People 2020 was  Achieve health and healthy
dan inititive created by the equity, eliminate behaviors across
U.S. Department of Health disparities, and all life states.
and Human Services. It improve the (Healthy People
was set up with four goals health of all 2020, 2019)
in mind: groups.
According to Jones
 Attain high-  Create social and (2018), nurses may
quality, longer physical be the best equipped
lives free of environments to address health
preventable that promote disparities associated
disease, good health for with SDoH. Social
disability, injury all. determinants are a
and premature major factor in both
death.  Promote quality of healthcare costs and
life, healthy health statuses.
development,

Analysis of Options
With the implementation of Healthy People 2020 there is an increased
focus on the objectives affecting health. Identifying social determinants
as the underlying issue to most patients ability to comply with health
treatments is only the first step. Every dimention must be evaluated
individually with solutions created to improve. By using strong
assessment skills and by asking appropriate qustions that focus on the
social needs of patients, providers will learn what patients truly need. If
we are able to get patients into a clinic or a primary care setting, that
opportunity must be capitilized on to develop strong relationships.
Continued follow up crutital to maintain compliance. As several nurses
enter the workforce with the desire to continue on to become nurse
practitioners (NPs), the possiblity of nurse navigators that can do
community outreach with ongoing case management seems more
feesible than ever.

Recommendations/Conclusion
Nurses must understand the perspective of the patient and their top priorities. Once
an understanding is reached, interventions can be developed. The Ontario Health
Technology Assessment Series (2016) suggest that outreach programs are
necessary for patients to ensure compliance. Other possible recommendations
include housing and supportive services as these are basic needs for people and
they cannot focus on their health until these are met. McLeod (2018) explains that
Maslow’s hierarchy of needs begins with physiological needs, safety needs,
belongingness and love needs, esteem needs and tops out with self actualization.
Life experiences will interrupt progress often forcing people to continue to focus on
just the basic needs. Work needs to continue on assisting people to meet their
needs such as food, shelter, water, clothing, and clean air.
Page 4 Polic y Brief: Social Determinates of Health

References
Ashlee Knoll
Ferris State University Babbel, B., Mackenzie, M., Hastings, A., & Watt, G. (2019, April). How do general
NURS 450 practitioners understand health inequalities and do their professional roles offer scope
for mitigation? Constructions derived from the deep end of primary care. Critical Public
Health, 29(2), 168-180.
doi:http://dx.doi.org.ezproxy.ferris.edu/10.1080/09581596.2017.1418499

Centers for Disease Control and Prevention. (2018, February 25). Social determinants
of health: know what affects health. In Centers for disease control and prevention.
Retrieved from https://www.cdc.gov/socialdeterminants/index.htm
DeVoe, J. E., Bazemore, A. W., Cottrell, E. K., Likumabuwa-Ackman, S., Grandmont,
J., Spach, N., & Gold, R. (2016, March). Perspectives in Primary Care: A Conceptual
Framework and Path for Integrating Social Determinants of Health Into Primary Care
Practice [Editorial]. Annals of Family Medicine, 14(2), 104-108. doi:10.1370/afm.1903

Health Quality Ontario (2016). Interventions to Improve Access to Primary Care for
People Who Are Homeless: A Systematic Review. Ontario health technology
assessment series, 16(9), 1-50.
Jones, M. L. (2018, December). Addressing the Social Determinants of Health is
Essential to Ensuring Positive Patient Outcomes! Mississippi RN, 10-12. Retrieved
from
http://web.a.ebscohost.com.ezproxy.ferris.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=5
456dc10-356d-430b-89b9-1fd9243597c4%40sessionmgr4010

McLeod, S. (2018). Maslow's Hierarchy of Needs. In Simply Psychology. Retrieved

from https://www.simplypsychology.org/maslow.html

U.S. Department of Education . (2018, May). Public High School Graduation Rates .
In National Center for Education Statistics . Retrieved from
https://nces.ed.gov/programs/coe/indicator_coi.asp

U.S. Department of Health and Human Services. (2019, February 26). 2020 Topics
and Objectives . In Office of Disease Prevention and Health Promotion. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-
health