18.3 Health disparities and social determinants of health

Health disparities stem from complex social, economic, and environmental factors. These inequities disproportionately affect marginalized groups, leading to poorer health outcomes and reduced access to care. Understanding these determinants is crucial for nurses to provide equitable, patient-centered care.

Addressing health disparities requires a multifaceted approach. Nurses play a vital role in advocating for policies that promote health equity, providing culturally competent care, and connecting patients with resources to address social needs. By recognizing and addressing these factors, nurses can help reduce health inequities and improve outcomes for all patients.

Social Determinants of Health and Health Disparities

Factors in health disparities

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• Social factors significantly impact health disparities
  • Discrimination and social exclusion lead to chronic stress and limited access to resources (healthcare, education, employment)
  • Lack of social support networks reduces access to information, resources, and emotional support during health challenges
  • Adverse early life experiences (childhood trauma, neglect) have long-term effects on physical and mental health
• Economic factors contribute to health inequities
  • Poverty and income inequality limit access to healthcare, healthy food, safe housing, and other health-promoting resources
  • Unemployment and job insecurity cause chronic stress and financial barriers to accessing healthcare
  • Lack of access to quality education limits future employment opportunities and health literacy
• Environmental factors play a role in health disparities
  • Poor housing conditions and overcrowding increase exposure to indoor pollutants (mold, lead) and infectious diseases
  • Lack of access to safe drinking water and sanitation leads to waterborne illnesses and poor hygiene
  • Exposure to air, water, and soil pollution increases risk of respiratory diseases, cancer, and other chronic conditions
  • Limited access to healthy food options (food deserts) contributes to poor nutrition and diet-related diseases (obesity, diabetes)

Populations at risk for inequities

• Racial and ethnic minorities experience significant health disparities
  • African Americans have higher rates of chronic diseases (hypertension, diabetes) and lower life expectancy
  • Hispanics/Latinos face language barriers and limited access to healthcare, leading to delayed diagnoses and treatment
  • Native Americans have high rates of obesity, diabetes, and substance abuse due to historical trauma and lack of resources
  • Asian Americans face cultural stigma around mental health and may delay seeking care
• Low-income individuals and families often struggle to afford healthcare, healthy food, and safe housing
• Uninsured or underinsured populations face financial barriers to accessing preventive care and treatment
• Homeless individuals have higher rates of chronic diseases, mental illness, and substance abuse due to lack of stable housing and healthcare access
• Individuals with disabilities may face physical barriers to accessing healthcare and experience discrimination in employment and housing
• LGBTQ+ community faces discrimination and stigma, leading to higher rates of mental illness, substance abuse, and delayed healthcare
• Elderly population is at higher risk for chronic diseases, cognitive decline, and social isolation
• Incarcerated individuals have higher rates of chronic diseases, mental illness, and infectious diseases due to overcrowding and limited healthcare access

Advocacy for health equity

• Support policies that improve access to quality healthcare
  • Expansion of Medicaid and Medicare increases insurance coverage for low-income and elderly populations
  • Subsidies for health insurance premiums make coverage more affordable for individuals and families
  • Funding for community health centers improves access to primary care in underserved areas
• Promote initiatives that address economic inequalities
  • Minimum wage increases help low-income workers afford basic needs (healthcare, housing, food)
  • Job training and employment programs provide opportunities for upward mobility and financial stability
  • Affordable housing initiatives reduce housing insecurity and improve living conditions
• Advocate for programs that improve educational opportunities
  • Early childhood education promotes cognitive development and school readiness
  • Funding for public schools in disadvantaged areas reduces educational disparities
  • College affordability and accessibility initiatives increase opportunities for higher education and career advancement
• Support policies that create healthier environments
  • Regulations to reduce air and water pollution improve respiratory and cardiovascular health
  • Zoning laws that promote access to healthy food options (farmers markets, grocery stores) reduce diet-related diseases
  • Investments in public transportation and green spaces encourage physical activity and reduce air pollution

Strategies to mitigate disparities

• Provide culturally competent care to diverse patient populations
  • Understand and respect cultural beliefs and practices around health and healthcare
  • Use language interpretation services when necessary to ensure effective communication
  • Engage in cultural humility and ongoing learning to improve cross-cultural interactions
• Address social needs during patient assessments
  • Screen for social determinants of health (housing, food insecurity, transportation) during patient visits
  • Connect patients with community resources and support services (food banks, housing assistance, legal aid)
  • Collaborate with social workers and case managers to address complex social needs
• Implement patient education and health promotion initiatives
  • Tailor education materials to patient's literacy level and cultural background to improve understanding and engagement
  • Engage community health workers and peer educators to provide culturally relevant education and support
  • Utilize technology and telemedicine to improve access to care for patients in remote or underserved areas
• Advocate for organizational policies that promote health equity
  • Collect and analyze data on health disparities within the organization to identify areas for improvement
  • Develop targeted interventions to address identified disparities (staff training, patient outreach, community partnerships)
  • Provide ongoing training for staff on health equity and cultural competence to improve patient care and outcomes