👨‍⚕️Nursing Care of Vulnerable Populations Unit 1 – Social Determinants of Health in Nursing

Key Concepts and Definitions

• Social determinants of health (SDOH) encompass the economic and social conditions that influence individual and group differences in health status
• Health equity ensures everyone has a fair opportunity to attain their highest level of health
• Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged populations
• Vulnerable populations are groups at increased risk for poor physical, psychological, and social health outcomes and inadequate healthcare (low-income, racial/ethnic minorities, elderly, homeless)
• Social gradient in health refers to the stepwise fashion health outcomes improve as socioeconomic position improves
• Upstream factors are social, economic, and political factors that influence health (education, employment, income)
  • Downstream factors are individual behaviors and choices influenced by upstream factors (diet, physical activity, substance use)
• Health in All Policies (HiAP) is an approach incorporating health considerations into decision-making across sectors and policy areas

Historical Context and Importance

• SDOH gained prominence in the 1980s with the Black Report in the UK highlighting the role of social class in health outcomes
• Healthy People 2000, 2010, and 2020 increasingly emphasized SDOH in the US
• WHO Commission on Social Determinants of Health (2005-2008) raised global awareness and provided recommendations
• Addressing SDOH is crucial to improving health outcomes, reducing disparities, and promoting health equity
  • Traditional focus on individual behavior change and healthcare access is insufficient
• Nurses play a vital role in addressing SDOH through patient advocacy, care coordination, and community engagement
• Understanding SDOH allows nurses to provide culturally competent, patient-centered care and address root causes of poor health

Major Social Determinants of Health

• Economic stability (poverty, employment, food security, housing stability)
  • Poverty limits access to healthy foods, safe neighborhoods, and quality education and healthcare
• Education access and quality (high school graduation, enrollment in higher education, language and literacy)
  • Higher education levels are associated with better health outcomes, health-promoting behaviors, and health literacy
• Healthcare access and quality (health coverage, provider availability, provider linguistic and cultural competency, quality of care)
• Neighborhood and built environment (access to healthy foods, quality of housing, crime and violence, environmental conditions)
  • Poor housing conditions (overcrowding, mold, pests) contribute to asthma, lead poisoning, and injuries
• Social and community context (social cohesion, civic participation, discrimination, incarceration)
  • Discrimination and chronic stress lead to physiological changes and increased risk of chronic diseases
• Health and health care (access to primary care, health literacy)
• Social norms and attitudes (discrimination, racism, distrust of government)

Health Disparities and Inequities

• Racial and ethnic minorities experience higher rates of chronic diseases, infant mortality, and premature death
  • African Americans have higher rates of hypertension, diabetes, and asthma compared to non-Hispanic whites
• Low-income populations have higher rates of heart disease, stroke, and cancer
• Rural populations face challenges accessing healthcare services and have higher rates of obesity and tobacco use
• LGBTQ+ individuals experience higher rates of mental health disorders, substance abuse, and suicide
  • Discrimination and stigma contribute to health disparities among LGBTQ+ populations
• Individuals with disabilities have higher rates of obesity, smoking, and physical inactivity
• Health inequities are rooted in social, economic, and environmental disadvantages
  • Addressing health inequities requires targeting the root causes and ensuring equitable access to resources and opportunities

Vulnerable Populations in Healthcare

• Elderly populations (age 65+) have higher rates of chronic diseases, functional limitations, and healthcare utilization
  • Older adults may face challenges with transportation, social isolation, and navigating complex healthcare systems
• Homeless individuals have higher rates of mental illness, substance abuse, and chronic diseases
  • Lack of stable housing and competing priorities (food, safety) create barriers to healthcare access and adherence
• Immigrants and refugees may face language barriers, cultural differences, and limited health insurance coverage
  • Fear of deportation can deter undocumented immigrants from seeking healthcare services
• Incarcerated populations have higher rates of infectious diseases, mental illness, and substance abuse
  • Correctional facilities often have limited resources for providing comprehensive healthcare services
• Veterans may experience physical and mental health challenges related to their military service
  • Access to VA healthcare services and reintegration into civilian life can be challenging for some veterans
• Addressing the unique needs of vulnerable populations requires culturally competent care, care coordination, and partnerships with community organizations

Assessment Tools and Frameworks

• Social Determinants of Health Framework (Healthy People 2030) organizes SDOH into five domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context
• Health Equity Assessment Toolkit (HEAT) is a step-by-step guide for assessing health inequities and planning actions to address them
  • HEAT includes six steps: prepare and plan; assess health inequities; analyze root causes; decide on actions; implement actions; and monitor and evaluate progress
• Health Impact Assessment (HIA) is a process for assessing the potential health effects of a policy, plan, or project
  • HIA includes six steps: screening; scoping; assessment; recommendations; reporting; and monitoring and evaluation
• Life Course Approach recognizes the cumulative impact of social, economic, and environmental factors across the lifespan
  • Interventions targeting early life experiences and critical periods of development can have long-term health benefits
• Community-Based Participatory Research (CBPR) involves collaborating with community members to identify health issues and develop interventions
  • CBPR emphasizes building trust, sharing power, and leveraging community strengths and resources

Nursing Interventions and Strategies

• Incorporate SDOH screening into patient assessments (housing, food security, transportation, social support)
  • Use standardized screening tools (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE])
• Provide patient education on health-promoting behaviors and connect patients to community resources (food banks, housing assistance, job training)
• Collaborate with interprofessional teams (social workers, community health workers) to address patients' social needs
• Advocate for policies that address SDOH at the local, state, and national levels (affordable housing, living wage, paid family leave)
  • Participate in professional organizations and coalitions working to advance health equity
• Promote culturally competent care by understanding patients' cultural beliefs, values, and practices
  • Provide language interpretation services and culturally appropriate patient education materials
• Engage in community outreach and partnership building to identify and address community health needs
  • Participate in community health fairs, school-based clinics, and mobile health units
• Support research and data collection efforts to better understand and monitor SDOH and health disparities

Ethical Considerations and Advocacy

• Respect for autonomy: support patients' right to make informed decisions about their health and healthcare
  • Provide clear, understandable information about treatment options and potential outcomes
• Beneficence: strive to promote patients' well-being and prevent harm
  • Consider the impact of SDOH on patients' health and tailor interventions accordingly
• Non-maleficence: avoid causing harm to patients, both intentionally and unintentionally
  • Be aware of implicit biases and how they may influence patient care and decision-making
• Justice: ensure fair and equitable distribution of healthcare resources and services
  • Advocate for policies and programs that address SDOH and promote health equity
• Veracity: provide accurate, truthful information to patients and colleagues
  • Acknowledge the limitations of current knowledge and research on SDOH and health disparities
• Fidelity: maintain the trust and confidence of patients and the public
  • Protect patient privacy and confidentiality when collecting and sharing SDOH data
• Nurses have a professional and ethical obligation to advocate for patients and address SDOH
  • Advocacy efforts can include individual patient advocacy, community engagement, and policy involvement