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Social Determinants of Health


It is important to be aware of both the social and physical determinates of health, which prevent a healthy lifestyle. The advanced nurse practitioner should be mindful of what boundaries afflict the population of patients they care for.

Social Determinants of Health

Established in 1961, the Organisation for Economic Co-operation and Development (OECD) provides a forum for a conglomeration of countries to collaborate in order to solve problems each country shares. Thirty-five countries comprise the OECD, including many of the world's most economically advanced countries, as well as developing counties like Mexico, Chile, and Turkey (Organisation for Economic Co-operation and Development, 2016). Despite the United States leading the world in medical care and research, when compared to the other OECD countries the United States lags behind for life expectancy rates (Keiser Family Foundation, 2017). One of the reasons why life expectancy rates are lower in the United States than other developed nations is the social determinants of health.

The World Health Organization defines the social determinants of health as, "the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels," (World Health Organization, 2017, p. 1). Unfortunately, it is these social determinants which foster health inequalities both within and between countries. Health care disparities must be addressed and advanced practice nurses can be instrumental in improving health outcomes for these vulnerable populations.

Health care inequality is deeply rooted in economic, social and political injustices. One of the four goals of Healthy People 2020 stresses the importance of addressing the social determinants of health including to, "create social and physical environments that promote good health for all," (Secretary's Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020, 2010, p. 1). Factors which contribute to the social determinants of health and are broken down into social and physical determinants. These determinants have a direct impact on health, functioning, and quality of life.

The social environment is defined as the compilation of social and cultural institutions, norms, patterns, beliefs, and processes which effect the life of a single person or community (US Department of Health and Human Services, 2010). Social determinants impact one's ability to obtain daily needs such as job opportunities, education (including access to quality schools), healthy foods, and living wages. Discrimination is another factor which is a strong social determinant.

The physical environment component of a social determinant is made up of all of the natural and constructed environments a person is exposed to, and how the structure and function of the environment impacts health (U.S. Department of Health and Human Services, 2010). Examples of physical determinants includes natural environment (plants, weather, or climate change), manufactured environment (buildings), physical barriers (especially for people with disabilities), and exposure to physical hazards. "Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment," (U.S. Department of Health and Human Services, 2010, p. 5). The disease process of asthma is a prime example of a poor health outcome which is directly related to the environment. The increase of air pollution and decrease in the quality of clean air has led to an increase in asthma rates, (U.S. Department of Health and Human Services, 2010). It is important to understand that social factors, both physical and social determinants, impact health outcomes. However, these are not the only factors.

"Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health," (Health Poverty Action, 2015, p. 2). The underprivileged have limited access to health care, including the ability to obtain health insurance, which has grave effects on health (World Health Organization, 2017). Uninsured people are less likely to receive medical care, more likely to die early, and more likely to have poor health status (U.S. Department of Health and Human Services, 2010). In fact, one out of every five Americans under the age of sixty-five does not have medical insurance. This can lead to inconsistency of the location where medical care is received, decrease one's drive to seek out medical attention, and cause an increase in risk of serious and disabling health conditions. Even the underprivileged populations who do have health insurance may not be able to afford the care once it is sought; the burden of seeking medical care is just too great.

The way in which social determinants of health should be fixed is a highly political. Despite both the Democratic and Republican parties acknowledging that health inequalities must be repaired, each party has different views. This has created a political gridlock on the subject, which has been preventing progress (Robert Wood Johnson Foundation, 2010). Despite the political gridlock, it is important to note that social exclusion, the rising inequality in both assets and income, and increase in poverty level are all factors that create deeper health disparities. The generation and distribution of funds reflects political priorities. The creation of a universal health care, designed to be equal in access and outcomes for all, would help to reduce health care disparities. Changes in policies must reflect the goal of decreasing health care disparities, and all levels of government should take actions which reflect the same goal (Michael & Jessica, 2014).

The way in which health care is viewed by an individual is also a factor which impacts health. Culture affects how an individual views both health and illness. Culture includes language, spiritual and religious beliefs, ethnicity, sexual orientation, life experiences, and upbringing. Culture also affects what treatment one may or may not seek out. In some cultures, mental illness or physical illness is viewed as the evil eye, or daemon, and treatment may not be sought out (Canadian Paediatric Society, 2017). Cultural influence can also impact self-care, therefore increasing or decreasing one's medication compliance. Nutrition may also be influenced by culture, which may lead to nutrition-related diseases, such as hypertension and obesity (Canadian Paediatric Society, 2017).

Vulnerable populations, such as those of low socioeconomic status, the underserved, people afflicted with chronic diseases, or those at higher risk of developing an illness or disease are significantly impacted by health care policy and the policy process (De Chesnay & Anderson, 2016). Effective health policies and the distribution of public health resources can positively impact public health. Policies can impact public health on many different levels, such as individually or collectively. An example of this is placing a tax on sugary food as a way to decrease diabetes and obesity. Advance practice nurses need advocate for the vulnerable population by alerting legislators of problems which affect the public health. This can be done by utilizing the media to bring light to certain causes, (De Chesnay & Anderson, 2016).

Problems surrounding social justice are also political issues. "Discrimination against marginalized populations and against people based on health status, income, employment status, or type of disease or disability is unethical and unjust and may be illegal in the United States," (De Chesnay & Anderson, 2016, p. 542). It is the responsibility of the advance practice nurse to help confront those problems, and bring a voice to the vulnerable populations who do not have a voice. Nurses can help government workers to define health problems and disparities that the government workers are unable to. Changes in policy may take years to obtain, but it is the duty of the advanced practice nurse to fight for the rights of their patients (De Chesnay & Anderson, 2016).

Social determinants of health care are key to understanding health care disparities and the creation of vulnerable populations. It is important to be aware of both the social and physical determinates of health, which prevent a healthy lifestyle. The advanced nurse practitioner should be mindful of what boundaries afflict the population of patients they care for. Low socioeconomic status also is attributed to poor health outcomes due to the inability to have direct access to health care. People of low income rarely have continuous health care, or seek medical attention for illnesses which may have grave consequences. Having easily accessible, public health facilities, to care for the poor would help to decrease this disparity. Furthermore, a person's culture also impacts how they view their own health care and illnesses.

Advanced practice nurses must provide culturally competent care to their clients. Lastly, the state of public health care effects vulnerable populations immensely. If a population's health care needs are being unmet, the advanced practice nurse should make it his or her priority to inform members of the government. Advance practice nurses need to be the voices to those populations without one. Repairing health care disparities, based off of social determinants of health, decrease vulnerable populations and may increase the life expectancy of all Americans.


Canadian Paediatric Society. (2017). Caring for kids new to Canada. Retrieved from How Culture Influences Health |Culture & Health |Caring for Kids New to Canada

De Chesnay, M., & Anderson, B. A. (2016). Caring for the vulnerable (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Health Poverty Action. (2015). Key facts: Poverty and poor health. Retrieved from Key Facts Poverty and Poor Health - Health Poverty ActionHealth Poverty Action

Keiser Family Foundation. (2017). Life expectancy in the U.S. and how it compares to other countries slideshow. Retrieved from Life Expectancy in the U.S. and How It Compares to Other Countries Slideshow | The Henry J. Kaiser Family Foundation

Michael, M., & Jessica, A. (2014, September). Social determinants of health equality. American Journal of Public Health, 104 (4), s517-s519. Error: DOI Not Found from

Organisation for Economic Co-operation and Development. (2016). About the Organisation for Co-operation and Development. Retrieved from About the OECD - OECD

Robert Wood Johnson Foundation. (2010). A new way to talk about the social determinants of health. Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2010/rwjf63023

Secretary's Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020. (2010). Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States. Retrieved from Healthy People 22: An Opportunity to Address Societal Determinants of Health in the United States

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I have been a pediatric nurse for 10 years. Currently I am school for finishing my masters of nursing in the pediatric nurse practitioner track.

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2 Comment(s)

calivianya, BSN, RN

Specializes in ICU.

Good article! Thanks.

In nursing school, we had clinicals for our "nursing in the community" rotation at a low income government subsidized housing building. It had been a hotel in the past. It had tiny rooms that had things like fridges shoved in corners so it could be considered a place to "live." There was a once a week clinic my school ran there, where we'd take people's blood pressure, help with organizing medications, etc.

Nursing students were the only access to healthcare these people had, for the most part.

The conditions were unbelievably horrendous. It was mostly elderly people. A lot of them were veterans. Lots of the hallway lights were out, and it wasn't uncommon for exposed electrical wires to be dangling in the hallway. It was the most run down building I'd ever been in, and there were hundreds of vulnerable old people living there.

The worst part of all of it, thought, was the food situation. This place was situated smack in the middle of the bad side of downtown. For those who were able to walk more than a few feet at a time, there was a corner convenience store. They had bread, milk, Honey Buns, Twinkies, and lots of beer. Oh, and of course, the next closest thing were the expensive downtown restaurants that the inhabitants of this place couldn't afford.

The nearest grocery stores were miles and miles away, and almost none of these people had cars. Most of our "respected" elderly veterans in that place were living off of canned beans, macaroni and cheese, Twinkies, and beer because they had no way to get groceries - a lot of them couldn't walk, and they didn't have money to pay the bus to take them to the grocery store, let alone to buy groceries.

It was disgusting. It's hard to imagine worse treatment for those people. It really opened my eyes to just how bad things can get. The worst for poor vulnerable elderly people is pretty bad.


Has 5 years experience.

Wow! Wow!