Examples Of Social Determinants Of Health
“What is the definition of health?” When I was first asked this question at the start of the semester, my initial thoughts jumped to a more direct answer that encompassed a person’s physical and mental health; observations of weight, musculature, neural defects, acumen, and mental clarity were some of the gauges I considered in determining a person’s measure of health. While I do not consider this definition wrong by any means, the defining of a person’s health should not cease on the surface level, for a far greater understanding arises when it is viewed at the roots. Concepts such as the Social Determinants of Health, change theories, and growth and development theories are some of many models a nurse can embrace in order to understand
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the depth of a patients struggles, and achieve a more genuine level of care and empathy. While the idea that individuals are in compete control of their health is a pleasant notion, it is far too idealistic.
Beyond lifestyle choices are numerous uncontrollable factors that influence how healthy a person will be in his or her life, such as how people were raised, the environment they grew up in, and the opportunities that they were presented in life. These uncontrollable aspects can be categorized through the Social Determinants of Health (SDoH), which is a model that recognises that the main factors in shaping a person’s health is their experiences within their living environments, and consists of fifteen determinants, which are the following listed:
Social Determinants of Health
1. Stress, Bodies, and Illness Prolonged stress can negatively impact an individuals hormonal, metabolic, and immune systems, which leaves them more susceptible to illness, disease, and unfavorable coping mechanisms.
2. Income and Income Distribution Income impacts almost all facets of life. Necessities like food and shelter, superior education and growing opportunities, and less stress from more leisurely activities and savings are associated with a higher income.
3. Education Provides a greater foundation in life while growing up, and provides greater financial opportunities through post-secondary
education.
4. Unemployment and Job Security Stress, anxiety, and depression are associated with unemployment and job security, for a job not only provides income, but it can provide a sense of worth.
5. Employment and Working Conditions Poor working conditions, such as lengthy hours or feeling undervalued, can lead to stress and feelings of dejection.
6. Early Childhood Development Inadequate or poor early childhood development can lead to severe and long lasting physical, social, and psychological issues.
7. Food Insecurity Food is crucial for human development, and a deficiency in nutritional requirements growing up can lead inadequate physical growth as well as intellectual concerns.
8. Housing Housing grants access to shelter and basic sanitation, so issues like homelessness or overburdened homes can lead to stress, transmission of illnesses, and poor health.
9. Social Exclusion Socially excluded individuals have reduced access to cultural, economic, and social resources. A lack of social support also can also lead to feelings of loneliness.
10. Social Safety Net Consists of services like counselling and community services. Social safety nets can provide feelings of security and warmth during times of hardship.
11. Health Services A lot of treatments in Canada are not covered through insurance, such as dental work on adults or many prescriptions, and this can severely impact an individual’s health if sufficient funds are not available.
12. Aboriginal Status Due to colonization, relocation of families, and residential schools, many Aboriginals live in overcrowded homes, and have issues with food insecurity and low income, which results in a magnitude of related health issues.
13. Gender On average, men experience more violence and homelessness in life, whereas women tend to lack secured employment and earn lower wages. Homosexual and transgender Canadians experience discrimination. All of these will induce negative health affects.
14. Race Racism can negatively impact an individual’s health through – be it through feelings of segregation in society, or a inadequate care in health care facilities.
15. Disability
People who have disabilities are more likely to be unemployed or earn lower wages in comparison to those without any disabilities; in addition, Canada’s social benefits to those with disabilities are some of the lowest in the developing world, which hinders their capacity to engage in society.
(Kozier, Berman, Snyder, Frandsen, Buck, Ferguson, & Yiu, 2018, 115-116).
According to Raphael (2009), these determinants “have been shown to have strong effects upon the health of Canadians’,” and he goes on further to state that these factors have a more potent impact on health than “diet, physical activity, and even tobacco and excessive alcohol use” does. For a nurse, it is invaluable to understand the consequences that the SDoH have on individuals. For example, if a nurse received a patient that was pregnant, obese, and a smoker, the nurse’s first thoughts may be that of judgement and scold the woman for her behaviour; however, what would that achieve? When people feel attacked, they close up and become defensive – they become impenetrable to any advice or persuasion – and as a nurse trying to help the patient, that outcome is objectively a failure. Instead, the nurse could approach the situation with empathy and respect, and try to grasp why the woman is in her situation through acknowledging the SDoH and asking questions. Was this woman ever educated on pregnancy, nutrition, and smoking? Does she have any support from her family, friends, or community? Is she under so much stress in her life that eating and smoking are her only means of escape? If a nurse is able to take a step back and understand the underlying causes of a patient’s issues, the possibility of forming a genuine connection with his or her patient occurs, and once this connection is established, the appropriate care and advice will be much likely to be taken to heart and embodied by the patient. After an understanding of a patient’s issues has been attained, change theories can be employed to help guide them towards their goals. Change theories, true to their name, are theories that promote positive behavioural changes in individuals (Kozier et al, 2018, 128), and they act as a blueprint of sorts by providing a guideline of what needs to be achieved, and what challenges might arise at certain stages. Promoting change in individuals in paramount in nursing, yet this is not often an easy task. Change can be a challenging and frightening process that often provides feelings of unease and a desire to resist, so it is crucial for nurses to act as a pillar of support to their patients who need it when they are changing an aspect of their lives. According to Kozier et al, “nurses are often change [coaches], that is, individuals who initiate, motivate, and implement change,” and goes on further to state that change coaches must possess the characteristics of the following list:
• Excellent communication and interpersonal skills. • Knowledge of available resources. • Skill in problem solving. • Skill in teaching. • Respect of those involved in the change. • Ability to encourage and nurture those going through change. • Self-confidence, ability to take risks and inspire trust in self and others. • Ability to make decisions. • A broad base of knowledge. • A good sense of timing (2008, 531).
One example of a change theory the Lewin’s Change Theory (LCT), which encompasses three concepts of driving forces, restraining forces, and equilibrium, and possess three stages of unfreezing, movement, and refreezing (Kritsonis). For the concepts, the driving force is the variables that induce a lifestyle change, such as someone changing his or her a diet to lose weight; the restraining force is the variables that oppose the driving forces, such as a diet being too expensive or inconvenient to pursue; and equilibrium is the point where the driving forces and restraining forces are equal, and thus nothing occurs yet (Kritsonis). For the three stages of LCT, unfreezing consists of finding something that it makes feasible for a person to discard a detrimental pattern, such as a smoker using a nicotine patch, or not hanging out with his or her colleagues during a smoke break; movement is when progression is made, and a productive change in feelings, thoughts, or behavior occur; and refreezing is when the change is established as the new status quo, such as a ex-smoker no longer feeling at risk of having a cigarette (Kritsonis). The advantage of the LCT lies in its simplicity and ease to follow, but it is important to keep in mind that even if a nurse has the ideal outline for a patient to improve his or her health, it has to be in steps that he or she can achieve – consideration into the driving and restraining forces must be taken into account; for example, if a morbidly obese man that was struggling to lose weight came into a clinic to ask for help, the nurse cannot give idealistic advice such as suggesting a an hour daily workout plan and strict dietary guidelines. While this would work that would work if embraced by the patient, the chance that it would be too overwhelming is extremely high. Instead, the nurse should discuss with the man about his situation, and how his past attempts at losing weight have gone to have an idea of where he is at. Perhaps the man is working seventy hours a week and is too exhausted to cook or exercise, or perhaps he is suffering from depression and lacks any motivation at the moment and is feeling helpless. Once the nurse has determined the driving and resisting factors, then he or she can act as a change coach and appropriately implement a change theory, such as the LCT. Smaller steps in the unfreezing stage – steps that the man could achieve in his current state -- such as short ten minute walks per day, or cutting out soft drinks in favor of water, could be implemented; is these steps are achieved and reach the refreezing stage, then another round of the LCT could be employed with slightly more difficult goals. It is easy to get caught in the trap of providing end-goals rather than advice, such as telling someone overweight to “just eat less,” or someone with depression to “think happier thoughts;” however, this holds about as much use as telling someone the answer to a mathematics problem, rather than teaching them how to solve it. Nurses must understand the level their patients are at, and be prepared to give guidance that they will able to be able to follow and embrace, for before a goal can be achieved, a foundation must be set.
the depth of a patients struggles, and achieve a more genuine level of care and empathy. While the idea that individuals are in compete control of their health is a pleasant notion, it is far too idealistic.
Beyond lifestyle choices are numerous uncontrollable factors that influence how healthy a person will be in his or her life, such as how people were raised, the environment they grew up in, and the opportunities that they were presented in life. These uncontrollable aspects can be categorized through the Social Determinants of Health (SDoH), which is a model that recognises that the main factors in shaping a person’s health is their experiences within their living environments, and consists of fifteen determinants, which are the following listed:
Social Determinants of Health
1. Stress, Bodies, and Illness Prolonged stress can negatively impact an individuals hormonal, metabolic, and immune systems, which leaves them more susceptible to illness, disease, and unfavorable coping mechanisms.
2. Income and Income Distribution Income impacts almost all facets of life. Necessities like food and shelter, superior education and growing opportunities, and less stress from more leisurely activities and savings are associated with a higher income.
3. Education Provides a greater foundation in life while growing up, and provides greater financial opportunities through post-secondary
education.
4. Unemployment and Job Security Stress, anxiety, and depression are associated with unemployment and job security, for a job not only provides income, but it can provide a sense of worth.
5. Employment and Working Conditions Poor working conditions, such as lengthy hours or feeling undervalued, can lead to stress and feelings of dejection.
6. Early Childhood Development Inadequate or poor early childhood development can lead to severe and long lasting physical, social, and psychological issues.
7. Food Insecurity Food is crucial for human development, and a deficiency in nutritional requirements growing up can lead inadequate physical growth as well as intellectual concerns.
8. Housing Housing grants access to shelter and basic sanitation, so issues like homelessness or overburdened homes can lead to stress, transmission of illnesses, and poor health.
9. Social Exclusion Socially excluded individuals have reduced access to cultural, economic, and social resources. A lack of social support also can also lead to feelings of loneliness.
10. Social Safety Net Consists of services like counselling and community services. Social safety nets can provide feelings of security and warmth during times of hardship.
11. Health Services A lot of treatments in Canada are not covered through insurance, such as dental work on adults or many prescriptions, and this can severely impact an individual’s health if sufficient funds are not available.
12. Aboriginal Status Due to colonization, relocation of families, and residential schools, many Aboriginals live in overcrowded homes, and have issues with food insecurity and low income, which results in a magnitude of related health issues.
13. Gender On average, men experience more violence and homelessness in life, whereas women tend to lack secured employment and earn lower wages. Homosexual and transgender Canadians experience discrimination. All of these will induce negative health affects.
14. Race Racism can negatively impact an individual’s health through – be it through feelings of segregation in society, or a inadequate care in health care facilities.
15. Disability
People who have disabilities are more likely to be unemployed or earn lower wages in comparison to those without any disabilities; in addition, Canada’s social benefits to those with disabilities are some of the lowest in the developing world, which hinders their capacity to engage in society.
(Kozier, Berman, Snyder, Frandsen, Buck, Ferguson, & Yiu, 2018, 115-116).
According to Raphael (2009), these determinants “have been shown to have strong effects upon the health of Canadians’,” and he goes on further to state that these factors have a more potent impact on health than “diet, physical activity, and even tobacco and excessive alcohol use” does. For a nurse, it is invaluable to understand the consequences that the SDoH have on individuals. For example, if a nurse received a patient that was pregnant, obese, and a smoker, the nurse’s first thoughts may be that of judgement and scold the woman for her behaviour; however, what would that achieve? When people feel attacked, they close up and become defensive – they become impenetrable to any advice or persuasion – and as a nurse trying to help the patient, that outcome is objectively a failure. Instead, the nurse could approach the situation with empathy and respect, and try to grasp why the woman is in her situation through acknowledging the SDoH and asking questions. Was this woman ever educated on pregnancy, nutrition, and smoking? Does she have any support from her family, friends, or community? Is she under so much stress in her life that eating and smoking are her only means of escape? If a nurse is able to take a step back and understand the underlying causes of a patient’s issues, the possibility of forming a genuine connection with his or her patient occurs, and once this connection is established, the appropriate care and advice will be much likely to be taken to heart and embodied by the patient. After an understanding of a patient’s issues has been attained, change theories can be employed to help guide them towards their goals. Change theories, true to their name, are theories that promote positive behavioural changes in individuals (Kozier et al, 2018, 128), and they act as a blueprint of sorts by providing a guideline of what needs to be achieved, and what challenges might arise at certain stages. Promoting change in individuals in paramount in nursing, yet this is not often an easy task. Change can be a challenging and frightening process that often provides feelings of unease and a desire to resist, so it is crucial for nurses to act as a pillar of support to their patients who need it when they are changing an aspect of their lives. According to Kozier et al, “nurses are often change [coaches], that is, individuals who initiate, motivate, and implement change,” and goes on further to state that change coaches must possess the characteristics of the following list:
• Excellent communication and interpersonal skills. • Knowledge of available resources. • Skill in problem solving. • Skill in teaching. • Respect of those involved in the change. • Ability to encourage and nurture those going through change. • Self-confidence, ability to take risks and inspire trust in self and others. • Ability to make decisions. • A broad base of knowledge. • A good sense of timing (2008, 531).
One example of a change theory the Lewin’s Change Theory (LCT), which encompasses three concepts of driving forces, restraining forces, and equilibrium, and possess three stages of unfreezing, movement, and refreezing (Kritsonis). For the concepts, the driving force is the variables that induce a lifestyle change, such as someone changing his or her a diet to lose weight; the restraining force is the variables that oppose the driving forces, such as a diet being too expensive or inconvenient to pursue; and equilibrium is the point where the driving forces and restraining forces are equal, and thus nothing occurs yet (Kritsonis). For the three stages of LCT, unfreezing consists of finding something that it makes feasible for a person to discard a detrimental pattern, such as a smoker using a nicotine patch, or not hanging out with his or her colleagues during a smoke break; movement is when progression is made, and a productive change in feelings, thoughts, or behavior occur; and refreezing is when the change is established as the new status quo, such as a ex-smoker no longer feeling at risk of having a cigarette (Kritsonis). The advantage of the LCT lies in its simplicity and ease to follow, but it is important to keep in mind that even if a nurse has the ideal outline for a patient to improve his or her health, it has to be in steps that he or she can achieve – consideration into the driving and restraining forces must be taken into account; for example, if a morbidly obese man that was struggling to lose weight came into a clinic to ask for help, the nurse cannot give idealistic advice such as suggesting a an hour daily workout plan and strict dietary guidelines. While this would work that would work if embraced by the patient, the chance that it would be too overwhelming is extremely high. Instead, the nurse should discuss with the man about his situation, and how his past attempts at losing weight have gone to have an idea of where he is at. Perhaps the man is working seventy hours a week and is too exhausted to cook or exercise, or perhaps he is suffering from depression and lacks any motivation at the moment and is feeling helpless. Once the nurse has determined the driving and resisting factors, then he or she can act as a change coach and appropriately implement a change theory, such as the LCT. Smaller steps in the unfreezing stage – steps that the man could achieve in his current state -- such as short ten minute walks per day, or cutting out soft drinks in favor of water, could be implemented; is these steps are achieved and reach the refreezing stage, then another round of the LCT could be employed with slightly more difficult goals. It is easy to get caught in the trap of providing end-goals rather than advice, such as telling someone overweight to “just eat less,” or someone with depression to “think happier thoughts;” however, this holds about as much use as telling someone the answer to a mathematics problem, rather than teaching them how to solve it. Nurses must understand the level their patients are at, and be prepared to give guidance that they will able to be able to follow and embrace, for before a goal can be achieved, a foundation must be set.