Environmental factors largely determine the health of a community. A nurse and advocate for population health says nurses are the healthcare providers best-suited to affect positive change.
Food insecurity, neighborhood violence, homelessness, unemployment, and underemployment are not abstract ideas.
To many they are everyday realities.
These burdens are specific, and too-familiar examples of what the World Health Organization has as defined as social determinants of health: The "conditions in which people are born, grow, work, live, and age" as well as political and economic systems that affect day-to-day life.
SDH are also specific, actionable problems that can be solved or alleviated.
Increasingly healthcare providers are coming to understand their role.
"Social determinants are things that are not biomedical, but more psychological or social," says Ellen Olshansky, RN, PhD, chair of the School of Social Work Department of Nursing at the University of Southern California.
"Social context, behavioral [context], and economics [are parts] of it. It's what's in the environment in which we live that affects our health," she says.
Social determinants strongly influence population health, which is a key component of the Affordable Care Act. The Centers for Disease Control and Prevention says they account for 75% of population health while genes, biology, and health behaviors like smoking and drug use comprise the rest.
Because of nursing's history delving into SDH—think of Lillian Wald providing care for the poor and sick in New York's Lower East Side in the early 1900s—Olshansky see nurses as natural leaders in addressing social determinants and their effects on population health.
"Social determinants have been part of nursing for a long time, as opposed to in medicine. That's why I think nursing can really take a strong leadership role," she says.
Which is why, when it launches this fall, USC's new online family nurse practitioner program will make SDH a key component in its curriculum.
"We (nurses) come from a perspective of valuing the social determinants of health," Olshansky says. "What is missing is that the typical curriculum for nursing, while it includes social determinants, needs to include them more."
Improve SDH, Improve Costs
Olshansky, who earned a degree in social work before she became a nurse, is passionate about SDH because health is a social justice issue for her. She also understands that tackling SDH can affect another important piece of healthcare delivery—costs.
"Ultimately, what we're all trying to do in the work we do in healthcare is to improve the health of populations," she says.
"We also want to cut costs. From the business person's perspective it may not be obvious to look at what we're talking about—improving the neighborhood. That may not look like a direct link between saving money. It may look like we have to put money into it. If you look over time and if we can do things to optimize health and prevent illness, in the long run we're going to save money."
Olshansky says SDH also affect the acute care realm.
"When someone's in the ICU, we don't think about [SDH]. We just think about 'Do they have to be intubated?' Those are the priorities and of course," she says.
"But these are still people who have lives and who knows what their social context is?
When they're discharged where are they going and what are they going to do? We need to bring this consciousness about it to all aspects of healthcare."
Olshansky hopes that one day, the importance of social determinants of health are fully understood in the healthcare system.
Ideally, "We would give in our system of health and human services equal weight to the social determinants and the biomedical," she says. "We should look at them as integrated with one another."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.