Module Components

• Overview

Topics

• Definitions
• Social Determinants of Health
• Health Disparities
• Social Justice and Ethics
• Role of the Public Health Nurse

Nurs 467 - Community / Public Health Nursing

Module 2: Foundational Concepts: Social Determinants, Social Justice and Ethics

SOCIAL Determinants of Health

A person’s health is determined by a variety of factors – genetics, biology, environmental factors, living conditions, etc. This range of personal, social, economic, environmental and biological factors that influence health status are known as determinants of health. Determinants of health are broadly categorized as biological, behavioral, environmental and societal.

Individual Determinants

Biological and behavioral determinants are considered individual determinants. These personal factors include non-modifiable personal characteristics like age, race and gender. Individual determinants also include modifiable behavioral factors like diet, exercise, and substance and tobacco use. Together these factors account for between 70-74% (USDHHS 2012) of premature mortality nationally. There may be little we can do to change age, race, gender and genetics; however, changing behaviors is key to changing health outcomes in the United States.

The remaining 30% of the contribution to premature mortality is related to negative influences on health that are difficult for the individual to control. These factors impede efforts to change personal behaviors and are the Social Determinants of Health.

SOCIAL DETERMINANTS

The World Health Organization has defined 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. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries (commission on the Social Determinants of Health, 2008, p. 5).

View the following video for an introduction to the Social Determinants of Health

Social and environmental conditions are inextricably connected to health outcomes and often affect entire populations. Social conditions include socioeconomic status (SES), quality education, adequate and affordable housing, economic opportunity, recreational activities, and quality, accessible health and social services. Income linked to education and occupation has been a reliable predictor for mortality. Healthy communities support and facilitate healthy behaviors by ensuring the provision of these resources. Unfortunately, not all communities are healthy and the most vulnerable populations are the likely inhabitants of under-resourced communities. Poor quality education and lack of economic opportunity contribute to persistent poverty that is passed down through generations.

The physical environment also plays a significant role in poor health. Air and water pollution, toxic waste disposal, exposure to chemical and biologic agents, food contamination, disasters (man-made and natural), even sidewalk disrepair can all be impediments to good health. There are countless examples of actual and potential hazardous exposures and subsequent threats to the public’s health. Individuals have little control over their exposure and social and environmental health threats, regardless of their personal behaviors. Nurses, other health professionals, governments, and politicians all have a role to play in ensuring the public’s health.