Connecting the dots on social determinants of health

The National Academies of Medicine held a town hall open to the public in Chicago recently to discuss the future of nursing. The purpose was “to hear your insights on ways to advance the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century.”  

Nurse educators, policy wonks, federal regulators, nurse administrators, researchers, practice experts, and non-nurse colleagues repeatedly referred to the “social determinants of health” related to access to healthy food, good schools, safe neighborhoods, and jobs with livable wages.

For more than a decade health-care providers and health researchers have addressed the social determinants of health, but a gap remains in connection between the social determinants and individual health.  

A new study, sponsored by the Kaiser Permanente Health System, reports, “Safe housing, balanced meals, transportation, and social support are essential to Americans’ health and well-being.” But, “Americans across demographic segments face challenges meeting these needs, leading to significant negative impacts on physical and mental health.”

As nurses who work on the West Side of Chicago, we understand the poor health of our patients is not completely in their control. We advocate for our patients at all levels, but we need help, as we cannot address the social determinants alone.

And if we agree that health is the shared goal, then we must accept that equity and social justice is no longer just the health-care system’s problem. More needs to be done to address the social determinants of health on a national policy level.  

The Centers for Disease Control and Prevention defines the social determinants of health as economic stability, education, social and community context, health and health care (including access), and the neighborhood and built environment. 

These are the conditions in which people live, work, learn, and play, and are shaped by broader economics and social policies such as one-year paid parental leave policies for the birth of a new child, universal health-care systems, and strong pollution regulations.

According to the Robert Wood Johnson Foundation, 80 percent of health outcomes are directly influenced by the social determinants of health. This means only 20 percent of health outcomes result from actual health-care practices and interventions.

As health-care providers, this is sobering. We have known for some time that despite our health-care interventions, many of our patients still have deeply troubling health outcomes.

For example, infant mortality rates, disease and injury incidence, and life expectancy are all worse in the U.S. when compared to peer countries. These poorer health outcomes occur while health-care spending accounts for close to 20 percent of the gross domestic product.  As a country, we have not addressed the daily stressors that our detrimental to our health, we have only focused on medical breakthroughs to treat the disease, rather than preventing the disease.

Recently, one of us cared for a homeless man with stage three colorectal cancer who has a state of the art portable chemo pump. Yet he is also dealing with bed bugs and does not have a reliable, warm, dry place to recuperate from his aggressive treatment. If resources went toward stable housing and regular nutritious meals, he will have a better chance of survival.

A recent paper from the Anthem Public Policy Institute stated patients and their health care providers view the social determinants of health differently. The study shows patients are more focused on what is the most urgent issue for them today.

But we as providers need to discuss with patients what can affect their health before they get sick. For those with chronic conditions we need to work together with our patients to identify what social factors are impacting their ability to manage their illness. This includes where they live.

Research shows zip codes determine life expectancy. We witness this in Chicago, where according to the Virginia Commonwealth University Center on Society and Health, Chicagoans who live in a wealthy neighborhood like Lincoln Park have an average life expectancy of 81 years.

But in East Garfield Park, a low-income neighborhood, the life expectancy drops to 72 years. While income is a factor, air quality also contributes, as in East Garfield Park pollution is worse than in Lincoln Park.

This country needs a fundamental philosophical shift from thinking about health only when ill and only within the context of the health-care system. This is difficult and will take time, and it won’t happen without a critical mass pushing the agenda for a proactive rather than a reactive health-care system.

Terry Gallagher is an assistant professor and family nurse practitioner at Rush University College of Nursing and a Rush Public Voices fellow through The OpEd Project. Angela Moss is an assistant dean of faculty practice, assistant professor and nurse practitioner at Rush University College of Nursing and a former Public Voices fellow through The OpEd Project.