Which factors would the nurse consider related to the social determinants of health?

Nurses 'have a really important role in improving health equity and addressing societal factors,' AONL conference speaker says.

Nurses play a vital role in uncovering and addressing patients' social determinants of health (SDOH), Julia Resnick, the American Hospital Association's (AHA) senior program manager of strategic initiatives, told nurse leaders during AONL 2021, the annual conference of the American Organization of Nursing Leadership.

"Health is more than just healthcare and there is a growing body of evidence showing how societal factors are linked to health outcomes across an individual's life," Resnick said during the two-day virtual conference.

"They can impact your health status, quality of life, or even how long you live," Resnick said during the program, "The Growing Role of Nurses in Addressing Societal Factors."

"[Societal factors are] the things that we experience every day—the air we breathe, the homes we live in, the food we eat, the jobs we do, and where we send our kids to school," Resnick said. "And if our air is not clean, our home is not safe, or our food isn't nutritious, if our job doesn't cover our bills, or our children don't receive a quality education, our health inevitably suffers in both the short and long term."

Role of the Nurse

Hospitals and health systems increasingly recognize the societal factors that influence health, and nurses have a vital part to play.

"What is the role of nurses in all of this? Well, lucky for us, the National Academy of Medicine (NAM) agrees with me that nurses have a really important role in improving health equity and addressing societal factors," Resnick said, referring to the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report released in May.

Indeed, the report states that "all nurses, at all levels, and no matter the setting in which they work, have a duty and responsibility to work with other health professionals and sectors to address SDOH and help achieve health equity."

As such, government agencies, healthcare and public health organizations, and payers should ensure nurses have the resources and support to address SDOH in a more comprehensive way, the report says.

"[The report] outlines four areas when nurses can make an impact in those areas," Resnick said.

1. For the patient

"The first is addressing social needs in clinical settings which include screening for social needs and referrals," she said.

Nurses can ask questions and conduct screenings for a patient to help create care plans or to refer the patient to social services or other community health workers, she said.

"NAM also noted a need to train nurses on how to have these conversations and respond to those difficult situations that might arise," she said.

2. In the community

"The second area was addressing social needs and social determinants in the community, and they specifically call out that public health nurses and home visiting nurses as being uniquely well-positioned to build trust and respect in the community," Resnick said, "and also when they're in a patient's home, recognizing that patient's limitation or social needs.

NAM noted that nurses are in a unique position to engage with partners across social, health, and other sectors to engage in health promotion and disease prevention, particularly around coalition building in case management, she said.

3. Across disciplines and sectors

"The third area was working across disciplines and sectors," Resnick said. "Community-based nurses can address health-related needs from diabetes management to transportation."

The report noted that the Community Health Needs Assessment Process is a great opportunity to involve nurses from clinical and community settings in all phases from the assessment phase through implementation, she said.

4. At the policy level

"And last but not least, there's advocating for policy change, something that nurses can contribute to," Resnick said. "They can bring a health lens to public policy and decision making since they understand these upstream determinants of health."

Nurses can engage in change efforts at the local, state, or federal level by serving in public and private sector leadership positions, she said.
"So, there's certainly an incredible role that nurses can play," Resnick said, "in advancing this work in their hospitals and communities."

A health and economic issue

Adverse societal factors can affect anyone, despite age, gender, or race, but people of color tend to experience them at a higher rate, she said.

Adverse conditions are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes, according to the U.S. Centers for Disease Control and Prevention.

Additionally, data indicates that addressing health equity is more than a health issue; it's also an economic issue, with immense costs, she said.

Resnick cited a 2011 study by Thomas LaVeist and colleagues on how racial health disparity results in substantial annual economic losses nationally, including $35 billion in excess healthcare expenditures, $10 billion in illness-related lost productivity, and $200 billion in premature deaths.

"There's also much to be gained," she said, citing a study that found that if the U.S. eliminated racial disparities in the areas of health education, incarceration, and employment, the economy could be $8 trillion larger by 2050. "So as a country and as a society, we can't afford not to address it."

Continue Reading:  From Crisis to Opportunity: Partnering to Address SDOH, Health Disparities

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.

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