Social determinants of health

Online Journal of Rural Nursing and Health Care, 17(1) http://dx.doi.org/10.14574/ojrnhc.v17i1.452 1

Editorial

Social Determinants of Health and Rural Nursing

Pamela Stewart Fahs, PhD, RN, Editor

Social determinants of health is a term defined by the Healthy People 2020 (Office of

Disease Prevention and Health Promotion, n.d., section Understanding) as “…conditions in the

environment in which people are born, live, learn, work, play, worship and age that affect a wide

range of health, functioning, and quality of life outcomes and risks”. In this definition “place”

matters, as does race/ethnicity, age, education, social support etc. – all of the factors that are part

of one’s socio-economic status. Thus being a rural dweller alone does not put your health at risk

but if you are a rural dweller with little social and economic resources you will have a higher risk

for ill health. You may need to use more resources to access health care than someone in a more

urban place, simply because of limited accessibility. For those living in a rural setting without

reliable transportation being able to access health care is more arduous than for those with access

to transportation as well as health care.

Anyone with even a modicum of knowledge on the history of nursing can connect the

profession and past efforts and successes in enhancing population health through work on the

social determinants of health. This work can be seen in urban areas by nurses such as Lillian

Wald at Henry House in New York and rural areas in the work of Mary Breckenridge and the

Frontier Nursing Service. In both cases nursing was caring for individuals and families but also

looking at the macro level problems of poverty, lack of formal education, poor housing, lack of

access to health care; all of which would be deemed today as improving the social determinants

of health. Since the 1920’s with the work of Wald and Breckinridge we have made inroads into

the health status of people in the US. In general we have better living situations for individuals

Online Journal of Rural Nursing and Health Care, 17(1) http://dx.doi.org/10.14574/ojrnhc.v17i1.452 2

and families, more education and more wealth. However, the upward trajectory in health status

over the years is not carrying all and Healthy People 2020 (n.d.) promotes a place based

organizing framework that addresses five major determinants of health: a) Economic Stability, b)

Education, c) Social and Community Context, d) Health and Health Care, and e) Neighborhood

and Built Environment. Nursing has a clear role in providing health care beyond care of the

individual. Flynn (2016) writes that “…nursing may have more potential than other health

professions in bringing power and authority to the idea of social determinants and incorporating

this content into training and professional perspectives” (p.7). How as nurses do we influence

social determinants of health? First, in order to address an issue, nurses have to be aware of the

problems posed. The problems are not ones with an easy or quick fix. Nurses need to use our

abilities to collaborate and coordinate with other professions to address these broad problems.

Interventions must go beyond the micro or individual problems to the macro level of the issues.

This type of intervention requires that we use our collective power, experience and knowledge to

address issues of families, communities and societies. There is an ever increasing need for

nurses to influence health policy. Nurses can also be instrumental in helping to assure that the

environments in which our population lives is one that supports health and wellness. It is as

imperative today has it has ever been for nurses to be leaders in all facets of health care.

References

Flynn, M. (2016). Health plus social: In inquiry into the social determinants of health. CA:

USC School of Social Work, Green House.

Office of Disease Prevention and Health Promotion (n.d.). Healthy People 2020. Author.

Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-

determinants-of-health