Most health professionals have some point in their career where all of a sudden, a lightbulb seems to turn on.
It happens often and powerfully with nurses, who spend so much time and emotional energy with their patients, that eventually, inevitably, there will come a time when they see that the greatest sources of our sickness, or our health, are not microbial or behavioural. They're social, political and economic.
We want to help you tell the story of when this first happened to you. It can focus on your own perspective, or the lives and experiences of your patients. Keep reading for a useful list of these social determinants of health, and the questions you can ask yourself to get the ball rolling.
1. Poverty and income inequality
- In your story, has your patient come to their health outcomes by way of poverty, a lack of income, and/or because of being at an economic disadvantage in society?
- Did they realize the link between their lack of income, and being in their situation at the time? Did they ever discuss it with you?
- Please share your perspective, your thoughts and your feelings about seeing your patient at the ‘end Stage of poverty’. How did it make you feel? What should we do so it doesn’t keep happening?
2. Education, educational inequality and deficit
- We know that dropping out of high school is as damaging to our health, and as contributive to our mortality rates, as a life time of smoking and/or poor diet.
- In your story, has your patient experienced the damaging health impacts of a lack of education?
- Did they recognize the ways that their lack of education and lack of opportunities, determined other things in their life, like income, access to healthy food and access to health care?
- Did they recognize the link between their education history and their health outcome? Did you discuss it?
- Please share your perspective, your thoughts and your feelings about seeing your patient at the “End Stage of Educational Deficit”. How did it make you feel? What should we do so it doesn’t keep happening?
3. Precarious employment, unemployment and unsafe work conditions
- The new trend of precarious work, and the rise of what’s being called the “precariat” class, has enormous implications for the future of health at the individual, community and national levels. Work can be considered precarious when it is unpredictable, insecure, and/or lacking in income or benefits.
- Have you cared for a patient who had to work multiple jobs with unreasonable or insufficient hours, frequently unsure when or if they would have another shift, or what their employment/income situation would be in the days and weeks to come? Perhaps they had a partner, parent or child in this situation, whose health was also impacted.
- Precarious work can have a direct effect on mental health in many ways, such as the stress of unpredictability and insecurity, the challenge to one’s identity and sense of fulfilment by not having steady work, complications of sporadically qualifying and not qualifying for social assistance, and many other factors. Have you cared for a patient whose physical or mental health was affected by these challenges?
4. Inadequate, crowded and unaffordable housing
- We know that affordable, safe and appropriate housing can set a person up to access a host of other health contributing activities.
- In your story, did your patient experience unsafe, overcrowded, or unstable housing? Were they exposed to environmental factors that they weren’t able to mitigate such as mould, smoke, insects, or the elements due to lack of or inadequate shelter?
- Did they recognize the ways that their lack of housing security determined other things in their life, such as income, access to healthy food and access to health care? Did you discuss it?
- Please share your perspective, your thoughts and your feelings about seeing your patient at the “End Stage of inaccessible housing”. How did it make you feel? What should we do so it doesn’t keep happening?
5. Food insecurity and nutrition
- Good nutrition is key, but not everyone is able to access good food. Individuals and families face cost barriers as well as accessibility barriers.
- In your story, did your patient experience aAny of these barriers to good foods?
- Did they recognize the ways that their lack of access to healthy food impacted their health? Did you discuss it?
- Please share your perspective, your thoughts and your feelings about seeing your patient at the “End Stage of Food Insecurity”. How did it make you feel? What should we do so it doesn’t keep happening?
6. Exclusion, isolation and loneliness
- Various factors, including potentially all the other social determinants of health, can conspire to exclude individuals, families and communities from wider society. Environmental and geographical isolation can be barriers to accessing healthcare directly. Have you encountered trends amongst patients where these challenges either created or worsened poor health outcomes?
- Poverty, inadequate income and housing, and deficits in education and nutrition can directly or indirectly exclude people from social and economic benefits of the mainstream. The social determinant of poverty/inadequate income can prevent someone from having access to a car, for example, making it harder in-turn to get a decent job, leading to the inability to buy nutritious food, and so forth. Have you witnessed these sorts of trends? How did you see them connect to other social determinants of health?
- The data show that loneliness can be a greater factor for all-cause mortality than smoking or obesity. People disproportionately affected include the elderly, new immigrants, those who identify as LGBT, and those in remote communities.