Essay
Abstract
Researchers have long been exploring the various factors that affect the health condition of individuals and/or groups. They have reported the key factors that seemingly determine health outcomes for vulnerable populations, namely, socioeconomic status (e.g. income, education, and occupation), cultural practices, and social services (e.g. housing, medical care). These so-called social determinants of health largely contribute to health disparities. Health policy has also been reported to significantly influence the health condition of vulnerable population. For instance, in the U.S., health policy is more focused on 'cure' than 'prevention', which, in consequence, channels bulk of the resources toward clinical treatment and medical research. Advanced practice nurses must therefore step up and use their capability and influence as professional role models to help improve the health condition of vulnerable population.
Introduction
The concept of 'social determinants of health' seems to have arisen from the efforts of researchers to determine the particular factors that explain the differences in the health status of various socioeconomic groups. The World Health Organization (WHO, 2016) defines social determinants of health (SDH) as the “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (WHO, 2016, para 1). Although it was widely reported that people in different socioeconomic groups exhibited varying health outcomes, the particular factors and ways through which these factors resulted in disease, illness, or poor health status have yet to be determined. Tarlov, in his pioneering work Social Determinants of Health: The Sociobiological Translation, found out that disparities in the quality of social determinants of income, employment, social acceptance, education, and housing are converted into illness-related mechanisms through people measuring themselves up critically or adversely to others (Blane et al., 2002). This essay critically analyzes the social determinants of health.
A number of studies report a significant correlation between health condition and socioeconomic variables like occupation, education, and income. Several scholars claim that these variables determine and are more influential than lifestyles or health services in affecting mortality and morbidity. In their efforts to identify the connection between health and socioeconomic variables, some scholars underline the immediate effect of low income, deprivation, and poverty on quality of life; others place greater emphasis on the impact of inequality in a given society (Robert Wood Johnson Foundation, 2010). Some researchers have also found out that racial affinity is strongly associated with socioeconomic factors but also exhibits a separate impact on health status. According to Treadwell and colleagues (2012), different mediating factors between health and socioeconomic status are also studied-- the biological impact of stress across the lifespan, the design of the workplace, unchangeable mechanisms in early childhood, and the lack or presence of social support and security at the community or state level.
Economic, Social, Cultural, and Political Factors Affecting Health
Starting in the early 19th century, scholars formulated the notion of socioeconomic status. Moreover, they created comprehensive methods to conceptualize the meaning of socioeconomic status and categorize people. In the U.S., the meaning has largely comprised indicators that are mainly economic, such as professional standing, educational status, and family income. In highly industrialized countries like the U.S., health outcomes, in part determined through life expectancy, is significantly related to socioeconomic status (Marmot & Wilkinson, 2005). Longer life expectancy is partly attributed to higher socioeconomic standing. Higher economic status normally suggests higher quality of life and or better living conditions. Healthier cooking and consumption practices, better access to quality health care, less congestion, and better hygiene and sanitation (Treadwell et al., 2012) are all significantly correlated with higher economic standing in the U.S.
Education is another factor significantly correlated with more favorable health outcomes. It could influence health status and enhance longevity by promoting behavioral patterns that enhance protective mechanisms against illness and also lessen vulnerability to behaviors that increase the person's susceptibility to illnesses. Higher educational achievement, alongside bigger resources that higher income or economic status can offer, could enhance access to quality health care services and generate better capability of protecting oneself from health risks (Kronenfeld et al., 2012). People with lower income or those belonging to the bottom of the socioeconomic ladder are more susceptible to health risks in their immediate environment through the food they consume, in the water they ingest, and in the harmful air substances they inhale. Nevertheless, these factors, although significant, cannot be attributed to all the reported disparities in life expectancy among people of various socioeconomic standing. According to Shi and Stevens (2008), the prevalence of coronary heart disease, for example, are significantly greater among low-income individuals.
Numerous studies are currently being aimed at gaining a more accurate understanding of the abovementioned effects and other outcomes of socioeconomic status. A key theoretical explanation is that social participation and social control may affect such major health disparities. It explains that control over the process of making choices or decisions are better among people of higher socioeconomic standing (Robert Wood Johnson Foundation, 2010). This theoretical perspective argues that the capability of having control over one's life could be linked to biological factors that influence one's health condition.
In the meantime, culture shapes an individual's worldview and behavioral patterns. Culture distinguishes what is right or wrong, and what is health and wellbeing. This could involve health beliefs and lifestyle practices-- for instance, disciplined eating habits in some cultures imply a healthy lifestyle, not excessive eating or other extravagant habits. Culture strongly influences lifestyle patterns (Shi & Stevens, 2008). According to Marmot and Wilkinson (2005), food preparation and preservation procedures and food preferences are influenced by culture, including socioeconomic status.
Culture is also associated with a person's reaction to symptoms and compliance with treatments or interventions. For instance, in numerous cultures, medical services are solely for individuals with symptoms and are not preventive mechanisms. Numerous customary cultures have created elaborate self-medication and self-care practices promoted by traditional healers and family members. Such cultural practices significantly influence how people react to symptoms and the kinds of public health and medical treatments they will comply with (Shi & Stevens, 2008). Numerous cultures permit and even promote the application of traditional interventions along with Western public health and medical interventions. Current studies of alternative medicine have presented empirical findings proving that particular customary interventions, like chiropractic and osteopathic treatment and acupuncture, have quantifiable advantages (Treadwell et al., 2012). Hence, cultural diversity must not be seen as issues to be resolved, but instead as practices to be taken into consideration.
Social determinants of health affect a broad array of diseases and illnesses brought about by social, cultural, economic, and political factors. Current growth in the number of studies focusing on the social determinants of health has been motivated by their linkage to health disparities. Health disparities have an adverse impact on individuals and/or groups that have consistently encountered bigger economic or social barriers to health (Marmot & Wilkinson, 2005). These barriers originate from aspects historically associated with exclusion, oppression, or discrimination, like geographic location, sexual preference, mental health, gender, socioeconomic status, religion, ethnicity, and race.
Disparities arise in a broad array of health situations, including environmental safety and health and non-transmittable and transmittable illnesses. Some examples of such health disparities are as follows (Treadwell et al., 2012): White people 65 years old and above usually have a greater prevalence of influenza vaccine coverage in comparison to other ethnic/racial groups; disparities in rates of colorectal cancer screening are attributed to levels of income and education; and Blacks are much more prone to stroke and cardiovascular disease in comparison to their White counterparts.
The dividing line that scholars distinguished between the role of health care and the role of social determinants in shaping the health condition of individuals and/or groups resembles that of the broadly known differentiation between medical care and public health. Even though health care places emphasis on providing treatment to patients, usually after they have already exhibited symptoms, public health underlines the value of enhancing the wellbeing of populations or communities, usually through disease prevention (Shi & Stevens, 2008). Because public health concentrates on disease prevention, it generally tries to deal with social determinants; therefore, public health, as well as its policy and processes, may also be regarded as a social determinant.
How does health policy and the policy process impact vulnerable populations and health outcomes?
Local, state, and federal laws all affect circumstances that determine a population's health condition. Public policy may be described as instrumental to community health and an element that affects all other factors that determine general health. Public policy influences the environment, the access to and quality of health care services, food availability, income, education, and housing (Barr, 2011). However, a great deal of health policy in the U.S. concentrates on insurance and medical care. Not much emphasis is given to the quality of population health (Harrington, 2004). Moreover, the focus of health policy making does not take into full consideration the historical background of the causes of large-scale changes in populations' general health.
The notion that the U.S. could attain improved population health without absolutely raising expenditure or investment in health care may appear incongruent, insofar as it is believed that health care is the primary determining factor of health. As far-reaching and important as health care is for individuals, numerous empirical findings show that such health care is not the primary determinant of the general quality of population health (Barr, 2011). Instead, environmental, behavioral, psychological, social, and economic variables are more predicted to be the primary determinants of the health of populations.
Generally, public health policy has a more favorable effect on a larger number of individuals than does medical care. The delivery of clean water to a neighborhood, for instance, could be produce more benefits to the health of the residents than will the administration of treatment to individuals who report symptoms of water-borne illnesses. Similarly, more individuals can be protected from lung or throat diseases by discouraging cigarette smoking than by curing smoking-related diseases (Shi & Stevens, 2008). Recognition of the role of social determinants indicates that policies that focus casually on health- for instance, reducing social inequality-- could also produce valuable health benefits.
However, in spite of the relevance of social determinants to health, the health policy of the United States places emphasis on the health care system. The U.S. allocates a significant portion of its GDP to health care services, yet bulk of those resources is invested in clinical intervention and medical research (Kronenfeld et al., 2012). A significantly small portion is invested in public health programs. The Patient Protection and Affordable Care Act (ACA) of 2010, for instance, considerably broadened the coverage of clinical preventions by mandating insurance providers to perform preventive services (e.g. screenings) for free (Kronenfeld et al., 2012). In fact, the proponents of ACA stressed its emphasis on prevention, but very little funding has been allocated to primary prevention. Therefore, effective distribution of public health resources and successful development and implementation of health policies can significantly enhance public health.
What role can advanced practice nurses play in improving health outcomes in vulnerable populations?
Advanced practice nurses are in the best position to help improve the health condition of vulnerable populations. Above all, the nurse should be aware and responsive to the health issues and healthcare services needed by the vulnerable population, besides having a wide-ranging understanding and knowledge of the available resources and ways to access these valuable resources. Moreover, the nurse should have the needed communication skills to professionally and competently coordinate and communicate to the patient the health care plan or range of healthcare services (Stanhope & Lancaster, 2015). The nurse must persevere when working with and helping a vulnerable population. Patience, determined efforts, and time are crucial and absolutely needed to sustain communication with the patients and guide them toward valuable resources that would help improve their health condition.
Furthermore, advanced practice nurses can help vulnerable populations achieve better health outcomes by taking part in policymaking and co-operating with policymakers. Advanced practice nurses have the capability to collaborate with private and public organizations to generate and deliver the needed resources for additional inclusive health care services. A case in point is making use of informal and formal means to talk about or negotiated issues pertaining to public health with politicians and policymakers (De Chesnay & Anderson, 2015). During these collaborative efforts the nurse is viewed as a professional possessing specialized knowledge and influence. Advanced practice nurses have powerful opportunities to promote health policies that would enhance the health and economic condition of vulnerable populations.
Conclusions
The health condition of vulnerable populations is influenced by numerous factors-- economic, social, cultural, and political. The social determinants of health explain how health outcomes of individuals and/or groups are shaped by both internal and external circumstances. Health policy can also be considered a determinant of health outcomes for vulnerable populations, but must not be considered as a major social determinant of health. Advanced practice nurses are in the best position to help vulnerable populations achieve better health outcomes by providing their healthcare needs and promoting their interests through collaboration with policymakers and elected officials.
References
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Blane, D. et al. (2002). Health and social organization: towards a health policy for the 21st century. London: Routledge.
De Chesnay, M. & Anderson, B. (2015). Caring for the vulnerable. Sudbury, MA: Jones & Bartlett Publishers.
Harrington, C. (2004). Health policy: crisis and reform in the U.S. health care delivery system. Sudbury, MA: Jones & Bartlett Learning.
Kronenfeld, J. et al. (2012). Debates on U.S. health care. Thousand Oaks, CA: SAGE Publications.
Marmot, M. & Wilkinson, R. (2005). Social determinants of health. Oxford, UK: OUP Oxford.
Robert Wood Johnson Foundation (2010). A new way to talk about the social determinants of health. Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2010/rwjf63023
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Stanhope, M. & Lancaster, J. (2015). Public health nursing: population-centered health care in the community. New York: Elsevier Health Sciences.
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World Health Organization (WHO) (2016). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
