Nurses play a critical role in improving population health and advancing health equity by addressing the social determinants of health (SDOH), broadly defined as the conditions in which people live, grow, work, and play that affect health outcomes.1 Factors such as an individual's level of educational attainment, type of employment, access to affordable housing and food, and access to health care services are examples of social determinants that can create systemic and unjust inequities in health. Addressing SDOH is fundamental to achieving health equity.
The Future of Nursing 2020-2030 report emphasizes the key role nurses play in eliminating health inequities and building a healthier society by addressing SDOH.2 Similarly, the American Association of Colleges of Nursing's Essentials is focused on applying principles of competency-based education to prepare the next generation of nurses for contemporary practice.1 While future generations of nurses will be equipped with the knowledge and skills to incorporate principles of SDOH and health equity into their clinical practice, what steps can today's nurses, who may or may not have been exposed to this paradigm, take to address SDOH in their practice?
Awareness. Nurses must have a baseline understanding of SDOH and how they impact health outcomes specific to their patient population and/or clinical area. Nurses can refer to Closing the Gap in a Generation, the final report from the World Health Organization's Commission on SDOH,3 and the Future of Nursing 2020-2030. Nursing and other health care journals are increasingly addressing the impact of SDOH on patient health outcomes and ways that nurses can help address these factors.
Assessment. Patient encounters offer an opportunity to screen and assess for SDOH. Understanding how these factors impact a patient's ability to access and afford quality health care is key to treatment and discharge planning. A nurse's ability to pick up on cues during assessments is key to identifying and intervening in SDOH. To assist clinicians, health systems have adopted various SDOH screening tools, such as those from the Agency for Healthcare Research and Quality (http://www.ahrq.gov/sdoh/practice-improvement.html).
Assistance. Once a thorough evaluation of the patient's SDOH is completed, nurses can directly link patients to needed resources or make referrals to members of the interdisciplinary health care team. Social workers and financial navigators and/or legal advocates can help patients navigate the health system. Once patients are connected to resources directly or via referrals, follow-up assessments are essential to maintaining continuity of care.
Advocacy. Nursing is viewed as the epitome of patient advocacy. Advocating for policies that impact SDOH at the population health level can have a greater impact on health equity and requires nurses to move upstream. This includes advocacy efforts toward supporting social and economic policies and programs that intervene in factors such as housing, transportation, food access, and neighborhood conditions. Engaging in institutional, state, and federal policymaking to challenge social injustices and structural inequities is a core function of nursing that is central to eliminating health inequities.
By engaging in these simple steps to identify and address SDOH, nurses can bring about tremendous changes in the lives of patients as well as at the population health level. If every nurse incorporated even one of these strategies in their practice, the ripple effects would spark changes across health systems, communities, and the nation, bringing us one step closer to creating a more equitable society.
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