An individual’s health is influenced by many factors. Nurse Practitioners must be versed in all factors and adept in assessing the impact of economic conditions, education, environment, and social conditions on health.
Social Determinants of Health (SDOH) have a major impact on people’s health, well-being, and quality of life. Examples of SDOH include:
Safe housing, transportation, and neighborhoods
Racism, discrimination, and violence
Education, job opportunities, and income
Access to nutritious foods and physical activity opportunities
Polluted air and water
Language and literacy skills
For this Discussion, you will explore Social Determinants of Health and five areas that are impacted. For your community where you reside, assess these five areas. You will also explore available instruments to complete a full assessment of an individual’s SDOH.
2. Education Access and Quality 🏫
Education is a key determinant of health. The high school graduation rate in my area is about 90%, and a significant portion of the population (45%) holds a bachelor's degree or higher. This high educational attainment correlates with higher health literacy and better job opportunities. However, there is a clear divide in school funding and resources between affluent suburbs and inner-city schools, which affects the quality of education and, in turn, future health and economic prospects for students in those areas.
3. Healthcare Access and Quality 🏥
Access to healthcare in my community is relatively good, with several major hospitals and clinics. Approximately 93% of residents have health insurance. However, a major barrier is the lack of primary care physicians in certain low-income neighborhoods. This leads to longer wait times and forces residents to rely on emergency rooms for non-urgent care, which is both inefficient and costly. Additionally, mental health services are underfunded and have long waiting lists.
4. Neighborhood and Built Environment 🌳
My community is generally safe, with a low violent crime rate. We have numerous parks and recreational facilities, which promote physical activity. However, there are areas with older housing stock that may contain environmental hazards like lead paint. While the city has made efforts to improve public transportation, it remains a challenge, forcing many residents to rely on cars, which contributes to air pollution and can be a barrier to accessing jobs and services.
5. Social and Community Context🤝
The community has a vibrant social fabric with many local organizations and community centers. However, levels of civic engagement vary significantly by neighborhood. There are also instances of racial and socioeconomic segregation, which can lead to feelings of social isolation and distrust among different groups. Addressing this requires programs that promote cross-cultural understanding and collaboration.
SDOH Assessment Instrument
A valuable tool for assessing an individual’s SDOH is the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) tool.
What it is: PRAPARE is a national standardized patient risk assessment protocol developed by the National Association of Community Health Centers.
What it measures: It systematically screens for various SDOH domains, including:
Personal and family background
Housing and utilities
Food security
Financial resources
Social support
Transportation
Stress and safety
Veteran status
How it works: The tool consists of a series of questions that can be integrated into a clinic's intake process or EHR system. The responses provide a comprehensive view of a patient's social needs, allowing a nurse practitioner to move beyond clinical symptoms and address the root causes of health issues. For example, if a patient screens positive for food insecurity, the NP can connect them with a food bank or a social worker. This helps the practitioner provide holistic, patient-centered care.
Sample Answer
Social Determinants of Health (SDOH) significantly influence health outcomes, well-being, and quality of life. For my community, I'll assess five key areas impacted by SDOH and discuss a tool for individual assessment.
1. Economic Stability 💰
The economic stability of my community is a mixed picture. The median household income is approximately $75,000, which is slightly above the national average. However, the unemployment rate, while generally low at 3.5%, has disparities. Certain neighborhoods have unemployment rates closer to 8%, reflecting a lack of job opportunities and economic inequality within the same community. This impacts access to stable housing and healthcare.