Running head: SOCIAL DETERMINANTS OF HEALTH 1

Social Determinants of Health

Lindsay M. Winston

Professor Kathy Faw, RN

NUR 3116

October 5, 2017

Honor code “I Pledge”

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Social Determinants of Health

Introduction

Social determinants of health are the factors and conditions in someone’s environment or

community that basically shape the way they receive health care. Many factors go into a person’s

social determinants. Where a person lives and works, the religion they practice and their age are

just a few examples of social determinants. All of these factors are going to directly affect their

healthcare options, food choices, and much more, which ultimately correlates with quality of life

outcomes and risks. Throughout this paper the reader will learn about a specific individual and

how social determinants shape and affect that person’s quality of care.

Upstream Factors

Upstream factors are an integral part of a person’s life and are social determinants that

directly influence the care that they receive. Income, education and employment can ultimately

decide the level of care you will receive and your access to healthy foods, medications and much

more. Also, the actual physical environment you reside in makes a huge impact on your health

status and options. For example, people who live in largely polluted areas, or people who do not

have access to clean water, are going to have a higher chance of suffering from poor health than

someone who isn’t affected by environmental disadvantages. The interviewee is a ninety-one

year old retired veteran. He is currently receiving social security as his only form of income. He

served our country for twelve years and fought in World War II, serving a term in Germany. He

was released from the army by honorable discharge because he became ill with tuberculosis

during the time he was serving. Since he was honorably discharged, he does receive benefits

from Veterans Affairs. The interviewee verbalized how important the support from the VA is,

because without it, he would not be able to afford his in-home health care, his medical supplies
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and some medications. Fortunately, the interviewee lives in a very good part of town. He

currently resides in a handicap accessible home that can accommodate to his needs providing a

wheelchair ramp, handicap accessories in the bathroom, and appropriate assistive devices. The

physical environment itself provides clean water and not very many negative effects. Overall, the

interviewee expresses positive feedback about his current situation and living environment. Even

though he is unemployed and is only receiving social security, the benefits he receives from the

VA allow him to continue a positive lifestyle and receive great healthcare.

Population Factors

A person’s population factors can significantly influence the way they receive healthcare.

In healthcare, the goal is patient centered care. The care will vary depending on specific

population factors that the patient obtains. The population factors that define a person are not

only determined by the actual population, but they are also influenced by a person’s own

behavioral choices. As the interviewer, it was interesting to learn about the interviewee and what

specific population factors he obtains. The interviewee expressed that he has never participated

in smoking or drinking. He eats a very healthy diet that is cooked by his in home nurses. He did

state that he does not get much exercise because he does spend most of his time in a wheel chair.

However, the interviewee did say that he is still able to ambulate short distances with a walker

and tries to walk as much as possible. The physiological factors that the interviewee presented

with were remarkable and within normal limits. His vital signs were amazing for a person his age

and his lab values from his last in home visit were all within defined limits. The health state of

the interviewee is fairly healthy for his age. He did express that he has previously experienced a

stroke, which diminished his health status. He spends most of his time in a wheelchair and has to

have nurses to his house to assist with personal hygiene and other daily activities. As the
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interviewer, I could sense the interviewee suffers from slight dementia, but otherwise has a very

appropriate mental state. The interviewee could not express any genetic factors that he is affected

by and he proved resilience in his ability to recover from a stroke. It is obvious that the

interviewee is receiving the appropriate amount of care that is needed for him. He chose positive

lifestyle choices and sticks to his plan of care to result in a very healthy status for his current age.

Health Care System Factors

Health care systems may be one of the biggest determinants of health. Individuals can

choose positive lifestyle choices, eat healthy and be compliant with their medications, but if they

cannot afford a health care system, or do not have one available, how do they receive proper

care? In the interviewee’s case, he is very fortunate when it comes to health care systems. He

currently has three different in-home nurses that come to his house for twelve-hour shifts, seven

days a week. They provide him with basic everyday care, range of motion activities and even

emotional support. As far as the organizations that the interviewee receives care from, that would

only include Veterans Affairs. Since he qualifies for healthcare from the VA, they provide a

team of health care workers for him. The VA provides the interviewee with a personal RN,

Nurse Practitioner, Physical/Occupational therapist, social worker, etc. There is a whole team of

individuals who work together to provide care for the interviewee. In addition, they visit him in

his home since he is predominately wheel chair bound. This approach of health care is very

positive and very effective. First of all, you have a whole team of people in one place with easy

access to them. Most health care systems do not provide a whole team in one place making it

harder for the client to follow through with suggested appointments and filling their medications,

etc. Secondly, the health care team travels to the interviewee’s residence, which means he will

always be compliant with seeing the healthcare professionals. The system that the VA
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implements ensures primary prevention and allows the health care options for the veterans to be

very easily accessible. The interviewee expressed how much he appreciates his health care

system options and without them his ability to receive health care would diminish greatly.

Conclusion

Everyone on in the world has social determinants whether they are positive or negative.

Some may be more positive than others, but everyone has factors that correlate with their ability

to receive care. As the reader learned throughout this paper, upstream factors, population factors

and health care system factors shape someone’s individual ability to receive and keep up with

health care. Where you live, how much money you make, lifestyle decisions and physiological

factors are just some of the specific key points that go into determining your health care. As the

reader can see, the interviewee has a very positive health care status and situation. However, it is

not so easy for everyone. There are plenty of individuals who haven’t seen a doctor in years

because they simply cannot afford it. As nurses, it is important to recognize these factors and

accommodate to them as best as possible so that no matter what your status, you are receiving

the most appropriate health care you need.

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References

Fawcett, J & Ellenbecker, C. A. (2015). A Proposed Conceptual Model of Nursing and

Population Health. Nursing Outlook retrieved from

https://bsmcon.blackboard.com/courses/1/201718FALL-NUR3116-

GB/content/_207521_1/embedded/Fawcett J Ellenbecker CH _2015_.pdf