Political Aspects of the Social Determinants of Health
Political Aspects of the Social Determinants of Health
• The health of individuals and populations is determined
significantly by social factors.
• The social determinants of health produce great inequities in
health within and between societies.
• The poor and disadvantaged experience worse health than the
rich, have less access to care, and die younger in all societies.
• The social determinants of health can be measured and described.
• The measurement of the social determinants provides evidence
that can serve as the basis for political action.
• Evidence is generated and used in a continuous cycle of evidence
production, policy development, implementation, and
evaluation. Political Aspects of the Social Determinants of Health
• Evidence of the effects of policies and programs on inequities can
be measured and can provide data on the effectiveness of
interventions.
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• Evidence regarding the social determinants of health is
insufficient to bring about change on its own; political will
combined with evidence offers the most powerful strategy to
address the negative effects of the social determinants.
The ACA begins to carve out a role for the health care system in
addressing upstream factors. For example, the law requires that
nonprofit hospitals demonstrate a “community benefit” to receive
federal tax breaks. Hospitals must conduct a community health
assessment, develop a community health improvement plan, and
partner with others to implement it. This aligns with a growing
emphasis on population health: the health of a group, whether
defined by a common disease or health problem or by geographic
or demographic characteristics (Felt-Lisk & Higgins, 2011) Political Aspects of the Social Determinants of Health.
Consider the 11th Street Family Health Services. Located in an
underserved neighborhood in North Philadelphia, this federally
qualified, nurse-managed health center (NMHC) was the brainchild
of public health nurse Patricia Gerrity, PhD, RN, FAAN, a faculty
member at Drexel University School of Nursing. She recognized
that the leading health problems in the community were diabetes,
obesity, heart failure, and depression. Working with a community
advisory group, Gerrity realized that the health center had to
address nutrition as an “upstream factor” that could improve the
health of those living in the community. With no supermarket in
the neighborhood until 2011, she invited area farmers to come to
the neighborhood as part of a farmers’ market. She also created a
community vegetable garden maintained by the local youth. And
area residents were invited to attend nutrition classes on culturally
relevant, healthful cooking. 11th Street Family Health Services is
one of over 200 NMHCs in the United States that have improved
clinical and financial outcomes by addressing the needs of
individuals, families, and communities (American Academy of
Nursing, n.d., b).Political Aspects of the Social Determinants of Health The ACA authorizes continued support for these
centers, although the law does not mandate they be funded.
Congress would have to appropriate funding for NMHCs but has
not done so. (See Chapter 34 for a more detailed discussion of
NMHCs.)
The ACA may not go far enough in shifting attention to the
health of communities and populations. One approach gaining
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notice is that of “health in all policies,” the idea that policymakers
consider the health implications of social and economic policies that
focus on other sectors, such as education, community development,
tax codes, and housing (Leppo et al., 2013; Rudolph et al., 2013). As
health professionals who focus on the family and community
context of the patients they serve, nurses can help to raise questions
about the potential health impact of public policies Political Aspects of the Social Determinants of Health.
