Social Determinants of Health

Social Determinants of Health (SDH)

• SDH are conditions in which people are born, grow, live, work, and age, influencing health outcomes.
• SDH are mostly accountable for health inequities, defined as unfair and avoidable health status differences.
• SDH include, but are not limited to, social, economic, and environmental backgrounds, which influence individual and community health outcomes.
• SDH affect an individual's ability to maintain a healthy lifestyle, leaving lasting impacts on individual and community wellbeing.
• SDH affect a person's ability to adopt healthy lifestyles through factors like income, access to education, and resources like healthy food and safe exercise spaces.
• Lower incomes can limit access to nutritious food, healthcare, and safe physical activity locations.
• The built environment affects overall health (housing, air quality, safety), lifestyle factors (diet, exercise, smoking).
• Exposure to pollution, lack of clean water, and unsafe conditions increase disease risk, while unhealthy lifestyles contribute to chronic conditions.
• Poor living conditions increase stress and unhealthy coping mechanisms.
• SDH significantly affect child health and development, especially in sensitive early childhood.
• Housing quality, nutrition, parental education, socioeconomic status, and healthcare access influence child development.
• Children growing up impoverished with poor nutrition, unsafe conditions, or limited education are more likely to face developmental delays and health challenges.
• Good nutrition and supportive environments allow for better mental and physical health outcomes for children.
• SDH aid identifying community strengths (socioeconomic status, education, social networks) or challenges (economic hardships, poor education, social isolation).
• Addressing social inequalities and improving access to education and healthcare reduces health disparities and strengthens community health.
• Health professionals can better understand broader social factors by recognizing the SDH.

SDH's Impact on Healthcare Access in New Zealand

• SDH significantly impact people's access to healthcare services in New Zealand; barriers particularly affect marginalized communities.
• Addressing health inequities is crucial to ensure equitable access to healthcare for all New Zealanders.

Key SDH Impacting Healthcare Access in New Zealand

• Key points are to recall impacts within NZ rather than just globally
• Income is a significant determinant; low-income individuals face financial barriers
• GP visits and prescription costs can be prohibitive
• Subsidies are available via a card, but do not solve all issues
• Employment status matters as insecure jobs may not provide paid sick leave
• Unemployed individuals may lack access to employer health coverage

Geographic Location

• Rural/Remote areas face access challenges; lack of providers requires travel
• Rural public health services may be underfunded, delaying diagnoses and treatment
• Lack of transportation impacts appointment attendance

Cultural and Linguistic Barriers

• Cultural and linguistic differences create access barriers, particularly for Māori, Pasifika, and immigrants.
• Historic inequities and racism contribute to Māori/Pasifika mistrust, impacting health outcomes
• Healthcare systems need cultural competence improvements for better outcomes

Education and Health Literacy

• Health literacy strongly correlates with navigating the healthcare system and recognizing medical needs
• Lower literacy leads to struggles with medical instructions/information, and poor health outcomes
• Lower literacy leads to struggles with chronic diseases
• Higher education leads to better knowledge of individual rights

Access to Health Insurance

• Gaps in coverage, especially for specialist/elective care, persist despite a public system
• Lack of private insurance leads to long waits or inability to afford services

Housing and Living Conditions

• Substandard housing directly impacts health and access
• Overcrowding leads to more mental and respiratory conditions and infectious diseases
• Lack of resources also makes it harder to promote general health

Social Support and Networks

• Strong networks enable individuals to access services as a result of reminders and moral support
• Isolation poses challenges, especially for older and migrating demographics

Discrimination and Systemic Barriers

• Bias impacts access and causes avoidance of care
• Discrimination within healthcare, based on race/gender/socioeconomic status/disability, creates major barriers
• Implicit biases and structural racism, particularly for Māori and Pasifika, leads reluctance to trusting the system

Addressing Barriers

• Addressing these needs requires systemic changes including cultural understanding and the employment of appropriate care practices

Implications for Nursing Practice

• Nurses are increasingly responsible for chronic and long term care
• Care coordination, disease management, and understanding specific communities is increasingly important

Increased Health Service Pressure

• Increased pressure is impacting healthcare services across the board as a result of compounding issues

Governmental Solutions

• The government addresses this impact through programs to impact smoking and alcohol use
• Nurses play an important role delivering these treatments, especially supporting underserved communities

Nursing Adaptations to Improve Service Access During COVID-19

• Nursing rapidly adapted to improve things like telehealth and vaccinations.
• Services were prioritized to limit the impact of the pandemic, while continuing important care.

Key Adaptations

• Testing and Vaccination, including mobile clinics and drive-through
• Telehealth and virtual follow-ups for contact tracing and quarantine efforts
• Tailoring Health Education for groups and use of social media
• Mental Health support and psychological interventions to minimise isolation or concerns, with telehealth for easier continuity of care
• Home-Based care as adaptation to supporting vulnerable populations from Covid and limiting exposure

Community Health and Wellness: Principles of Primary Health Care

• Emphasis on creating and maintaining healthy communities with a focus on primary health care through collective responsibility

Key Themes

• Health promotion focuses on improving individual wellbeing beyond simply absence from physical and mental disease
• Care must remain universally accessible and affordable

Health Care Must Be Hollistic

• Care must consider education, housing, and employment
• Communities should be participating in program planning
• Social conditions must be taken into account to properly improve the public health

Importance of Nurses

• Not simply care givers, but advocates and educators
• Important that they work directly with local communities and know their own needs
• Requires focus, inclusivity, and a participation to promoting wellness and minimize illness

Importance of the SDH

• These should be directly addressed to solve inequity experienced by different communities
• Health factors also include economic stability, access to education, community, and access to clean environments.

Addressing This

• Social determinants must also be improved, addressing poverty, and improving access to things like education.
• Vulnerable populations experience higher rates of chronic conditions and disease
• It is important to target and consider multiple government sectors from schools, healthcare providers etc

SDH Global Perspective

• This is a global issue with global implications
• Health is interconnected worldwide and effective solutions should seek to solve the SDH

Action

• Action requires a combination of policies from the government and efforts among healthcare and the community

Framework

Some such frameworks include HIP, integrating health considerations into policy

Key points from all above

A multipronged and interconnected approach is essential to dealing with community access to healthcare

Nursing Workforce

• Nursing is practiced within three scopes; understand significance of how each practices to understand them properly.
• Nurses must recognize the practical limits of your own competencies

Enrolled Nurse

• Enrolled nurses need to practice under delegation from a RN, and provide health care to patients of all ages
• They help perform nursing assessment but the primary responsibility falls to the qualified RN

Enrolled Nurse Qualifications

• Enrolled nurses needed to be properly accredited upon competently completing a programme and passing a state exam

RN Work

• Utilise nursing knowledge and complex nursing judgment to assess health needs, and provide care, and to advise and support people to manage their health
• Delegate to and direct enrolled nurses, health care assistants and others
• Provide comprehensive assessments to develop, implement, and evaluate an integrated plan of health care, and provide interventions that require substantial scientific and professional knowledge, skills and clinical decision making.

Registered Nurse Requirements

• A bachelor’s degree, or equivalent graduate certificate at Level 7
• Requires state examination
• Assess physical and social care, as a result of greater holistic understanding of patient needs
• Can act as leaders or mentors as experts with unique care abilities

Nurse Practicioner

• NP's must have qualifications to register under New Zealand Nursing Council
• Works more as a peer offering direct care, diagnosing and treating, and prescribing medicine
• They combine skills and knowledge with diagnostic abilities

Contemporary Nursing Issues

• heavy workloads
• staff shortages
• patient acuity
• double shifts
• working through meal breaks
• working in unfamiliar areas/departments These factors can manifest into bullying behaviours.

Bullying Impact

• Nurses must be protected as its disruptive for overall patient saftey
• Nurses who are bullied are often the victim of low self esteem and financial difficulty

Annual Certificates

• Each year, you have to meet competencies to renew and demonstrate those achievements.
• NCNZ does not manage these requirements

Practice

• Nursing knowledge must be applied directly or indirectly in some workplace setting

Professional development

• Continuing nursing education can include internet courses and in service training

Delegation

• Delegation always fall under the scope of a registered nurse

Enrolled vs HCA

• CA's are not regulated and must work under instruction, the level of care is standardized
• Ultimately, the RN is accountable for delegating and understanding this principle

Registered Direction

• Indirect direction allows nurses to work with some degree of independence while direct allows active monitoring

New Zealand Council

• As an organization, is ultimately in charge and determines how to transfer skills from the RN to another with consideration
• In any health care situation it is important to know your scope and operate within reasonable limitations

Code

• Defines effective practice with respect and in accordance with standards

Organisations

• It is important to differentiate between professional and regulatory organisations

Practicing Registration

• Nurses requires registration which proves their practice maintained proper public safety

Legislation

• Requires the registration of health professionals and establishes guidelines to maintain best care
• Helps identify incompetence
• Oversees professional regulation and licensing, helps promote public safety and set registration standards

Conduct

• Maintain professionalism
• Be open
• Listen to patients

Equity

• In all instances, care must take into account cultural expression with equity on the medical sector

Provision of Equitable Services

• Make efforts to understand the specific cultural beliefs and address unique patient needs

Values

• Understand the underlying rights of all other team members to address healthcare needs with compassion

Te Tirili o Waitangi

• Understand how it applies to medical scenarios and use ethical values to support

Waitangi principles should include

• A collaborative approaach where each patients beliefs
• These practices are critical to ensure that care is holistic as each patients needs are heard

Te Ao Māori

• This means listening to different beliefs

Key Ethical Values

• Respect people and individual values
• Autonomy should respect the patients right to choose their own
• Beneficence or acting in the patients best interest
• Don't harm
• Be fair treating across all demographics

Nurses should be ethical

• By being transparent and accountable with their care

Cultural Safety

• Ensures that care is effectively delivered and in accordance with all appropriate cultural backgrounds practices

Explore how social determinants of health (SDH) shape individual and community well-being. SDH encompass conditions like socioeconomic status and environment, influencing health outcomes and inequities. Understand how SDH impact access to resources, healthy lifestyles, and overall health.