Roles Of Community Health Nurses In Health Promotion PDF

CHAPTER FOUR ROLES OF THE COMMUNITY HEALTH NURSES IN HEALTH PROMOTION LEARNING OBJECTIVES Upon completion of this chapter, students should be able to: 1. Describe the key roles of Community Health Nurses (CHNs) in health promotion. 2. Explain how CHNs w...

CHAPTER FOUR ROLES OF THE COMMUNITY HEALTH NURSES IN HEALTH PROMOTION LEARNING OBJECTIVES Upon completion of this chapter, students should be able to: 1. Describe the key roles of Community Health Nurses (CHNs) in health promotion. 2. Explain how CHNs work to reduce health disparities. 3. Identify the strategies CHNs use to prevent chronic diseases and lower healthcare costs. 4. Understand the role of CHNs in building health literacy and empowering individuals and communities to make informed health decisions. 5. Analyze the actions CHNs take to promote preventive health behaviors. 6. Evaluate how CHNs enhance community resilience. 7. Discuss the CHN's role in supporting mental health and well-being and reducing stigma. 8. Examine the importance of CHNs in improving social determinants of health. 9. Illustrate how CHNs influence public health policy through advocacy, data sharing, and community engagement. 10. Develop strategies for partnering with community stakeholders to implement successful health promotion initiatives. 1.1 INTRODUCTION ▪ Community health nurses (CHNs) play an integral role in health promotion, serving as frontline agents in improving the health and well-being of populations. ▪ Health promotion is a vital public health strategy focused on empowering individuals and communities to take control of their health by addressing the root causes of disease and enhancing quality of life through promoting health & preventing diseases. ▪ CHNs, with their unique blend of clinical expertise and deep community engagement, are key players in translating health promotion strategies into real-world practice. ▪ Their roles encompass educating the community on healthy behaviors, advocating for policies that improve social determinants of health, and fostering environments conducive to sustained health improvements. ▪ CHNs are essential in developing and implementing health promotion initiatives that align with core elements like empowerment, equity, community participation, and capacity building. ▪ They assess local health needs, create tailored health interventions, and collaborate with various stakeholders to ensure sustainable health outcomes. ▪ In the ever-changing landscape of public health, CHNs are not just caregivers, they are educators, advocates, and catalysts for change, promoting wellness at every level of prevention. ▪ By strategically using their skills in education, advocacy, and collaboration, CHNs ensure that health promotion is a priority and that communities are better prepared to tackle future health challenges. 1 1.2 KEY ROLES OF THE COMMUNITY HEALTH NURSE (CHN) IN HEALTH PROMOTION 1. REDUCING HEALTH DISPARITIES Role’s Significance ▪ One of the most critical contributions of CHNs in health promotion is addressing health inequities that affect marginalized populations, including low-income groups, rural communities, and ethnic minorities. ▪ These groups often experience barriers to accessing healthcare due to financial constraints, geographic isolation, or language and cultural differences. Role’s Actions 1. Identify underserved populations: Conduct community assessments to determine who lacks access to healthcare. 2. Organize outreach programs: Set up mobile clinics in rural areas or healthcare services in low- income neighbourhoods. 3. Culturally relevant health education: Develop health materials in multiple languages or formats to cater to diverse populations. 4. Collaborate with local organizations: Partner with local non-profits and social services to provide free health screenings and follow-up care. 5. Advocate for equitable healthcare access: Participate in community forums and advocate for policies that reduce healthcare costs for low-income groups. ▪ CHNs actively identify these disparities within the community and work toward bridging the gap by providing targeted health services, advocating for access to care, and developing culturally sensitive interventions. Example: They may ensure that immunization campaigns are accessible to all by organizing mobile health units in underserved areas. 2. PREVENTING CHRONIC DISEASES AND REDUCING HEALTHCARE COSTS Role’s Significance 1. The rising incidence of chronic diseases, such as diabetes, hypertension, and cardiovascular disease, places a tremendous burden on healthcare systems. 2. Preventive health promotion efforts led by CHNs are essential in curbing these trends. Role’s Actions 1. Develop health promotion campaigns: Lead community programs that focus on preventing lifestyle-related diseases like diabetes, hypertension, and heart disease. 2. Offer screenings and early detection: Conduct regular screenings for high blood pressure, cholesterol levels, and glucose monitoring in community centers. 3. Educate on lifestyle modification: Facilitate workshops on topics like smoking cessation, proper diet, and exercise. 4. Collaborate with healthcare providers: Work with primary care providers to implement preventive measures and follow up with patients to ensure compliance with health plans. 5. Measure outcomes: Track community health outcomes and report on the reduction of chronic diseases or hospital admissions due to early interventions. 2 3. BUILDING HEALTH LITERACY IN COMMUNITIES Role’s Significance 3. Health literacy, or the ability to obtain, process, and understand basic health information, is crucial for effective health promotion. 4. Many individuals in communities may lack the skills or resources to make informed health decisions, leading to poor health outcomes. Role’s Actions 1. Host educational workshops: Provide sessions on understanding health terminology, managing chronic illnesses, and making informed health decisions. 2. Create user-friendly resources: Distribute pamphlets, videos, or interactive content that simplify complex health topics. 3. Teach self-care practices: Help community members learn how to manage their conditions at home, such as monitoring blood pressure or blood sugar. 4. Partner with local schools: Work with schools to integrate health literacy education for both students and parents, promoting a lifelong understanding of healthcare. 5. Conduct one-on-one coaching: Offer personalized health literacy coaching for individuals struggling to comprehend medical instructions. 4. PROMOTING PREVENTIVE HEALTH BEHAVIORS Role’s Significance 5. Preventive health behaviors, such as vaccinations, healthy eating, exercise, and regular health check-ups, form the foundation of public health. 6. CHNs are central to promoting these behaviors at the individual and community levels. Role’s Actions 1. Run vaccination drives: Coordinate campaigns that promote immunizations against preventable diseases like flu or measles. 2. Promote regular check-ups: Encourage routine health screenings through awareness campaigns and community events. 3. Lead by example: CHNs can model healthy behaviors like regular exercise, proper nutrition, and stress management within the community. 4. Incorporate health into community events: Integrate health promotion into local fairs, festivals, and gatherings with on-site check-ups or demonstrations. 5. Create incentives for preventive care: Partner with local businesses to offer discounts or rewards for individuals who undergo health check-ups or engage in fitness activities. 5. ENHANCING COMMUNITY RESILIENCE Role’s Significance 7. Community resilience refers to the ability of a community to withstand and recover from adverse health events, such as natural disasters, pandemics, or outbreaks of disease. 8. CHNs contribute significantly to building this resilience through their promotion of health and preventive care. 3 Role’s Actions 1. Develop disaster preparedness plans: Train community members in emergency preparedness, first aid, and rapid response to health crises. 2. Facilitate recovery support: Organize community mental health and rehabilitation services post-crisis, ensuring access to emotional and medical care. 3. Coordinate with emergency responders: Collaborate with local authorities and emergency services to ensure a swift response during health emergencies, such as disease outbreaks. 4. Build resource networks: Establish local resource banks (e.g., first aid supplies, clean water reserves) that can be activated during emergencies. 5. Conduct resilience-building workshops: Teach community members coping strategies for stress and trauma, enhancing their ability to recover from disasters. 6. SUPPORTING MENTAL HEALTH AND WELL-BEING Role’s Significance 9. Mental health is an essential component of overall well-being, yet it often receives less attention compared to physical health. 10. CHNs are increasingly involved in promoting mental health awareness, reducing stigma, and connecting individuals to the appropriate mental health services. Role’s Actions 1. Lead mental health awareness campaigns: Educate communities about the importance of mental health, and reduce the stigma around seeking care. 2. Organize mental health screenings: Set up confidential mental health check-ups to detect early signs of depression, anxiety, or other disorders. 3. Provide emotional support groups: Facilitate community-based support groups for those dealing with stress, grief, or chronic illness. 4. Offer referrals to specialists: Connect individuals with appropriate mental health professionals or services for more specialized care. 5. Advocate for mental health services: Work with local authorities to push for more accessible mental health facilities and resources within the community. 7. IMPROVING THE SOCIAL DETERMINANTS OF HEALTH (SDOH) Role’s Significance 11. Social determinants of health, such as housing, education, employment, and social support networks, significantly affect individuals' health outcomes. 12. CHNs contribute to improving these determinants through community health promotion initiatives that address the root causes of health inequities. Role’s Actions 1. Address housing issues: Advocate for safe and affordable housing, helping individuals access shelters or housing subsidies. 2. Promote educational programs: Develop and support education initiatives that enhance life skills and health awareness, especially in marginalized communities. 3. Facilitate job-training and employment programs: Work with employment agencies to provide job-training workshops, enhancing economic stability and health outcomes. 4. Strengthen social support systems: Encourage community networks or peer support groups to provide emotional and practical help for isolated individuals. 4 5. Identify and address food insecurity: Partner with food banks or local farmers to provide healthy food options for families facing economic hardship. 8. FOSTERING A CULTURE OF PREVENTION Role’s Significance Creating a community-wide focus on preventive care is a long-term strategy that can significantly reduce disease burden. CHNs are at the forefront of this cultural shift. Role’s Actions 1. Engage in community-wide health campaigns: Develop initiatives focused on preventive care, such as fitness challenges or "healthy living" weeks. 2. Collaborate with schools and workplaces: Implement health and wellness programs in schools and businesses that focus on preventive care measures. 3. Host public forums: Organize town halls or public discussions about the importance of prevention, inviting local leaders and community members to participate. 4. Create long-term health goals: Guide communities in setting and achieving long-term health goals like reducing smoking rates or increasing physical activity. 5. Train local health promoters: Empower community members to become peer educators who advocate for preventive health behaviors within their own social circles. 9. INFLUENCING PUBLIC HEALTH POLICY Role’s Significance ▪ CHNs play a key role in influencing health policy at the local, regional, and even national levels. ▪ Their role as advocates ensures that the health needs of communities are considered in policy decisions. Role’s Actions 1. Attend policy meetings: Participate in local government health policy discussions, offering insights from community-level health promotion work. 2. Submit health data and research: Present community health data to policymakers to support new health programs or interventions. 3. Organize grassroots campaigns: Lead community efforts to advocate for changes in public health policies, such as improved healthcare access or better funding for public health initiatives. 4. Work with public health agencies: Collaborate with regional or national public health organizations to inform the development of policies that address local health disparities. 5. Engage in lobbying efforts: Represent the needs of the community in larger legislative discussions, advocating for policy reforms that benefit public health. 10. ASSESSING HEALTH NEEDS (HEALTH NEEDS ASSESSMENT) Role’s Significance ▪ Conducting health needs assessments is crucial for identifying the specific health challenges faced by a community. ▪ This allows CHNs to prioritize resources, tailor interventions, and address the most pressing health issues. 5 ▪ By assessing health needs, CHNs ensure that health promotion efforts are targeted, effective, and based on accurate data. Role’s Actions 1. Conduct community surveys: Develop and administer surveys or questionnaires to gather data on health concerns, lifestyle habits, and access to healthcare services. 2. Review health records and statistics: Analyze existing health data, such as hospital admission rates, disease prevalence, or mortality rates, to identify community health trends. 3. Engage with community members: Facilitate focus group discussions or interviews with local residents to understand their health priorities and challenges. 4. Collaborate with public health officials: Work with local health departments to compile data from various sources (e.g., clinics, schools) to form a comprehensive picture of community health needs. 5. Create health profiles: Use the collected data to develop community health profiles, summarizing key issues such as prevalent chronic diseases, access to healthcare, and social determinants affecting health. 6. Identify at-risk populations: Highlight vulnerable groups (e.g., elderly, children, low-income families) and focus on their unique health needs for targeted interventions. 11. PARTNERSHIP WITH COMMUNITY STAKEHOLDERS Role’s Significance ▪ Building strong partnerships with community stakeholders, such as local organizations, government agencies, and community leaders, is essential for promoting public health. ▪ These partnerships facilitate resource sharing, improve the reach of health programs, and ensure that interventions align with the community’s needs and values. ▪ CHNs play a pivotal role in fostering these collaborations, which help create sustainable and community-driven health solutions. Role’s Actions 1. Identify key stakeholders: Map out local organizations, healthcare providers, government agencies, and influential community leaders who can contribute to health promotion efforts. 2. Form advisory groups: Establish a committee of stakeholders to guide health promotion initiatives, ensuring community input and collaboration at each stage. 3. Co-develop health programs: Work with stakeholders to design joint health promotion initiatives, combining expertise and resources from various sectors (e.g., schools, religious groups, local businesses). 4. Organize regular stakeholder meetings: Hold meetings or forums to maintain communication, share updates on health programs, and gather feedback from stakeholders. 5. Advocate for shared resources: Encourage stakeholders to pool resources (e.g., funding, personnel, materials) to ensure the success of community health initiatives. 6. Evaluate and adjust programs: Involve stakeholders in the evaluation process to assess the effectiveness of health programs and make adjustments based on community feedback. 6 1.3 CHALLENGES FOR NURSES IN PROMOTING COMMUNITY HEALTH ▪ Community Health Nurses (CHNs) face several significant challenges in promoting community health. ▪ By addressing these challenges, CHNs can improve their effectiveness in promoting community health, although many of these obstacles require broader systemic changes and collaborative efforts. 1. RESOURCE LIMITATIONS ▪ Limited financial, human, and material resources make it difficult for CHNs to implement comprehensive health promotion programs. ▪ A lack of funding can hinder access to essential supplies, equipment, and personnel. Major Challenges 1. Insufficient funding: Inadequate budgets limit the scope of health promotion initiatives and reduce access to necessary tools, such as educational materials or transportation for home visits. 2. Staff shortages: CHNs often work in understaffed environments, which increases workload and limits the time available for health education and outreach activities. 3. Limited access to equipment: Lack of medical supplies or technological tools can impede efforts to conduct health screenings, monitor health trends, and implement preventive measures effectively. 2. CULTURAL AND LANGUAGE BARRIERS ▪ CHNs serve diverse communities, which often include individuals from various cultural and linguistic backgrounds. ▪ Differences in language, health beliefs, and cultural practices can make communication and engagement challenging. Major Challenges 1. Language differences: Inability to speak the community’s language or lack of translation services makes it difficult to convey important health information or understand patient concerns. 2. Cultural health beliefs: Community members may have differing views on health, illness, and medical interventions, creating resistance to recommended health promotion activities. 3. Trust issues: A lack of trust between healthcare providers and certain populations, especially marginalized groups, can hinder the success of health promotion efforts. 3. LACK OF COMMUNITY ENGAGEMENT ▪ Engaging the community in health promotion activities is vital for success. ▪ However, many CHNs face challenges in gaining sufficient community participation and involvement. 7 Major Challenges 1. Low awareness or interest: Community members may not be aware of or interested in health promotion programs, especially if they do not see the immediate relevance to their lives. 2. Time constraints: Individuals may have competing priorities, such as work or family obligations, that limit their participation in health promotion events or screenings. 3. Resistance to change: Some community members may be reluctant to change long-established behaviors or lifestyles, even when presented with information about the benefits of preventive care. 4. HEALTH LITERACY GAPS ▪ Low levels of health literacy can prevent community members from understanding and acting on health information, making it harder for CHNs to promote preventive health behaviors. Major Challenges 1. Complex medical terms: The use of technical or medical jargon can be confusing for individuals with low health literacy, reducing the effectiveness of health education sessions. 2. Limited access to education: In communities where education levels are low, people may lack the skills necessary to navigate the healthcare system or follow medical advice correctly. 3. Misinformation: The spread of inaccurate health information through social media or community networks can create confusion and mistrust in health promotion initiatives. 5. SOCIAL DETERMINANTS OF HEALTH ▪ CHNs must address the social determinants of health—factors like poverty, education, housing, and employment—that significantly impact health outcomes. ▪ However, these broader societal issues are often beyond the immediate control of nurses. Major Challenges 1. Poverty: Financial constraints limit individuals’ access to healthcare services, healthy foods, and preventive care measures, increasing their risk of chronic diseases. 2. Unstable housing: Inadequate or unsafe living conditions can exacerbate health problems, particularly among vulnerable populations like the homeless or those in overcrowded housing. 3. Lack of employment: Unemployment or low-wage jobs without health benefits prevent many individuals from seeking preventive care or affording necessary treatments. 6. POLICY AND LEGISLATIVE BARRIERS ▪ Public health policies and regulations influence the ability of CHNs to carry out effective health promotion activities. ▪ However, restrictive policies or lack of supportive legislation can present significant obstacles. Major Challenges 1. Limited policy support: In some regions, policies may not prioritize preventive health care, making it difficult for CHNs to secure funding or resources for their initiatives. 2. Regulatory constraints: Certain legal or regulatory frameworks may limit the scope of practice for CHNs, restricting their ability to provide certain services or implement specific interventions. 3. Lack of political will: Without strong advocacy or political support, health promotion programs may not receive the attention or funding they need to be successful. 8 7. WORKLOAD AND BURNOUT ▪ CHNs often manage large caseloads and face significant emotional and physical demands in their work, which can lead to burnout and negatively affect the quality of care they provide. Major Challenges 1. High patient loads: CHNs are often responsible for large populations, which can lead to time constraints and reduced individual attention for community members. 2. Emotional stress: Dealing with challenging cases, such as those involving severe illness, trauma, or social hardships, can contribute to emotional exhaustion. 3. Burnout: The combination of physical, emotional, and mental stress can result in burnout, reducing the nurse’s effectiveness in promoting health and engaging the community. 8. TECHNOLOGICAL BARRIERS ▪ While technology can aid in health promotion, many CHNs face barriers related to limited access to modern tools or a lack of technological infrastructure in the communities they serve. Major Challenges 1. Limited digital infrastructure: In rural or low-income areas, the absence of reliable internet or telemedicine tools can limit the ability of CHNs to reach community members or deliver virtual health education. 2. Lack of digital literacy: Community members may lack the skills needed to engage with digital health tools, such as online portals or telehealth services. 3. Technology gaps in healthcare settings: CHNs may not have access to modern tools like electronic health records or data analysis software, limiting their ability to track and monitor community health trends efficiently. 9 1.4 COMPETENCIES AND SKILLS REQUIRED FOR NURSES IN COMMUNITY HEALTH PROMOTION ▪ For Community Health Nurses (CHNs) to effectively promote health, they must possess a set of core competencies and skills that enable them to navigate the complexities of community- based care. ▪ Health promotion demands more than just clinical expertise; it requires leadership, advocacy, communication, cultural competence, and data analysis abilities. ▪ These skills allow CHNs to assess community needs, develop targeted interventions, and ensure the sustainability of health initiatives. Key Competencies and Skills 1. LEADERSHIP AND ADVOCACY: ▪ CHNs must be strong leaders and advocates for their communities. They often serve as the link between communities and healthcare systems, ensuring that the needs of underserved populations are heard and addressed. Advocacy includes pushing for policy changes that improve social determinants of health, such as housing, education, and access to care. Example: Advocating for policy changes that increase funding for mobile health clinics in rural areas. 2. HEALTH EDUCATION AND COMMUNICATION: ▪ CHNs must be skilled educators capable of simplifying complex health information so that individuals and communities can understand and apply it. Effective communication is key to promoting behavior change and empowering people to take control of their health. Example: Leading workshops on chronic disease management, using clear, accessible language and culturally relevant materials to reach different segments of the population. 3. CULTURAL COMPETENCE: ▪ CHNs work with diverse populations that have varying beliefs, practices, and health behaviors. Cultural competence is critical in ensuring that health promotion activities are respectful of these differences and effectively meet the needs of diverse communities. Example: Tailoring health education programs to account for local cultural beliefs about health, illness, and healthcare practices. 4. ANALYTICAL AND DATA INTERPRETATION SKILLS: ▪ CHNs must be able to gather and interpret data from health assessments, surveys, and health records to identify trends and health needs in their communities. This ability helps them develop evidence-based interventions that are tailored to specific community challenges. Example: Conducting a health needs assessment and analysing data to identify the most common chronic diseases in a community, then using this data to create targeted prevention programs. 10 5. COLLABORATION AND PARTNERSHIP-BUILDING: ▪ The success of health promotion efforts often depends on the ability of CHNs to work with a variety of stakeholders, including healthcare providers, government agencies, non-profits, and community leaders. Strong collaboration skills are essential for ensuring that health programs are well-supported and sustainable. Example: Partnering with local schools and businesses to run health promotion events that engage the broader community and increase awareness of preventive care. 1.5 ETHICAL AND LEGAL CONSIDERATIONS IN HEALTH PROMOTION ▪ Community Health Nurses (CHNs) face a range of ethical and legal challenges as they work to promote health within diverse communities. ▪ Health promotion requires nurses to navigate complex moral landscapes, particularly when dealing with vulnerable populations. ▪ Additionally, CHNs must comply with legal standards and policies that govern public health interventions, ensuring that their actions are not only effective but also ethically sound and legally compliant. ▪ Understanding these considerations is essential for CHNs to protect the rights of individuals and uphold the integrity of public health practice. 1. PATIENT AUTONOMY AND INFORMED CONSENT ▪ CHNs must respect the autonomy of individuals, ensuring that they have the right to make informed decisions about their health. ▪ This involves providing comprehensive information and obtaining consent before administering any form of treatment or intervention. Example: Before conducting a health screening, CHNs must explain the purpose, process, and potential outcomes to community members and ensure that they voluntarily agree to participate. 2. CONFIDENTIALITY AND PRIVACY ▪ Protecting the confidentiality of individuals’ health information is a legal and ethical obligation for CHNs. ▪ This becomes especially challenging when conducting community-based assessments or working with vulnerable populations where trust in the healthcare system may already be fragile. Example: Ensuring that data collected during health needs assessments is anonymized and securely stored, and that individuals' health details are not disclosed without their permission. 3. MANDATORY REPORTING ▪ In certain situations, CHNs are legally required to report specific health conditions, such as infectious diseases, child abuse, or elder neglect. ▪ Balancing this legal responsibility with ethical concerns about community trust can be challenging. Example: A CHN may be legally required to report a suspected case of child abuse, even if this might strain their relationship with the family or community. 11 4. EQUITY AND FAIRNESS ▪ CHNs are often tasked with distributing limited resources and must do so in a manner that promotes equity. ▪ Ethical dilemmas may arise when resources are scarce, and decisions must be made about how to allocate services fairly across the population. Example: When running a vaccination drive in a resource-limited area, CHNs must prioritize vulnerable groups (e.g., elderly, children) while ensuring that the broader population is not excluded. 5. NON-MALEFICENCE AND BENEFICENCE ▪ The principles of non-maleficence (do no harm) and beneficence (promote good) guide the actions of CHNs in their health promotion activities. ▪ These principles ensure that the interventions CHNs implement are designed to benefit the community without causing harm, either intentionally or unintentionally. Example: While promoting a community-wide vaccination program, a CHN must ensure that they provide clear information on potential side effects and respect any cultural or personal objections, all while advocating for the overall benefit of immunization. 6. LEGAL SCOPE OF PRACTICE ▪ CHNs must work within the legal boundaries of their nursing practice, which are often dictated by regional or national laws. ▪ They need to be aware of their legal responsibilities and the limitations of their roles in health promotion. Example: In some areas, CHNs may not be legally authorized to prescribe medications or administer certain treatments without a physician’s oversight, and they must respect these boundaries when offering health services. 7. COMMUNITY INVOLVEMENT AND ETHICAL PUBLIC HEALTH DECISION-MAKING: ▪ CHNs must involve the community in the decision-making process, ensuring that public health interventions are not only beneficial but also culturally acceptable and ethically justified. ▪ This can involve balancing individual rights with collective good, particularly during public health crises. Example: During a pandemic, CHNs might advocate for mandatory mask-wearing or quarantines, which could raise ethical questions about individual freedom versus public safety. 12 Class Discussion Scenario You are a Community Health Nurse assigned to a small, rural community with a high rate of chronic diseases such as hypertension, diabetes, and cardiovascular issues. The community also faces significant social and economic challenges, including limited access to healthcare, low health literacy, and high rates of unemployment. Additionally, there is a growing concern about mental health, with rising rates of depression and anxiety, particularly among the unemployed population. You’ve been tasked with developing a health promotion strategy to address these issues. Questions for Discussion: Please chose ONLY ONE question of the following five questions and discuss. 1. Health Needs Assessment: What specific steps would you take to assess the health needs of this community? What data would you collect, and how would you engage the community in the process? 2. Reducing Health Disparities: How would you prioritize addressing health disparities in this community? What actions would you take to ensure vulnerable groups have access to necessary healthcare services? 3. Partnership with Stakeholders: Which community stakeholders (e.g., local organizations, government agencies) would you partner with to tackle the health issues in this community? How would you involve them in your health promotion strategy? 4. Promoting Preventive Health Behaviors: What health promotion activities would you organize to encourage preventive health behaviors? 5. Improving Social Determinants of Health: Given the high rates of unemployment and poverty, what specific social determinants of health would you focus on improving? How would you address these broader issues in your health promotion strategy? 13