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Theory - SDOH Cheat Sheet (DRAFT) by

Social determinants of health - considerations for NPs

This is a draft cheat sheet. It is a work in progress and is not finished yet.

SDOH

Describe a person's place in the world
Social status, social inclusion or exclusion
Influence of enviro­nment on your health
Dr. Verchow, hippoc­rates and freud
Praviously used medical model when diseases were mainly infect­ious:
Now have chronic illnesses: figure out what causes them
Address SDOH to reduce health dispar­ities:
Will improve health
The non-me­dical factors that influence overall health outcomes
-condi­tions in which people are born, grow, work, live and age in
and the systems shaping these conditions

What do you have for love?

Relati­onships and supports
Childhood enviro­nme­nt/­dev­elo­pment
Family dynamics
Culture
Race
Discri­min­ation
Gender­/gender identity
Sexual orient­ation
Influences lifetsyle

-childhood influences what type of adult you turn out to be

What do you have for work?

Education
Food security
Employ­men­t/job securi­ty/­income
Housing/ neighb­ourhood
Geography
Basic amenities
Exposure to crime/­vio­lence
Access to HC/den­tis­t/p­hysio
Education most influe­ntial since it determines your employment

The systems that influence SDOH

Economic policies
Lenght of mat leave: conditions to meet for EI
Social policies
Social norms
Golf cart with drinks - drinking as a societal influence
Political systems - the party in power
Develo­pment agendas

The social gradient

 
The lower the socioe­conomic status the worse their health tends to be - vice versa
-> due to uneven distri­bution of resources, money and power

The SDOH

Early childhood develo­pment
Housing
Employ­men­t/w­orking conditions
Education
Unempl­oym­ent/job security
Disability
Food insecurity
Gender
Geography
Global­ization
Health services
Immigr­ation
Income
Indigenous ancestory
Race
Social exclusion
Disability is linked to decreased employment rate and increased Without employment cannot make an income and do not have basic needs
Affordable housing is a big issue - link btw poor housing and poor health outcomes
Geography affects HC, food and housing - worse conditions due to lack of PHC
Immigrants have harder time finding work -> unempl­oyment and worse mental health
Indigneous = double the unempl­oyment rate, more poverty
  

Why do SDOH matter?

30-55% of outcomes are directly attributed
They are more powerful than medical interv­entions
The comple­xities make it more difficult to address the health concern
-the more complx­ities the less likely to receive care
-> Promote health adn prevent illness: by unders­tanding the SDOH then can help to improve pt outcomes
- need to understand the enviro­nment they come from
-have cultural humility and understand own biases

Client Care ELC addressing SDOH

Culturally approp­riate commun­ication
Unders­tanding ancestry and race
Apply best evidence to pt situation:
cost, access to pharmacy
Know impact of SDOH to guide strategies to health promotion

Quality improv­ement ELC on SDOH

Eviden­ce-­inf­ormed practice
Partic­ipate in research

Leadership ELC on SDOH

Facilitate system change
Improve client care
Partic­ipate in profes­sional associ­ations, writing letters to politi­cians to advocate for health care

Education ELC on SDOH

Educate:
Self (refle­ction)
Client and community
members of the healthcare team

SDOH of indigenous popula­tions

Impacted by discri­min­ation and health inequities
Proximal:
daily aspect, education, employment
Interm­ediate:
Systemic: health care system
Distal:
Hx of discri­min­ation, racism

Rural and remote popula­tions

Lower overall education levels
Decreased access to education and employment
Higher smoking rates
Less access to healthy food

Rural and remote popula­tions

Factors:
Consid­era­tions:
Lower overall education levels
Decreased healthcare resources
Decreased access to education and employment
Travel time
Higher smoking rates
Less practi­tioners
Less access to healthy food
Ethical dilemmas providing care in small community
More indigenous popula­tions
Telehealth
Education level is more influe­ntial determ­inant
-pregnancy and childb­irth: they sometimes need to stay in other commun­ities after 36 weeks
-may not have specia­lized services
-SLP, dietetics can be facili­tated through telehealth
  

Inner-city popula­tions

Factors:
Consid­era­tions:
Poverty and unempl­oyment
Access to care
Homele­ssness
Trauma informed, harm reduction
Food insecurity
Support servic­es/­res­ources
Racism
Policy­/ad­vocate
Infectious diseases, substance use, trauma
-> programs
Harm reduction: safe injection sites, safe supply of opioids
Recgonize psycho­logical aspects
advocate to address health inequi­ties: harm reduction, housing
Screen Hep C/HIV

Refugee and immigrant popula­tions

Poor living conditions
Limited access to HC
Employment
Housing
Poverty
Social safety net
Decreased employmnet - language barrier, discri­mmi­nation
Trauma and stress they experi­enced in their homeland

LGTB2SQ

Factors:
Barriers:
Depression and anxiety
Homophobia (real or perceived)
Substance abuse
Hetero­nor­mative care
Family planning
Providers with limited knowledge
 
Limited coverage for gender­-af­firming surgery/ hormones
 
Long applic­ation process
Non-di­scl­osure affects quality of care
-creates delays in medical diagnosis and treatment if they do not disclose

Asking about SDOH in practice

Include social Hx in SOAP note
Cultural humility
Help access resource and supports
Self reflection of biases
CLEAR or RESPECT formats to help with questions
Improving access to care
Partner with local groups and PHC angencies
Be aware of available resources in community
Municipal committees and elections
Research
If you don't ask they don't usually bring it up

CLEAR tool kit

1. Treat
2. Ask
3. Refer
4. Advocate