We hear it over and over and probably say it to our patients: to be healthy, follow a proper diet, don’t smoke, and be active. And if diagnosed with an illness, adhere to the agreed-upon plan of care. Sounds simple—and when patients return time and again with the same issues, we often blame them (secretly, of course) for not taking care of themselves.
But for how many of our patients is what we’re asking them to do less a matter of personal choice than a function of the neighborhood in which they live and the limitations imposed by their socioeconomic circumstances?
Many people don’t live within walking distance of a grocery store that offers fresh vegetables and fruit. Or if they do, they may not be able to afford the more nutritious choices, which are often more expensive. Many urban areas lack playgrounds. Air pollution and substandard housing materials can cause asthma and heart disease. Being born into poverty can result in poor nutrition, contributing to poor health, as well as limited access to health care, education, and job opportunities.
Social determinants of health, before we called them that.
Nurse and social worker Lillian Wald understood this when she and colleague Mary Brewster established the Henry Street Settlement in New York City’s Lower East Side, where she offered health care, screening, and teaching to poor immigrant mothers, a playground and classes for children, and social services and advocacy for better living conditions in the tenements. (You can read Wald’s often vivid firsthand account, “The Nurses Settlement in New York”—PDF; free until December 27—from the May 1902 issue of AJN.)
Wald was far ahead of her time in addressing what we now call the social determinants of health (SDH)—“those conditions into which people are born, grow, live, work and age . . . ” (World Health Organization)
A role for nurses today.
In this month’s Viewpoint column, author Ellen Olshansky of the University of Southern California reminds us of the importance of these social and environmental aspects in shaping the health of our patients and calls for nurses to build on Wald’s legacy.
She notes, “Nursing can lead in translating SDH awareness into action,” and provides four steps to do so, one of which is to “[d]evelop interprofessional practice to include representatives of social work, public health, city planning, occupational health, police and fire fighters, and many others who can contribute to addressing SDH.”
The December Viewpoint is free. Let us know your thoughts!