Catherine Best, Nursing Lecturer at the University of Bradford, argues that all nurses need to understand the Social Determinants of Health.

The Policy Context

The debate surrounding social determinants of health is nothing new, with much being achieved through the work of public health pioneers. In 1978 the World Health Organisation (WHO), through the Alma Ata Declaration and again through the Ottawa Charter of 1986, declared that much needed to be done to protect and promote the health of the global population, which WHO argued could only be achieved by the provision of effective government policies.

The debate began to gather pace following the publication of The Black Report in 1980, probably the first of its kind in the UK to challenge social inequalities, swiftly followed by The Health Divide Review by Margaret Whitehead in 1987, The Acheson Report in 1998 and more recently Sir Michael Marmot’s Fair Society Healthy Lives published in 2010. In 2011, The Rio Political Declaration on Social Determinants of Health called for global action and the need for collective responsibility.

In contemporary society, many of the communicable diseases that once flourished are now largely controlled, including Polio, TB and Leprosy.  New critical challenges exist however within public health, including reducing non-communicable diseases. Despite this being considered one of the key aspects of public health and health promotion, challenges abound as to the role of all nurses and the contribution they make in improving the health and wellbeing of the public.

While many consider that much has been achieved through medical advancement in promoting the health and wellbeing of the population, it is the understanding of the social determinants of health and public health interventions that together have made the most significant contribution.

What Clinicians Can Do

In 2011, the British Medical Association (BMA) in their publication Social Determinants of Health – What Doctors Can Do defined social determinants of health as being the factors that can negatively impact on health and wellbeing. Factors associated with where we are born, grow, live, work and age, although not typically considered direct causes of ill health, have been described as the ‘causes of the causes of ill health’. The BMA posed a challenge to the medical profession and asked what doctors could do to reduce the numbers of lives blighted or wasted as a result of primarily preventable causes – the social determinants of health.

The Royal College of Nursing in their report Going upstream: nursing’s contribution to public health also challenge nurses to consider their role in reducing the impact of the social determinants of health and urge nurses to take every opportunity to deliver messages about healthier living and behaviours in every interaction they have. We know however that promoting positive health and wellbeing is not simply about giving advice on how to give up smoking, reduce alcohol intake and exercise more regularly, it is about uncovering or exploring the contribution that other factors make, such as where you live, who you live with, your income, where you work, your role and whether you are able to access the fundamental human needs of autonomy.

All Our Health

Today all healthcare professionals are considered important advocates for preventing ill health and protecting and promoting wellbeing. The All Our Health Framework is a useful resource in helping all healthcare professionals, including nurses, to understand the role we can all play in reducing health inequalities.  Why not take a look?

Furthermore, in their latest publication A vision for population health: Towards a healthier future The King’s Fund sets out a vision for population health, the rationale behind it and how improvements can be achieved.

International Women’s Day

Keeping ahead of this all-consuming challenge to healthcare reform requires time and determination to succeed. Multiple publications seem to draw us closer towards a sense of helplessness, for despite much of what we do as nurses, there is always more to achieve.

On 8 March 2019, we celebrate International Women’s Day. The theme is #BalanceforBetter. Women do great things, challenge, and ultimately are victorious in their attempts to change the way in which the global population lives and works for the better. This is no more evident than with the impact the Nursing Now Campaign is having and the determination to succeed.

In December 2018, nurses united for the launch of Nursing Now England. If you haven’t yet signed up to be an ambassador, please consider how you might be able to make a difference, by being part of this global network of nurses.

With the executive board of WHO proposing that 2020 be designated the ‘Year of the Nurse and Midwife’, we have to celebrate and to be proud of our achievements. This proposal will be presented to the member states of the 72nd World Health Assembly  for deliberation and endorsement, so watch this space.

Catherine Best, QN





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