Social determinants of health are the most influential ones in terms of health outcomes. Social factors provide the context, in which health issues either develop or vanish. The responsibility of advanced practice nurses is to ensure that the vulnerable populations are able to overcome the challenges associated with their status and receive the health care they need. Low income, low education level, stress in the workplace, lack of access to healthcare, absence of health insurance and other factors create the pool of issues to be addressed. Politicians are the major policymakers who can influence health outcomes by launching appropriate policies, programs, and initiatives. Advanced practice nurses are the stakeholders who can determine the vulnerable populations needs at the local, state, and national levels. By delivering different health messages, implementing health policies, and taking active part in policy processes, advanced practice nurses help the vulnerable populations to improve their health outcomes.
Social Determinants of Health
The health levels of the population in the United States are not uniform, and this differentiation is caused by many factors. Thus, these factors represent various characteristics and conditions, such as genetics, physical surroundings, gender, social, and economic ones, thus creating the context for health or the development of various diseases. Biological factors tend to be unchangeable, but the shifts in social determinants of health could significantly alter health outcomes. Most importantly, health practitioners can influence the progression towards healthier society by addressing the needs of the vulnerable populations as the weakest groups that require support.
Advanced practice nurses (APNs) promote healthy lifestyle and preventive measures to reduce diseases, although they realize that nowadays, health, to a lesser extent, depends solely on people and, particularly, on the affected populations. People, who belong to vulnerable populations, whether they are the elderly, low-income families, racial or ethnic minorities and others, experience stigmatization and discrimination, which prevents them from receiving quality health care. Thus, without proper social, political, and public policy support, the affected populations can hardly benefit from health care. Thus, even though medical care has a relatively low impact on the overall health level of the US population, social determinants of health provide the context and contribute to the health decline or its improvement, while advanced practice nurses are influential stakeholders in terms of health outcomes, especially of that for vulnerable populations.
The Factors Influential in Determining Health Outcomes
Social determinants of health imply the dependence of a persons health on various social and socioeconomic factors. The term social determinant is an all-embracing one since it also involves political and cultural issues. The World Health Organization (n.d.) defines these determinants as the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Social and economic policies, political systems, and cultural norms are among the most influential determinants that can cause health improvement or deterioration of affected populations.
Social and Socioeconomic Factors
The environment, in which people live, provides the context for their health outcomes. From a social perspective, the environment implies not only income, housing, education, and other socioeconomic factors but also political and cultural determinants to some extent. However, socioeconomic factors remain the major characteristics of the context, in which the affected populations live and perform. Researchers tend to consider socioeconomic determinants such as income, wealth, and education as the fundamental causes of a wide range of health outcomes (Braveman & Gottlieb, 2014, p.19). Thus, they are regarded as crucial in ensuring health outcomes.
Low income is one of the greatest contributors to poor health and health outcomes in vulnerable populations. The process of health formation starts from the early years of life, and the conditions that parents can ensure to their child play a significant role. Substandard housing and lack of sanitation result in infectious diseases, and they could potentially cause low cognitive abilities and chronic diseases (Braveman & Gottlieb, 2014). Moreover, lack of finance could prevent parents from buying expensive medications for their children. By contributing to poor physical health outcomes in children and teenagers, low income also creates the basis for psychological complexes in the future.
Stress in the workplace is another most influential determinant of health. Chronic stress, usually experienced in the workplace, has a negative impact on health outcomes both in the short and long term (Gouin, 2011). Such a stress leads to a greater exposure to infections, poorer results of immunization, and higher possibility of inflammations (Gouin, 2011). However, even realizing all dangers of stress, people can rarely cope with this problem themselves as they cannot change the corporate culture or their working surroundings. Sometimes, employees raise the issue of the stressful environment, but this hardly changes the situation. Therefore, APNs could convey the importance of reducing stress levels to policymakers, thus helping the affected populations.
Social exclusion is particularly crucial for stigmatized populations. For example, patients with AIDS feel excluded from society, which can prevent them from seeking help. Interestingly, as Bradley-Springer (2012) indicates, despite the previous perceptions of this problem, HIV prevails within poorer communities, while race has less relation to the spread of HIV. Advanced practice nurses ought to provide social services, which are even more important in this situation, as opposed to health services, with the former being more important for this type of population (Bradley-Springer, 2012). Social services could include awareness-raising programs for the vulnerable populations regarding their rights and opportunities and for the common people about their social responsibility.
Social and socioeconomic determinants are most often referred to in the local, state, and national health policies. While these determinants are unlikely to be improved for all US citizens, at least vulnerable populations must receive standard levels of health care that they are deprived of because of their current status. Discrimination and stigmatization, low income, or lack of education should not become the obstacles to obtaining proper health care. Advanced practice nurses must focus on improving social determinants for affected populations, as this is likely to enhance their health outcomes.
Politicians have influential tools to change health outcomes for the affected populations. However, these outcomes require a certain timeframe to be evaluated, while politicians are usually restricted by their periods of assignment. The identification of health effects can take years and even decades for chronic diseases or the effects of childhood adversities (Braveman & Gottlieb, 2014). Therefore, the political factor is somewhat limited in applying policies and strategic decisions effectively.
Another political impact can hardly be overlooked among other social factors since the attitude of the major competing parties, the Democrats and the Republicans, is quite different regarding health issues. The main difference is that the Republicans are more conservative and suspicious of change. The prevailing perspective is that healthcare does not have to be equal for all citizens. On the other hand, the Democrats advocate equality and fight against social, economic, and health disparities in society. Considering this confrontment, APNs must use careful wording when they address the affected populations. The message concerning health issues and solutions can be delivered effectively only when it reaches well-disposed listeners (Robert Wood Johnson Foundation, 2010). The vulnerable populations tend to give credit to those ideas that are aligned with their own beliefs (Robert Wood Johnson Foundation, 2010). Consequently, although politics and politicians have a significant impact on social determinants of health, APNs should not mention any political information in their awareness-raising messages.
The cultural factor shares certain responsibility for health outcomes as well. Within the context of health, culture implies traditions and customs of a family or a community that influence peoples health-related decisions. Moreover, the language, which is often part of ones culture, should be considered as well. Thus, the message concerning health issues will be perceived better if the APN avoids academic language. Relatable wording is more effective in this relation. For example, as the Vulnerable Populations Portfolio by Robert Wood Johnson Foundation (2010) indicates, a trillion spent on healthcare means nothing for the majority of people since this figure is difficult to imagine. But 3 dollars a day per one American resulting from health insurance reform creates an absolutely relatable message (Robert Wood Johnson Foundation, 2010). Thus, APNs need to be aware of the cultural peculiarities of the vulnerable populations they address to achieve the best result possible.
The Impact of Health Policy on Vulnerable Populations
Health policy and the policy process are implemented to improve the health outcomes in a given community or at the national level. Before referring to health policy and the influence of the policy process on vulnerable populations, it is important to define the latter. Vulnerable, or affected, populations imply those groups of citizens who experience any issues in obtaining healthcare services. Thus, these groups include low-income people, the homeless, the elderly, racial and ethnic minorities, people living in distant areas and deprived of proper access to healthcare services, and others. These groups often experience certain challenges in improving their health outcomes because they cannot change the context for alterations independently, and they require social or political support.
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The policy process puts certain obstacles for policymakers and APNs as policy implementers. First, if the policy is national, it integrates all social groups and considers American society as a whole in the context of health. This complex approach is crucial because when some communities have poor health outcomes, this definitely influences other communities and undermines the entire healthcare system of the country (Robert Wood Johnson Foundation, 2010). Immunization could be an example of the undermining factor: people not involved in vaccination processes could pose a significant threat to immunized citizens. However, an absolute immunization, covering all affected populations, is rather difficult if possible at all. Consequently, APNs have a responsible duty of informing the vulnerable populations about vaccination, which is likely to influence the whole system of American healthcare and its outcomes.
Second, APNs argue that another obstacle to realizing the influence of social factors on health is the way the policy process goes. Nurses find it difficult to collect information from various spheres of life of affected populations. Cross-sectional data collection about employment, education, housing, and other, faces bureaucratic challenges, time restrictions, lack of finances, or even social opposition (Braveman & Gottlieb, 2014). As Braveman and Gottlieb (2014) state, overcoming these barriers will require a major shift in financial and political incentives (p.30). The people could also confront the collection of data about them for religious motives.
Third, since the policy is all-embracing and complex, altering just one or two factors would not be decisive. Thus, creating the policy framework for reducing stress in the workplace would be beneficial, but without the increase in income levels, it would not lead to the desired outcomes. People, working in a less stressful working environment but feeling pressure of lack of finances, would still suffer from health disorders. The integrated system requires an integrated approach, and this poses a more complicated task for APNs and policymakers.
An example of a state policy, such as New Mexico for Responsible Sex Education (NMRSE), could be considered (Mendes, Plaza, & Wallerstein, 2016). The program was launched in 2005 when health care practitioners opposed federal policies focusing solely on addictions. Therefore, when implementing a policy, the government should discuss the most urgent issues with APNs who see the vulnerable populations needs from within. The outcome of the initiative was the cooperation of stakeholders, the identification of the role of politics in increasing sex education responsibility, identification of the challenges, and additional research in this realm (Mendes, Plaza, & Wallerstein, 2016). One of the major obstacles to the program implementation was the restrictions, imposed by federal programs. Consequently, when APNs participate in policy processes, they should provide feedback to the actual policymakers about the efficiency of this policy on-site. The important changes could be introduced during the processes, thus enhancing the expected health outcomes.
The Role of Advanced Practice Nurses
Advanced practice nurses play a significant role in enhancing the health of affected populations. Since healthcare involves not only treating diseases and their consequences but also preventing disorders and improving health, nurses are expected to inform the affected populations and promote a healthy lifestyle. However, APNs are often faced with certain challenges in their awareness-raising activities. As stated by the Robert Wood Johnson Foundation (2010), to address the vulnerable populations in the most effective way, they have to avoid criticism in evaluating the current situation, provide solutions instead of only describing problems, concentrate on one striking fact rather than juggling with many, and use colloquial language.
APNs have to address those social determinants of health that are integrated into the healthcare policy being implemented. Since concentrating on one factor, for example, health insurance provision would be ineffective, APNs should motivate and support affected populations in their striving to become a part of the overall system, aimed at improving health outcomes. Thus, working with affected populations, APNs should remind policymakers about the challenges that patients with AIDS often face. Stigmatization, social exclusion, and discrimination are those factors that could prevent such populations from seeking medical care (Bradley-Springer, 2012). In this situation, the quality of healthcare provision and advances in research would mean little, and APNs should address these social issues in the first place.
APNs could emphasize preventive measures. For example, they could regularly remind people living in distant areas, such as Native Americans reservations, and lacking access to healthcare of the need to visit a health practitioner and diagnose potential health problems before these problems become urgent (Bradley-Springer, 2012). Moreover, prevention should become a part of awareness-raising programs that could be delivered through educational institutions, working environments, and within particular communities.
Social determinants of health take a significant share in health outcomes, and advanced practice nurses possess influential tools to enhance those outcomes. The populations are not solely responsible for the health levels, and they cannot influence social determinants of health since this issue is beyond their competence. Policymakers must address the most urgent social problems and they should differentiate between the concepts of medical care and health care in this relation since health level depends on the context for health formation. Social determinants of health, which can significantly change health levels, are emphasized by APNs.
Through social determinants, APNs address not the consequences of health issues but the contexts, in which these issues either prosper or fade away. By implementing various health policies and taking an active part in policy processes, APNs are able to forward vulnerable populations to a significant improvement of health outcomes. For this reason, APNs should be major policy implementers, thus addressing the issues of the most disadvantaged American populations at the local, state, and national levels.
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