1
Q
Which social determinants of health have the greatest impact?
A
1) Income and social status
- Poverty has the greatest threat to health
- Income and social status affects all the others domains of health/wellness (physical, social, mental, emotional)
2
Q
Social Support Networks:
How do social connections affect health?
A
Affects health, healthy behaviors, and healthcare utilization
Strong Relationships as important as other high-risk factors
3
Q
Social Support Networks:
How does social isolation affect social support networks?
A
- Stress
- Depression
- Vulnerability
- Increased Risk Behaviours
4
Q
Which social determinant of health is strongly connected to education and literacy?
A
Income and social status
5
Q
What is health literacy?
A
ability to understand and apply new health information to changing circumstances
5
Q
What does Education provide for an individual?
A
increased job opportunity and security
5
Q
What kinds of impacts does literacy have on an individual?
A
direct and indirect impacts on health
6
Q
How does Un(Employment) affect a person’s health?
A
1) Affects physical, mental, social, and emotional health
2) Affects financial resources
3) Employment provides sense of purpose, hope, and growth
4) Employment provides social connections
5) Benefits/Pension
7
Q
What are 3 physical environments that affect health?
A
- Housing
- Food security
- Other environmental factors
8
Q
What are some environmental factors that affect health other than housing and food security?
A
- Smoking/Smoke-free
- Air, water, soil, contamination
- Climate and Climate Change
9
Q
How does housing affect a person’s health?
A
- Affects health directly (especially if inadequate) and indirectly (impact/connection to other determinants)
- High rent/housing costs use up resources that could be used elsewhere
- Homelessness has significant impact on health
10
Q
How does food security affect a person’s health?
A
Food choices, nutrition, have great impact on health
11
Q
How can biological and genetic endowment be influenced?
A
Can be influenced by social and physical environments, individual choices, and other determinants
12
Q
Can biological and genetic endowment be changed?
A
- Biological sex/Gender(?)
- Genetics
- Age
13
Q
What are some individual coping strategies that affect a person’s health?
A
- Many “risk” behaviours are also seen as coping strategies
- Physical (in)activity; directly impacts health, stress, and coping. Recommend 150 mins of moderate to vigorous activity per week
- Nutrition: obesity is at epidemic levels. Connected with many health outcomes
- Tobacco use still a major contributer to health issues in Canada
14
Q
What is toxic stress?
A
excessive and/or prolonged activation of body stress response systems in early childhood (pre-adolescence)
15
Q
What can toxic stress be a result of?
A
Can be the result of exposure to stressors such as poverty, violence, conflict, neglect, and food insecurity
16
Q
Does healthy childhood development influence lifelong health?
A
Conception to adolescence – critical to biological and brain development that will shape learning and health behaviour
17
Q
What is the purpose of early childhood education?
A
can promote proper cognitive and social development and have strong impact on future health
18
Q
What are 3 aspects about health services that impact a persons health?
A
1) Accessibility (Urban vs. Rural/remote) or (Public vs. Private)
2) Types of Services (Primary care, hospital care, home care, home care)
3) Quality of services (expertise and wait times)
19
Q
What are 2 things to consider about gender in regards to health?
A
Some diseases/conditions unique to, or much more prevalent in, one biological sex
- Pregnancy
- Prostate
- Cardiovascular
Many health issues are functions of gender-based social roles
- Also continues to influence many health behaviours
20
Q
What are some components of the Culture Wheel?
A
- Greater community
- Knowledge and stories
- Language
- Traditions & Rituals
- Techniques and skills
- Tools and objects
- The arts
- Food and drink
- Values
21
Q
What is something to consider about culture and ancestry regarding health?
A
- Many Health practices and choices influenced by culture
- Also influences their definition/understanding of health and wellness
22
Q
How does being an immigrant/refugee impact health?
A
- More vulnerable to experience unmet/negative determinants
- May also be impacted by experiences in country of origin
23
How does bias, discrimination, and prejudice impact health?
- Remain prevalent, based on racialization and ethnic identities
- May be systemic (structural), rather than on the individual level
- Indigenous Peoples and effects of colonization
24
How do social environments impact health?
Broadens lens to community/population level
Includes community norms/values, human rights, social security, and social relations
25
What is social exclusion?
marginalization and exclusion can occur based on many criteria; greatly impacts health
26
What is health promotion?
efforts directed toward increasing the level of well-being and self-actualization
27
What is disease prevention?
actions to avoid or forestall illness/disease
28
What are the 3 levels of Prevention?
1) Primary Prevention
2) Secondary Prevention
3) Tertiary Prevention
29
What is primary prevention?
protect against a disease BEFORE signs and symptoms occur
30
What is an example of primary prevention?
immunization
31
What is secondary prevention?
promote EARLY detection of disease
32
What is an example of secondary prevention?
Pap test or Prostate check
33
What is tertiary prevention?
minimize RESIDUAL effects/disability of a disease
34
What is an example of tertiary prevention?
Cardiac rehab after MI
35
What are structural determinants of health?
Expands on SDOH to include historical, political, societal, and economic structures within society that place particular groups of people at a disadvantage – particularly Indigenous Peoples.
36
What are the 3 categories that structural determinants of health are broken into?
1) Proximal
2) Intermediate
3) Distal (Root or Structural)
37
What does proximal determinants of health mean?
Proximal (Crown of Tree or Leaves) Determinants – influence health in the most obvious and direct ways
38
What are some examples of proximal determinants of health?
- Early Childhood Development
- Income and Social Status
- Education and Literacy
- Social Support Networks
- Employment
- Working Conditions
- Physical Environment
- Culture
- Gender
39
What does intermediate determinants of health mean?
Intermediate (Trunk of Tree) Determinants – facilitate or hinder health through systems that connect proximal and distal determinants
40
What are some examples of intermediate determinants of health?
- Health Promotion
- Health Care
- Education and Justice
- Social Supports/Kinship
- Networks
- Labour Markets
- Government
- Private Enterprise
- Kinship, Relationship to
- Land, Language,
-Ceremonies, and Knowledge Sharing
41
Does intermediate health have a direct impact on individual health?
Less direct impact on individual health, but huge impact on Proximal Determinants
42
What does distal determinants of health mean?
Distal (Roots of Tree) Determinants – deeply embedded influences that affect all other determinants
43
What are some examples of distal determinants health?
- Historical Foundations
- Political Context
- Ideological Foundations
- Economical Foundations
- Social Foundations
- Indigenous Worldview, spirituality, and self-determination
44
What is a pitfall of contemporary structures?
They continue to perpetuate systemic discrimination against indigenous peoples
45
What are negative consequences of contemporary structures?
- Many structures of colonialism endure
- Indigenous ways and knowledge systems often seen as inferior
- Continue to be marginalized geographically, socially, and intellectually
- Insufficient resources and funding for many aspects of determinants of health – has led to substantial health disparities and inequities that persist across generations
46
In order to improve the health of Indigenous peoples, what part of the structure determinants of health should be focused on?
Efforts to improve the health of Indigenous peoples needs to focus on the distal (roots) determinants, rather than the current primary focus on proximal determinants.
47
Do all levels of structural determinants of health influence each other?
Yes
48
Do structural synergies create advantage or disadvantage in structural determinants of health?
Yes
49
What is vulnerability?
Being in need, susceptible to injury, and at higher risk of harm than the rest of the population
50
What is structural vulnerability?
Political, economic, and social arrangements that contribute to harms and the production of poor health in society.
How we are positioned in society relative to class, age, gender, sexuality, and race make us more or less structurally vulnerable.
51
What are societal factors that create vulnerability?
- SDOH
- Structural Factors
- Health Inequities
52
What are individual factors that create vulnerability?
- Personal Choices
- Individual Characteristics
- Circumstances
53
Define Health in 4 Ways:
1) Is a product of people and their environment
2) Determined by the complex interplay between social and economic factors, individual decisions and behaviors, and the environment we live in
3) Anything that alters this interplay can be a critical concern for nursing
4) Must consider the SDOH when providing care in all situations
54
What does health inequalities mean?
Differences in health among groups in the population that may be either positive or negative.
55
What is the difference between health inequities and health inequalities?
Can be distinguished from health inequalities because they are the result of structural arrangements in society and judged to be unfair because they are avoidable.
56
What does health inequities mean?
Those differences in health that are deemed unfair or unjust because they are a product of social processes that can potentially be changed.
57
What are general conditions that contribute to vulnerability?
- Stigmatization
- Racialization
- Marginalization
- Discrimination
- Disadvantage
- SDOH – Intersecting Factors
- Lack of access to resources
- Victim Blaming
58
What are specific conditions that contribute to vulnerability?
- Poverty & Income
- Inequality
- Homelessness & Precarious Housing
- Food Insecurity
- Social Exclusion
- Violence/Trauma
- Age
59
What does victim blaming mean?
People who make this error view the individual victim as partially. responsible for what happened to them and ignore situational causes.
60
What does upstream mean?
macro-level intervention strategies tied to structural determinants of health that look at the root cause of inequality in our society .
Upstream thinking seeks to even out economic and social structures and provide an equitable distribution of wealth, resources, and opportunities amongst all populations
61
What does downstream mean?
micro-level intervention strategies that focus on issues of equitable access to care resources and providing resources to those in need.
For example, shelters, food banks, and soup kitchens are forms of downstream interventions that provide essential services to people who are unhoused or are experiencing housing instability.
62
What are some ways to reduce vulnerability ?
Promote Health Equity (Fair conditions in society that allow each person to reach his or her potential for health)
Upstream & Downstream Efforts (Focus on the social and structural determinants)
63
What is the role of the nurse in reducing vulnerabilities?
Understand the root cause factors leading to vulnerability (Include SDOH in the holistic assessment of the patient/client)
Advocate for improved access to healthcare and strengthen community resources
Promote structural and systemic changes- social justice
Counter stigmatization and discrimination
Act as a voice for those that don't have one
64
What are some social influences of health?
Health is a product of people AND their environment.
Social conditions that alter how people interact with their environment affect health
Social conditions of interest to health commonly called the Social Determinants of Health
Crucial for nurses to consider these determinants as part of the holistic treatment of patients and clients
65
What are some examples of social issues that affect health?
- Poverty
- Homelessness
- intimate-partner violence
- Aging demographic
- Discrimination
66
Homelessness and Precarious housing:
Often experience inadequate nutrition, exposure, and violence
Often have limited access to appropriate health care resources
Often experience exclusion, discrimination and marginalization
Difficulty accessing services
Are more likely to experience mental illness and other concurrent conditions
Are more likely to suffer from conditions affecting physical function, quality of life, and life expectancy
67
What happens when an individual lives in a violent relationship?
Those living in violent relationships can experience poor physical and psychological health; not only injuries directly from the violence, but also the effects of chronic stress and trauma
68
What 3 ways to not use language of violence?
1) Need to make sure our language is empowering and not threatening
2) Be very careful of Victim Blaming
3) Also be careful of Micro-aggressions
69
What does discrimination mean?
Any judgements and ACTIONS that create and reinforce oppressive conditions that marginalize and/or restrain the lives of those being discriminated against.
70
What is social justice?
Right to equitable treatment, allocation of resources, and support for their human rights regardless of culture, gender, sexual identity, etc.
71
Vulnerable Clients & the Nursing process (9)
1) Create a trusting environment
2) Show respect, compassion, and concern
3) Do not make assumptions
4) Coordinate services and providers
5) Advocate for accessible health care services
6) Focus on prevention
7) Know when to “walk beside” the client and when to encourage the client to “walk ahead”
8) Know what resources are available
9) Help clients develop their own support network
72
What are 3 components of Power?
1) Fluid and dynamic
2) Relational
3) Many Forms: Social, cultural, economic, political, structural/systemic
73
What does oppression rely on?
Relies on Structural/Systemic Power on societal, national, and global levels to perpetuate over time
Cycle of stereotyping and discrimination to preserve power structure
Those in power create the system in ways that maintain their privileged status
74
Is oppression often invisible or visible?
Invisible
Have to work to make them visible in order to challenge them
Mechanisms of action or inaction are
normalized and not clearly visible
75
What is privilege?
- Rights, Benefits or Advantages available only to a particular person or group
- Usually granted to those in positions of power
- Usually denied to those who are being oppressed; is a form of oppression itself
76
Define Power
the authority or ability to carry out an action or influence others
77
Define Empower
to facilitate that ability in another person
78
Define Empowerment (3)
1) Process of recognizing, promoting, and enhancing people’s abilities to meet their own needs, take action, solve their own problems, and mobilize resources in order to feel in control of their own lives
2) Is a construct, rather than a concept, as it is not something one can observe; rather it is something one feels
3) Implies a choice to accept responsibility and accountability for one’s own actions and choices
79
Why is professional empowerment important?
Nurses must feel personally and professionally empowered in order to take action
Requires nurses to be knowledgeable about and address systemic as well as interpersonal issues
80
Empowerment of nurses can have personal, institutional, and patient care implications such as....?
Empowered individual nurses are more likely to come together and form collaborative teams that work together to achieve shared goals for all unit activities
Empowered nurses are more likely to accept divergent and conflicting solutions to problems, choose to support others, and work collaboratively rather than choosing divisiveness.
81
How do nurses empower patients?
Nurses can enable the process for patients to become empowered to manage their own health needs
Nurses need to act as advocates, facilitators, and resources, rather than as simply care provider
- Relinquish control; involve patient in own care planning and decision making
- Empowerment is an interactive-therefore it requires communication
- To make choice, patients must have adequate knowledge and understanding
82
How does NESA BN programs define intersectionality?
a way of understanding and analyzing complexity in the world, in people, and in human experiences, including responding in ways that demonstrate cultural safety. The events and conditions of social and political life and the self can seldom be understood as shaped by any one factor (or identity). They are shaped by many factors in diverse and mutually influencing ways. When it comes to social inequality, people’s lives and the organization of power in a given society are better understood as being shaped not by a single axis of social division (be it race, or gender, or class), but by many axes that work together and influence each other. Intersectionality as an analytic tool gives people better access to the complexity of the world and of themselves
83
How does Bowleg define intersectionality?
a theoretical framework for understanding how multiple social identities such as race, gender, sexual orientation, SES, and disability intersect at the micro level of individual experience to reflect interlocking systems of privilege and oppression
84
What different aspects does intersectionality look at?
Intersectionality looks at how the different aspects of our personal identities determine what power, privilege, and/or oppression we experience within our current social and political context or environment.
85
Intersectionality is a way to think about and act upon on _____
It is a way to think about and act upon social inequality and discrimination.
86
Intersectionality and the social determinants of health ______
- Strong connections between many SDOH and experiences of privilege or discrimination by, and within, the healthcare system
- SDOH also influence access to the healthcare system
87
Intersectionality and the impacts on health _______
- How you define yourself has influence on how you define your health, and vice versa
- Intersectionality provides a lens for looking at health promotion, by challenging existing inequities and definitions
- Intersectionality offers a way to expose how structural factors interact to produce specific health outcomes for specific individuals
88
How are social hierarchies created?
Created by comparison of various "labels"
89
What do social determinants of health become?
A series of labels that create a web of privilege of oppression
90
What are our social locations determined by?
While largely determined by structures of inequality inherent in a social system, social location is also often lived as a deeply felt identity by individuals as they negotiate their position in a social setting.
90
What does the expression social location (social position) used to capture?
capture the idea that while each of us occupies a specific and individual place in the world, it is produced by our relationship to the social settings in which live.
91
What are social locations shaped by?
That is, our social locations are relational, shifting and shaped by our positions in the social structures we inhabit.
92
What is important to note about social location?
It is important to note that the same processes that create disadvantage also produce locations of privilege.
93
The intersectional approach moves beyond explaining relationship between various discrete variables to address ______
Moves beyond explaining the relationship between various discrete variables to address why those relationships occur and illuminate the social and context-dependent constructs or the power structures within those relationships.
94
Is the intersectional approach particularly powerful?
Particularly powerful for the design and implementation of interventions, not just at the personal and population levels, but also at the structural or “macro” levels of power.
95
What status/social determinant of health has the greatest impact?
Socioeconomic status has a large impact on peoples health outcomes
96
What is the cycle of oppression?
A cyclic process created and sustained by ruling power relations (creates systems of advantage, privilege and disadvantage)
97
How do you break the cycle of opression?
Recognizing that there is oppression and what is causing it
98
What are the 4 phases of oppression?
1) Biased information leads to stereotyping (IDEA)
2) Prejudice (JUDGEMENT)
3) Discrimination (ACTION)
4) Oppression
99
Phases of Oppression:
Biased information leads to stereotyping
Stereotyping: An often negative exaggerated belief, fixed image, or distorted idea held by persons, groups, political/economic decision makers- is embedded in, and reinforced by, oppressive power relations
100
Phases of Oppression:
Prejudice
A way of thinking based on stereotypes- is embedded on stereotypes - is embedded in, and reinforced by, oppressive power relations
101
Phases of Oppression:
Discrimination
Action or inaction based on prejudice- made possible/condoned implicitly or explicitly by oppressive power relations
102
Phases of Oppression:
Oppression
Discrimination backed up by systemic power relations (ex: government, education, legal, and health systems policies, multinational corporations)
103
What is the goal of intersectionality?
To make things visible that are not
104
Intersectionality
visible vs. invisible
Choose many “labels” due to their connection to privilege or distance from oppression
105
Can intersectionality be used as a framework for research? (Caiola Article)
Yes, this article discusses how there are relationships that need to be researched
NSG 1600 Nursing & Intersectionality
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Decks in class (5)
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