Week 8 - SDOH

Question 1

Social determinants of health

Answer 1

conditionsin which peopleare born, grow, live, work,and age, includingaccess to power, money, and resources

Question 2

What explains variations in health outcomes?

Answer 2

SDOH

Question 3

Community Health Nurses of Canada - SDOH (many)

Answer 3

income and income distribution/poverty

education/literacy/education systems

unemployment/job security/precarious employment

employment and working conditions

early childhood development/experiences

food insecurity

housing

physical environment/environmental stewardship

migration/dislocation

immigration

cultural continuity

relationships with territory/land

social environmental

Question 4

Structural determinants of health

Answer 4

governance, laws, policies, and institutional practices that produce or address health inequity

Question 5

What do structural determinants of health set the context for?

Answer 5

all of other social determinants of health

e.g. policy, taxation, legislation

Question 6

Example of structural determinant of health that negatively affects Indigenous health

Answer 6

Indian Act

Canada Health Act

Question 7

Pathways by which SDOH affect health (many)

Answer 7

stress

prolonged fight-or-flight

weakened immune system

vulnerable to chronic illnesses

psychological impacts

hopelessness, exhaustion

addition

barriers to healthy food, physical activity

Question 8

Health promotion strategies must target… (2 - broad)

Answer 8

1) individual behaviours

2) social and structural determinants

Question 9

Examples of health promotion strategies that address social and structural determinants of health

Answer 9

policy advocacy

increasing access to resources

coalition-building

programming that addresses wider determinants

UPSTREAM

Question 10

What else can help reduce gaps in care?

Answer 10

community-based participatory approaches and partnerships

Question 11

Real-world barriers (4 examples)

Answer 11

poverty

housing instability

stigma

institutionalized discrimination

Question 12

Community-based strategies (examples)

Answer 12

advocacy for inclusive policies

culturally tailored health services

targeted social supports

participatory decision-making in program design

Question 13

T or F: HIV interventions that address structural determinants of health and root causes are more effective than those focusing exclusive on individual behaviour change.

Answer 13

TRUE

Question 14

What are Indigenous health inequities rooted in?

Answer 14

colonialism

residential schools

Indian Act

Question 15

Effective strategies for addressing health inequities among Indigenous populations include…

Answer 15

supporting self-determination

equitable funding for Indigenous-led health services

training professionals in culturally safe care

community-based programming

Question 16

Canada’s Disability Inclusion Action
Plan - 4 key pillars

Answer 16

1) financial security (addressing financial and systemic inequities)

2) employment (promoting quality jobs and workplace inclusion)

3) accessible and inclusive communities (removing physical and attitudinal barriers)

4) modern approach to disability (improving federal program access and responsiveness)

Question 17

Canadian Nurses role in Addressing Social Determinants of Health (5 main)

Answer 17

1) policy advocacy

2) system navigation and care coordination

3) health promotion and education

4) leadership and collaboration

5) professional standards

Question 18

1) policy advocacy example

Answer 18

participate in campaigns for affordable housing policies, income support programs, and health equity by joining nursing associations and writing to policy-makers

Question 19

2) system navigation and care coordination

Answer 19

inquire about clients’ housing, income, employment, education, and food security to guide care plans and referrals (e.g., screening for food insecurity and connecting clients to community resources)

Question 20

3) health promotion and education

Answer 20

provide information to communities about how social factors affect health, helping people access supports like subsidized child care, nutrition programs, or literacy services

Question 21

4) leadership and collaboration

Answer 21

nurses work with other professionals on initiatives such as shelter-based outreach and community health partnerships to support marginalized groups

(e.g., partnering with housing NGOs to address chronic homelessness)

Question 22

Why does addressing stigma matter?

Answer 22

public health issue

fundamental cause of health inequity

fundamental to delivering quality healthcare and improving patient outcomes

part of compassionate care as nurse

Question 23

Stigma definition

Answer 23

labeling of differences and negative stereotyping of people creating a separation between “us” and “them”

Question 24

How does stigma lead to disadvantage and inequitable social and health outcomes?

Answer 24

devalued

subjected to discrimination

Question 25

Levels at which stigma occurs (4)

Answer 25

1) institutions (healthcare) 2) population (norms and values) 3) interpersonal relationships 4) internally

Question 26

What does stigma target?

Answer 26

identities, characteristics, behaviours, practices, or health conditions e.g. race, gender, HIV, obesity

Question 27

Stigma is a significant barrier to...

Answer 27

housing employment income improvement heath care

Question 28

Cost of stigma

Answer 28

reduces accessibility and quality of health care avoidance, delays, non-disclosure increase severity of symptoms, hospitalization, ER visit etc ($$$)

Question 29

In the healthcare setting, how does stigma decrease the quality of care?

Answer 29

lack of communication decreased empowerment decreased therapeutic alliance poor clinical outcomes exclusion, mistrust

Question 30

Drivers of stigma

Answer 30

language matters implicit and conscious biases lack of respect and understanding of people’s lives fear of danger and of contagion stigmatizing organizational cultures

Question 31

What can we do to address stigma?

Answer 31

recognize and name stigmas use inclusive language/don't use dehumanizing language examine assumptions and biases engage in making change to policy and education

Question 32

Barriers to addressing stigma

Answer 32

time current health care and nursing shortage personal biases

Question 33

Tree metaphor - soil

Answer 33

structural determinants of health e.g. policies, systems need to do more here*

Question 34

Tree metaphor - roots

Answer 34

conditions of daily life e.g. housing, income, education

Question 35

Tree metaphor - trunk

Answer 35

behaviours e.g. diet, exercise, substance use

Question 36

Tree metaphor - leaves

Answer 36

health outcomes e.g. asthma, diabetes, depression, low birth weight

Question 37

PHAC report - main ways that stigma affects physical and mental health (3)

Answer 37

1) reduces access to protective resources 2) chronic stress 3) violence and assault