Case Study: Social determinants of Health
Maria Santos is an 85-year-old, Spanish-speaking, Venezuelan immigrant. She lives with her husband, who also only speaks Spanish, on a farm on the outskirts of a small town comprised mostly of migrant farm workers. The downtown area has a grocery store, a gas station, and a small Hispanic restaurant.
Two days ago, Maria’s husband arrived by taxi to the hospital to pick her up. She was being discharged after a 9-day stay. Her primary diagnosis was “viral pneumonia.” She has secondary diagnoses of “dysphagia” and “osteoporosis,” and she ambulates using a walker. During the hospital discharge process, the respiratory therapist, along with a language interpreter, ensured that Maria could adequately breathe the room air. The nurse ensured that the correct oral and inhaler prescriptions were issued. Maria would receive a follow-up appointment with the primary doctor and a referral for home care services.
After Maria arrived home, her prescriptions were never filled and she ate very little. Today, when the home care nurse arrives at the farm home, Maria is in bed and breathing with labored breaths. The nurse notices that Maria’s husband is acting odd. He appears to have early dementia. Clearly, the husband is incapable of assisting Maria with even the most basic tasks for daily living. Maria’s discharge plan failed.
Nurses need to understand how social, economic, and environmental factors, also known as social determinants of health (SDOH), impact chronic morbidity, survival, and the well-being of older adults. In Maria’s case, obvious and unique health challenges are present in her environment. Support systems, personal lifestyle, cultural beliefs, and language barriers impact her health behaviors.
- Identify two socioeconomic-related questions that the nurse could have asked Maria that fall under the umbrella of SDOH.
- Describe how the nurse could have addressed one of the following areas to better prepare Maria for discharge.
- Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
- Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
- Access to healthcare services
- Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
- Transportation options
- Public safety
- Social support
- Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
- Residential segregation
- Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
- Discuss a health policy currently in place or a health policy that is needed that would support Maria as she transitions back to her home environment.
Social Support – The nurse should have asked Maria whether there is someone at home, whether a family member or friends, whom she can fully rely on to help her take her medication on a regular basis.
Language/Literacy – The second question that the nurse should have asked her is whether her language barrier may act as a hindrance in the administration of her medication while at home.
If the nurse had asked Maria the first question posted above concerning social support, he or she would have discovered that the patient’s husband is suffering from dementia. She would also seek to find out whether there is someone else besides the patient’s husband that was capable of helping her meet her basic needs. According to this particular scenario, Maria only lives with her husband, who is the immediate source of social support. In this case, however, he has been deemed incapable of providing the adequate support needed for Maria’s successful recovery.
A social support network would be the most appropriate route for the nurse to take. This network may comprise of friends, other members of the family and peers (sometimes coworkers). It is not necessarily a support group, which is more of a structured meeting headed by a mental health professional or lay leader. A social support network helps relieve the patient from stressful situations since they are surrounded by people who love and care for them (Cherry).
In Maria’s case, the nurse should have contacted her next of kin or close friends who live near her. On the other hand, those who live far from her may also offer moral support by contacting her regularly. Friends and members of the family that live close to Maria’s home may take turns to visit them (Maria and her Husband) to ensure that she has taken her medication and has had something to eat.
Discharge planning, when conducted effectively, plays a crucial role in the continuity of care after patients have been discharged. There are several procedures and activities associated with the discharge planning process. These take place on admission, during admission, at least 48 hours before discharge, day of discharge, and follow-up care (Waring et al.).
On admission, nurses are required to prepare an accurate and detailed patient record. They should also review assessment information and come up with a plausible date of discharge. During admission, they should conduct multidisciplinary assessments of the patient’s condition so as to classify and assess the conditions of discharge.
The patient and their family should also be informed of the ongoing needs. At least 48 hours to discharge, the multidisciplinary team should be informed of the estimated date of discharge. The nurse should then initiate referrals to social care agencies. Any agencies concerned with ordering or installing medical equipment at home or conducting home modifications should also be contacted.
On the day of discharge, the nurse in charge of the patient should contact the patient’s family or carers to confirm matters related to the follow-up arrangements, to ensure the completion of medical documentation, and to confirm transport. During follow-up care, the nurse should assess the continuing health-care package. When necessary, they should consult with a general practitioner (GP) (Waring et al.)
Cherry, Kendra. “Social Support Is Imperative for Health and Well-Being.” Verywell Mind, 2018, www.verywellmind.com/social-support-for-psychological-health-4119970. Accessed 10 Mar. 2021.
Waring, Justin, et al. “Hospital Discharge and Patient Safety: Reviews of the Literature.” Nih.gov, NIHR Journals Library, Sept. 2014, www.ncbi.nlm.nih.gov/books/NBK259995/. Accessed 10 Mar. 2021.
Social Determinants of Health Example 2
Healthcare problems affect many areas of a nation, including the economy. They must be promptly addressed to maintain a healthy and productive nation. Countries face healthcare problems to varying degrees. Assessing healthcare systems and these burdens helps governments and other stakeholders develop interventions to manage the weaknesses. This essay selects a country and the healthcare problems facing it and selects a single problem to focus on.
Selected Country and the Reasons
Kenya is the selected country of interest. It is a developing country but has one of the best economies in Africa after countries such as Egypt, South Africa, and Nigeria. Some areas have improved, but others are ailing it and preventing its healthcare systems from progressing. Most of these problems are related to poor governance, healthcare disparities, and uneven distribution of resources (Umeh, 2018).
The country has a high rate of infectious diseases, some of which are endemic due to its location; tropical diseases are highly neglected. The country is located in East Africa, a tropical region, hence a high prevalence of tropical diseases. Another critical aspect of the nation is the significantly low government healthcare spending (less than 6% of the annual budget) on health compared to other well-developed countries such as South Africa (Umeh, 2018).
Tuberculosis, HIV/AIDS, and malaria are the health issues of interest in this country. Tuberculosis prevalence in Kenya lurks above 400 per 100,000 individuals, the most affected being those living in urban settlements due to congestion and poor sanitation and hygiene in most areas (Kenya Tuberculosis Roadmap Overview, 2021). In addition, more males contract the disease than females. Kenya is ranked as one of the high TB burden countries, at number fifteen.
Tuberculosis has a high mortality rate of 50 per 100,000, making it the fourth leading cause of death in Kenya (Enos et al., 2018). The disease has a high treatment success rate. The Kenyan government and other organizations such as the CDC instituted interventions such as tuberculosis immunization, healthcare screening, free tuberculosis medical care, and other interventions such as community education and strict patient follow-up (Enos et al., 2018). Campaigns such as the beyond-zero campaign helped reduce tuberculosis transmission significantly.
A major improvement was Kenya’s exiting from the 30 high multidrug-resistant tuberculosis countries. Malaria is a common illness in Kenya and also poses a significant burden to the Kenyan population. Kenya reports approximately 3.5 million clinical cases, over 10,000 deaths, and 34000 deaths in under-fives from malaria, and it also contributes to over 30% of outpatient visits and over 15% of in-patients (CDC, 2018).
HIV/AIDS poses a significant threat to the Kenyan Health system. Kenya ranks third among the high HIV burden countries globally, with more than 1.5 million HIV-positive patients (NACC, 2018). About 69% of the adults and about 61% of the children under five access treatment (NACC, 2018). Many local and international organizations have pooled resources to address the issue and improve the health of HIV individuals through interventions such as free ARVs, social support, community education, and increased access to resources.
The high prevalence shows significant gaps in community education on the disease. Numerous healthcare and non-healthcare organizations have joined hands in the fight against the disease with varying degrees of success. The disease does not kill but compromises the immunity allowing other opportunistic infections such as tuberculosis and pneumonia to cause patients’ death (NACC, 2018). Many of these infected individuals live longer, healthy lives free of opportunistic infections due to HIV’s aggressive management.
Malaria is the healthcare issue of interest among the three healthcare issues. It is a tropical disease, meaning the incidences are high throughout the year. Statistics show that over 75% of the population in Kenya is at risk of contracting malaria (CDC, 2018). The transmission rates fluctuate depending on the time of the year. Unlike HIV and tuberculosis, where there is follow-up and free treatment, malaria lacks free treatment, and the drugs are hardly available in healthcare facilities.
In addition, most individuals who suspect malaria do self-medication, making it difficult to track the actual burden and efforts to develop effective interventions against the disease (CDC, 2018). The government has focused more on pregnant women and neglected the larger population’s burden. Much can be done to address the malaria health issue.
Healthcare systems face problems at varying degrees, and these nations have varying abilities to manage these problems. The health issues of interest in Kenya are HIV, tuberculosis, and malaria. The nation is marked as a high burden for these three healthcare conditions. However, tuberculosis and HIV have received much attention; hence, the prevalence and incidences have reduced over time. Malaria receives less attention despite the population’s high risk of contracting the disease, making it the disease of interest for this assessment.
Center for Disease Control and Prevention (CDC) (2018). Malaria. CDC Activities in Kenya. Accessed from https://www.cdc.gov/parasites/malaria
Enos, M., Sitienei, J., Ong’ang’o, J., Mungai, B., Kamene, M., Wambugu, J., Kipruto, H., Manduku, V., Mburu, J., Nyaboke, D., Ngari, F., Omesa, E., Omale, N., Mwirigi, N., Okallo, G., Njoroge, J., Githiomi, M., Mwangi, M., Kirathe, D., and Weyenga, H. (2018). Kenya Tuberculosis Prevalence Survey 2016: Challenges and opportunities of ending TB in Kenya. PloS One, 13(12), e0209098. https://doi.org/10.1371/journal.pone.0209098
National AIDS Control Council (2018). Kenya HIV Estimates. Report 2018. Accessed from https://nacc.or.ke/wp-content/uploads/2018/11/HIV-estimates-report-Kenya-20182.pdf
Umeh, C. A. (2018). Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania. The International Journal Of Health Planning And Management, 33(4), 794–805. https://doi.org/10.1002/hpm.2610
United States Agency for International Development (USAID) (2021). Kenya Tuberculosis Roadmap Overview, Fiscal Year 2021. Accessed from https://nacc.or.ke/wp-content/uploads/2018/11/HIV-estimates-report-Kenya-20182.pdf