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We already do this a bit though already I think.  I absolutelyagree that education is the key.  Although to be frank, unless someone has insight into their current behaviour, they wont change. We already see that with our patients. Chronically poorly controlled type 2 diabetes, the copd pt who wont stop smoking etc etc.  It's easier to pop a pill, or pop into hospital for a quick fix until next time!  You can lead a horse to water....

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We already do this a bit though already I think.  I absolutelyagree that education is the key.  Although to be frank, unless someone has insight into their current behaviour, they wont change. We already see that with our patients. Chronically poorly controlled type 2 diabetes, the copd pt who wont stop smoking etc etc.  It's easier to pop a pill, or pop into hospital for a quick fix until next time!  You can lead a horse to water....

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Naomi W

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Kerry, Its very interesting isnt it?! Healthcare is a big black bottomless money pit.  We will never have enough money to continue along the current biomedical model.  Our hospitals are already struggling. We see it first hand! There was an article in todays Age about nurse burnout. It all links up. We have trouble providing morally safe care due to the organisational system, which is only getting worse. Surely we are all aware that health does not sit as an individual entity, but, as you say, as a social context?  It is just such a huge undertaking to address these issues, and youre right, the financial impact here is huge. To implement it would mean continuing to finance our current system, and then to finance on top of that, the change.  Somethings got to give! Our current system is overloaded, and we cannot keep going in this direction!! 

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Kerry, Its very interesting isnt it?! Healthcare is a big black bottomless money pit.  We will never have enough money to continue along the current biomedical model.  Our hospitals are already struggling. We see it first hand! There was an article in todays Age about nurse burnout. It all links up. We have trouble providing morally safe care due to the organisational system, which is only getting worse. Surely we are all aware that health does not sit as an individual entity, but, as you say, as a social context?  It is just such a huge undertaking to address these issues, and youre right, the financial impact here is huge. To implement it would mean continuing to finance our current system, and then to finance on top of that, the change.  Somethings got to give! Our current system is overloaded, and we cannot keep going in this direction!! 

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Naomi W

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By focusing and providing more resources which focus more on the social determinants of health, organisations have the power to arm the populationwith the education they require to make healthier, informed choices for themselves and for their families. Education appears to be a common thread as “examples of partner organisations and groups who could be well placed” to address lifestyle factors and other social determinants of health. As mentioned by Bernie, this would be a slow shift, but by educating individuals from an early age about the effects of smoking, dietary and other lifestyle choices, slowly, this will filter through the generations to eventually lead to better outcomes for all Australians. For many reasons, I can see how this would be a challenge for health care organisations who are already stretched beyond their means. Perhaps by investing more resources into education targeting these social determinants, focused on prevention of disease and promotion of good health for a concentrated period of time, the country will reap the rewards by having to eventually spend less on treating preventable illness and diseases of lifestyle. Isabelle Legrigore

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For those of you interested. Q&A on ABC iView is interesting this week. All were great speakers, however Michael Marmot was impressive about his answer to inequalities and health. Very worth watching!

Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. Health is not just about health care, it is broader than this. This means looking beyond the illness and moving towards the social context of health. Though I don’t think we ignore healthcare either. Addressing the issues above would be a major financial issue but in the long term addressing the issues would be life changing.  Addressing the wealth inequality would be a start to this process. Kerry M

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The nature of social determinants of health is that the factors impacting on the persons social wellbeing are external to the person. As such nurses, health care teams and public systems can have an influence on this aspect of a person’s health.Making changes to the social factors that impinge on a person having both equal access to health care and access to health that is equitable and culturally specific is complex in nature. An article by Spurling and Hayman (2010) look at just such a phenomena when inquiring into the health seeking behaviours of indigenous people living in the metropolitan areas. The study found that while there were health care facilities that were in close proximity, and equip to manage their physical and mental health, they were not being accessed. The limited degree to which the health services provided cultural sensitive and safe environments were thought to play a role. This is made more credible in findings by Hinton,  Kavanagh, Barclay,  Chenhall, and Nagel, (2015), that indicate that, while rural and remote indigenous community’s face difficulties with service availability, when outreach services are provided by within the community presentations are increased and health care seeking behaviours improve. These studies indicate that decreasing the impact of social determinants of health on the health and wellbeing or marginalised communities means making the changes in both the equal opportunity and equity of the service. Community clinical team leaders have a  challenging position in role modelling the concept that consumers accessing the service is more than just the presence of service provision, but that access is guided by multiple social factors that determine the person’s ability to seek care. Lussier and Achua (2016) talk about the leadership skills of political behaviour and understanding organisational culture that can be used to influence outcomes.  Therefore developing leadership characteristics that perform the function of having  influence within the organisation arena while advocating their consumer population further strengthens a team’s commitment to lessening the impacts negative social determinants have on an at risk populations Hinton, R., Kavanagh, D., Barclay, L., Chenhall, R., & Nagel, T. (2015). Developing a best practice pathway to support improvements in Indigenous Australians’ mental health and well-being: A qualitative study. BMJ Open, 5. doi: 10.1136/bmjopen-2015-007938. Lussier, R. & Achua, C. (2016). Leadership theory application, & skill development. Australia: Cengage Learning. Spurling, G. & Hayman, N. (2010). Self-rated health status in an urban Indigenous primary care setting: Implications for clinicians and public health policy. Australian and New Zealand Journal of Public Health, 34(6), 598-601. doi: 10.1111/j.1753-6405.2010.00627.x

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The nature of social determinants of health is that the factors impacting on the persons social wellbeing are external to the person. As such nurses, health care teams and public systems can have an influence on this aspect of a person’s health.Making changes to the social factors that impinge on a person having both equal access to health care and access to health that is equitable and culturally specific is complex in nature. An article by Spurling and Hayman (2010) look at just such a phenomena when inquiring into the health seeking behaviours of indigenous people living in the metropolitan areas. The study found that while there were health care facilities that were in close proximity, and equip to manage their physical and mental health, they were not being accessed. The limited degree to which the health services provided cultural sensitive and safe environments were thought to play a role. This is made more credible in findings by Hinton,  Kavanagh, Barclay,  Chenhall, and Nagel, (2015), that indicate that, while rural and remote indigenous community’s face difficulties with service availability, when outreach services are provided by within the community presentations are increased and health care seeking behaviours improve. These studies indicate that decreasing the impact of social determinants of health on the health and wellbeing or marginalised communities means making the changes in both the equal opportunity and equity of the service. Community clinical team leaders have a  challenging position in role modelling the concept that consumers accessing the service is more than just the presence of service provision, but that access is guided by multiple social factors that determine the person’s ability to seek care. Lussier and Achua (2016) talk about the leadership skills of political behaviour and understanding organisational culture that can be used to influence outcomes.  Therefore developing leadership characteristics that perform the function of having  influence within the organisation arena while advocating their consumer population further strengthens a team’s commitment to lessening the impacts negative social determinants have on an at risk populations Hinton, R., Kavanagh, D., Barclay, L., Chenhall, R., & Nagel, T. (2015). Developing a best practice pathway to support improvements in Indigenous Australians’ mental health and well-being: A qualitative study. BMJ Open, 5. doi: 10.1136/bmjopen-2015-007938. Lussier, R. & Achua, C. (2016). Leadership theory application, & skill development. Australia: Cengage Learning. Spurling, G. & Hayman, N. (2010). Self-rated health status in an urban Indigenous primary care setting: Implications for clinicians and public health policy. Australian and New Zealand Journal of Public Health, 34(6), 598-601. doi: 10.1111/j.1753-6405.2010.00627.x

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Amanda

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A greater focus on the social detirminants of health, to the level of impacting on health care organisations, would be a slow shift across more than a generation. Hypothetically,  I believe this would result in job redesigns, changes to education, funding shifts and new avenues and types of facilities for health access. Shifts of this dimension require multi-level leadership, usually involving all tiers of Government, policy and funding direction,educational/workforce involvement, and a community development approach. 

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A greater focus on the social detirminants of health, to the level of impacting on health care organisations, would be a slow shift across more than a generation. Hypothetically,  I believe this would result in job redesigns, changes to education, funding shifts and new avenues and types of facilities for health access. Shifts of this dimension require multi-level leadership, usually involving all tiers of Government, policy and funding direction,educational/workforce involvement, and a community development approach. 

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Bernie Cavanagh

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When critiquing this question I looked at The World Health Organizations (WHO)Health Impact Assessment (HIA). Social determinates is only one area of health determinates that effect the health outcomes of an individual. To focus on the socio economical only is not appropriate to determine health outcomes. Many other factors contribute to the individuals health such as the physical environment and the individuals characteristics. A persons health in unlikely to be controlled by their social status. When a person demonstrates a higher income this in turn links to better health. It is also evident that the larger the gap between wealthy and poor the larger the health status. If there were a greater focus on the social determinates on health the ideology is that health outcomes for all areas would be beneficial, though the realistic vision is that crossing all areas from Metropolitan to remote would  require significant budgetary input. An example of this is the Syphilis outbreak in Northern Territory with children as young as 10 reported contracting the infection, and a baby dying from the same infection. If that was to occur in the ACT  there would be outrage due to the education and socio economic status largely of the population . Data collected by the Kirby Institute (2015), reflected that syphilis was epidemic proportions, in the Northern Territory though due to the cultural, socio economical and environmental factors it is extremely difficult to address. So yes in answer to the question,  if the focus on social determinates of health was greater, we would achieve better health outcomes for all Australians. The challenge with so many social variants is how to achieve this.

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When critiquing this question I looked at The World Health Organizations (WHO)Health Impact Assessment (HIA). Social determinates is only one area of health determinates that effect the health outcomes of an individual. To focus on the socio economical only is not appropriate to determine health outcomes. Many other factors contribute to the individuals health such as the physical environment and the individuals characteristics. A persons health in unlikely to be controlled by their social status. When a person demonstrates a higher income this in turn links to better health. It is also evident that the larger the gap between wealthy and poor the larger the health status. If there were a greater focus on the social determinates on health the ideology is that health outcomes for all areas would be beneficial, though the realistic vision is that crossing all areas from Metropolitan to remote would  require significant budgetary input. An example of this is the Syphilis outbreak in Northern Territory with children as young as 10 reported contracting the infection, and a baby dying from the same infection. If that was to occur in the ACT  there would be outrage due to the education and socio economic status largely of the population . Data collected by the Kirby Institute (2015), reflected that syphilis was epidemic proportions, in the Northern Territory though due to the cultural, socio economical and environmental factors it is extremely difficult to address. So yes in answer to the question,  if the focus on social determinates of health was greater, we would achieve better health outcomes for all Australians. The challenge with so many social variants is how to achieve this.

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Catherine Maher