Correction Required: SDOH Paper

Social Determinants of Health

Essentials of Advanced Nursing Roles and Interprofessional Practice D025

March 22nd , 2021.

Please use the attached Policy Brief template for the AWM1 task (which is beneath the AWM1 rubric).

Social Determinants of Health

A. 1. Income and health You will need to clearly identify 1 SDOH and provide a county reference for it. For example: “Economic instability contributing to lack of access to health affordable foods.”

The social determinant of health affecting the community is income. Income impacts the health of the community in myriad ways. First, people earning higher incomes are healthier than people with low incomes (Lenhart, 2017). The rates of distribution of income and poverty have caused health inequalities in the community. People with higher incomes are healthier because they can afford to pay for health services, while the poor can hardly afford healthcare services. Data healthcare data from the community shows that the number of households from impoverished families visiting hospitals is twice less than patients from wealthy families.

According to the American Academy of Family Physicians, poverty and low-income status of the citizens significantly impacts health outcomes in the sense that it leads to shorter life expectancy, higher rates of infant mortality as well as higher death rates for 14 leading causes of death (Whit et al., 2018). Scientific research studies have recommended that these effects can best be mediated through both individual and community-based mechanisms. Poverty and low income for the citizens restrict the access to resources necessary for the avoidance of risks and adoption of positive health behaviors.

Additionally, low income makes the citizens live in the suburbs far away from the healthcare facilities. According to the Robert Wood Johnson Foundation, there is a 25-year difference in the average life expectancy between the inner city and the suburban neighborhoods for the babies who are born in New Orleans (French et al., 2019), and a 14-year difference n the average life expectancy between the two Kansas City neighborhoods that are nearly three miles apart.

2. Characteristics of the target population This is where you include Age 18-64, Females, Resident of Champaign County. Does the county data/information also indicate low seriocomic level associated with obesity and lack of access to health foods? If so, you’d want to include that here too.

The target population of the policy change is the people with low-income rates. These people are diversified in several aspects such as socioeconomic status, level of education, neighborhood, physical environment, employment status, as well as access to support networks. Suggestion to add: Policy makers would need to ensure that resources to address the SDOH were provide in bilingual options and that the needs of handicapped residents are taken into consideration. Their characteristics are:

· Most of the poor people live in rural and adversely remote areas of the community.

· They have a large family size that exceeds the average family size

· They earn little incomes that can only afford their large family sizes 3 (Lenhart, 2017).

3. Policymakers who will receive the policy brief:

Who will receive this policy brief? Who are key people in your area who could influence the preferred/proposed policy to be moved forward? Provide a group or individual (name and title).

Among the essential policymakers who will receive the policy brief stipulating the need for a policy change to reduce the health disparities are:

I. All healthcare managers within the community

II. Health for All community-based organization

III. Health Care Service Insurance Corporation (HCSIC)

In addition to this, other key policymakers include; physicians, institutional healthcare service administrators, insurance executives, large employers, as well as the president of the entire United States government; Mr. Joe Biden, the Secretary of the Department of Health and Human Services in the United States; Xavier Becerra, the head of the Public Health Service in the United States; Rear Admiral Susan Orsega.

4. The Need for Policy Makers

The attention of policymakers is that they will help gather information on how community health has been affected by the people's income. Also, the policymakers will help conduct research, consultation, and extract from the information that will be presented a policy or policies that can be implemented to reduce the effect of income on community health.

There has been a lack of a policy that can help ease access to healthcare for residents with low incomes in the area. As a result, the health disparities between the poor and the rich have increased over the past (Lenhart, 2017). The ethical implications of the trend are; healthcare is a reserve of the rich in the community, and poverty is a threat to universal healthcare goals.

Beneficence, non-maleficence, autonomy, and justice encompass the four principles of ethics. Beneficence requires that physicians should only act for the benefit of the patient. In this regard, physicians should support the moral rules to protect and defend others' rights, prevent harm, eliminate the probable conditions that will cause harm, help people with disability, and rescue the people in danger (Morley et al., 2020). In this sense, this principle emphasizes benefiting the patients and promoting their welfare.

Nonmaleficence provides that the physician should not cause harm to the patient. In this regard, the physician should not kill, not inflict pain, not cause suffering, not offend, not deprive the patients of their good life as well as not causing incapacitation to the patients. In this regard, the physician should weigh the benefits against the burdens regarding patient treatment and only choose the best cause of action for the patient. Suffering is relieved through the use of appropriate drugs (Morley et al., 2020). According to the philosophers; Immanuel Kant (1724–1804) and John Stuart Mill (1806–1873), the principle of autonomy is whereby the patients are given the freedom to make their choices regarding their treatment. Therefore, their ability to take part in a decision should not be undermined.

Economic Stability	Neighborhood and Physical Environment	Education	Food	Community and social context	Healthcare system
Employment Income Expenses Debt Medical bills Support	Housing Transportation Safety Parks Playgrounds Walkability Zipcode/Geography	Literacy Language Early Childhood Education Vocational training Higher education	Hunger Access to healthcare options	Social integration Support systems Community engagement Discrimination stress	Health coverage Healthcare provider availability Healthcare provider linguistic and cultural competency Quality of care

1. Policy Proposal and Implementation Plan

The 2 policy alternatives and the preferred policy should be more at your local community/county level.

For example: initiate creating community gardens.

For each of the 2 alternatives, provide the strategy/initiative, how it could address the SDOH and provide a reference to support that it could be a good idea.

Policy Alternatives

I. Progressive wealth distribution mechanisms- Progressive wealth distribution gives every community member access to wealth. Consequently, poverty is reduced. A reduction in poverty levels leads to a decrease in health disparities between the poor and the rich.

II. More significant investment in services for low-income families in the community- Investment increases access to resources. When many members of the community can access resources, poverty levels will decline. The decline will lead to a decrease in health inequalities.

2. Progressive wealth creation is the best proposal because it gives community members equal access to economic opportunities. Once you have revised this, you will also need a reference here to support it could be a good idea to address the SDOH.

3. Another policy alternative regarding healthcare in the United States is the creation of Healthcare Savings Accounts for the citizens. In combination with the highly deductible health plan, this policy alternative will help cover the citizens' medical expenses while offering them significant tax advantages. Besides, it will help in covering catastrophic illnesses as well as injuries. These accounts are generally available through employers. The individuals can also set it up to benefit the unemployed. The payments that are made into this account are generally pre-taxed. Therefore, there is no tax penalty for either spending or withdrawing money provided that it is used to pay for medical expenses.

Various research studies have found out that the creation of wealth and income among the people who have lacked opportunities is quite significant regarding healthcare service acquisition (Yearby, 2018). In this regard, it improves health equity. Further studies have revealed that substantial levels of wealth greatly predict positive health outcomes. For instance, in 2007, a systematic review that was conducted on 29 studies revealed that people with greater wealth generally have a long life span, and they also have lower rates of chronic illnesses and better functional statuses in their entire life (Yearby, 2018). The creation of wealth positively impacts healthcare services in the sense that it lowers mortality rates, increases life expectancy, and reduces risks of obesity, hypertension, and asthma. The University of California examined a report that presented significant links between wealth creation and health equity in the United States (Yearby, 2018). This data found out that health is significantly linked with its general level of wealth and how wealth is distributed.

4. Impacts of progressive wealth distribution

Progressive wealth distribution will lead to an increase in the living standards of many members of the community. An increase in living standards will address the gap of health disparities resulting from low incomes because every member will be afforded equal healthcare access (Marmot, 2002). The progressive wealth distribution policy proposal will be worked on by the government. A lot of costs will be incurred because the government in general and the healthcare sector, in particular, will be required to implement various initiatives that will lead to an increase in wealth creation in the community. The ethical implication is that increase in wealth creation in the community will decrease health disparities because more community members will be able to afford healthcare services. Nevertheless, there will still be health disparities because not every community member will access the wealth.

5. Potential barriers to implementing Progressive Wealth Distribution According to Thomas Shapiro, other barriers include both historical injustices and the ongoing policy choices in the United States (Oliver & Shapiro, 2019). In this regard, the racial income gap between the whites and the blacks and the whites and Latinos is nearly $40,000. On the other hand, the wealth is over $100,000. The median white household had over $110,000 in wealth holdings in the year 2011, as compared to over $8,000 for the median Latino household and $7,000 for the median Black household (Oliver & Shapiro, 2019). Implementing progressive wealth distribution policy will help narrow down the gap between the poor and the rich. When implemented properly, this policy will help to lower the poverty level by reducing inequality (Crowley et al., 2020). In terms of economic development, this policy will lead to more equitable income distribution, higher revenue, less financial and economic volatility, and faster economic growth.

The possible barriers to implementing the policy could be financial costs. The government may not have enough funds to implement progressive wealth creation. Also, opposition from key healthcare stakeholders and government could be a challenge towards implementing the policy (Marmot, 2002). Lastly, lack of human resources could also be disastrous to the efficient implementation of the policy.

6. Communicating the Policy

Several methods will be used to communicate the policy. The primary communication method to be used will be face-to-face communication with stakeholders to discuss the need for change. Letters will also be used to communicate to stakeholders in distant areas. Sections B3, B4, B5, and B6 are all related to the preferred/proposed policy

7. Impacts of Inaction

Failure to deliver on the policy proposal will further widen the health disparities and make it more difficult for low-income families to afford healthcare (Lenhart, 2017). Also, lack of implementation will prompt continued push to the government and other stakeholders to find new alternatives that could address the increasing health disparities resulting from incomes.

C. Executive Summary

Social determinants have greatly influenced healthcare delivery in the communities. Among the notable SDOH has been the income. The policy covers income as the SDOH contributing to the increased health disparities between communities (Marmot, 2002). Progressive wealth distribution will increase access to health by community members by reducing policy prevalence rates. To achieve the change, the policymakers will be required to ensure that they conduct enough research and consultations to gauge the plan's merit. Also, enough funds will be needed to effect the new policy.

Income inequality has significantly affected healthcare services in most of the communities in the entire United States. Lack of proper incomes has made most citizens live in the suburbs, places far away from the better healthcare facilities. The life expectancy of these people is seen below. This is because they live in poor houses and lack the necessary funds to pay for better healthcare services. These people are therefore at risk of various diseases that tend to lower their life expectancy. Lack of income also makes it difficult for these people to access good education and build proper houses. Therefore, this policy is meant to uplift the living conditions of these people in regards to their acquisition of healthcare service. This will also ensure that these people are left behind in terms of the availability of wealth that they can use to get the necessary funds to pay for their medication, food, school fees, as well as build houses that are in good condition. The United States government is making efforts to ensure that there is equity in regards to the creation of wealth for her citizens.

D. Reflection

Identifying the weaknesses in healthcare and providing elaborate solutions was very impactful in influencing the policy change. Proving how access to wealth could increase access to healthcare was also crucial towards achieving the needed change. In the future, good communication, research, and persuasive skills will be vital in leading policy changes.

In regards to policy implementation, I would act as a change agent in the following ways; education is the most significant source of wealth that a parent can invest in. therefore, I would recommend that the parents be empowered on the importance of education to their children. Education will help their children lead better lives and afford better healthcare services in the community. According to this policy implementation, I learned that collaboration with other professionals who have similar interests is quite important. This enables the process of policy implementation to succeed at all levels.

The government should ensure that the policymakers have the requisite knowledge regarding policy implementation in all sectors of the economy. In this regard, the policymakers should have the analytical skills to identify the relevant trends and themes that support the development of both user-focused and evidence-based policy. They should also have the collaborative skills to work with others across the community in achieving the common goals for society.

References

French, D. D., Wang, A., Prager, A. J., & Margo, C. E. (2019). Association of the Robert Wood Johnson Foundations' social determinants of health and medicare ocular hospitalizations: a cross sectional data analysis. Ophthalmology and therapy, 8(4), 611-622.

Lenhart, O. (2017). The Effects of Income on Health: New Evidence from the Earned Income Tax Credit. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2969140

Marmot, M. (2002). The Influence Of Income On Health: Views Of An Epidemiologist. Health Affairs, 21(2), 31–46. https://doi.org/10.1377/hlthaff.21.2.31

Morley, J., Machado, C. C., Burr, C., Cowls, J., Joshi, I., Taddeo, M., & Floridi, L. (2020). The ethics of AI in health care: A mapping review. Social Science & Medicine, 113172.

Oliver, M. L., & Shapiro, T. M. (2019). Disrupting the racial wealth gap. Contexts, 18(1), 16-21.

White, P. H., Cooley, W. C., American Academy of Pediatrics, & American Academy of Family

Physicians. (2018). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics, 142(5).

Yearby, R. (2018). Racial disparities in health status and access to healthcare: the continuation of inequality in the United States due to structural racism. American Journal of Economics and Sociology, 77(3-4), 1113-1152.