Project

Social Determinants and Health Policy

Michell Muldrow

Columbia Southern University

MHA5201

Dr. Alicia Chatman

Date

Social Determinants and Health Policy

Healthcare access and quality, and neighborhood and built environment are among the five major social determinants of health (SDOH) domains. SDOH involves conditions where individuals live, work, and age that influence their health outcomes. The paper examines legal and ethical foundations linked with the two SDOHs and establishes their impact on healthcare and health policy.

Healthcare Access and Quality

Many Americans do not receive the services of health they require. About 10% of Americans, which translates to more than 33 million people lack health insurance (Singu et al., 2020). This population is less likely to afford care services, primary care providers, or medications they need for better health outcomes. The cost of healthcare is high in the U.S., and with insurance coverage, one may be able to afford quality care. Interventions to improve insurance coverage are critical to ensure every American can acquire the right healthcare services, such as preventive care and chronic illness treatment. Sometimes individuals do not receive the recommended healthcare services, like cancer screenings, due to a lack of a primary care provider. Moreover, the healthcare provider can be far away, making it challenging to access healthcare services. 

The International Covenant on Economic, Social, and Cultural Rights (ICESCR) and WHO recognize the right to health as a fundamental human right. In 1966, ICESCR recognized the right to health, including medical care, and different treaties have demonstrated their support (J.D. & Alan, 2023). The right to health is considered relevant to all countries, as each has at least an international human rights treaty recognizing this right. Every citizen has the right to access quality healthcare services. Nursing ethical standards require caregivers to do good and considering health as a human right is ethical and the right thing to do.

The Affordable Care Act (ACA) aims to increase healthcare access through increased healthcare insurance coverage (Baumgartner et al., 2020). This forms a critical legal foundation for health as a priority and basic need for all, and nobody should be denied the right to enjoy the highest achievable health. Additionally, interventions like telehealth are key to increasing healthcare accessibility as it provides care through technology regardless of the distance between caregiver and patient, reducing care costs. Healthcare costs are an important barrier to healthcare access, and any intervention cutting the cost of care boost access. There are three elements that healthcare accessibility intervention should improve, the quality of services, timeliness of receiving the service, and workforce, which include qualified, capable, and culturally competent caregivers.

Limited access to healthcare significantly affects population health outcomes as patients cannot get timely quality healthcare. This determiner leads to poor chronic disease management and increased disease burden because of preventable disability, diseases, and premature deaths. When people cannot receive their required healthcare services due to high costs, their health outcomes may worsen. 

The limited healthcare access created the need for introducing the Affordable Care Act to address healthcare access issues through enhanced insurance coverage. ACA policy has greatly improved care access and the quality of healthcare services. Today, most people enjoy healthcare coverage through the policy and can easily afford quality services for a healthy society.

Neighborhood and Built Environment

The neighborhood communities live in greatly influence their well-being and health. Many Americans stay in areas with an increased level of unsafe water and air. Ethnic/racial minorities and people with low-income backgrounds have higher chances of living in these high-risk neighborhoods. Moreover, some neighborhoods expose people to hazards like loud noises and secondhand smoke.

The United Nations General Assembly declared that every person on earth has a right to a healthy environment. The Clean Air Act (CAA) limits particular air pollutants, including establishing how much contamination can be in the air across the U.S. (Glazener & Khreis, 2019). Policy and intervention change at federal, state, or local levels can decrease safety and health risks and improve health outcomes. Creating sidewalks and bike lanes encourages people to walk and cycle, improving their quality of life.

Environmental conditions form a critical determinant of health. Environmental factors include where we live, availability of quality housing and healthy foods, and physical activity facilities significantly impact health. Environmental contaminants determine the quality of air, drinking water, and chemical exposure from industries. People living near landfills are at risk of breathing in carbon dioxide, which can lead to certain cancers. Moreover, living in houses with poor plumbing, mold, and poor ventilation can result in lead poisoning and carbon monoxide poisoning, all of which are cancer risk factors. Those living in areas with increased crime neighborhoods are unlikely to go out for physical activity due to fear for their safety, leading to poor health outcomes.

           This social determiner of health has contributed to the introduction and implementation of the CAA, which regulates all air emission sources. The 1970 Clean Air Act legislation authorizes the U.S. Environmental Protection Agency (EPA) to create National Ambient Air Quality Standards (NAAQS) on the environment and public health protection (Glazener & Khreis, 2019). The policy helps keep the population safe from risk environmental pollutants.

References

Baumgartner, J., Collins, S., Radley, D., & Hayes, S. (2020). How the Affordable Care Act (ACA) Has Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Health Care, 2013‐18.  Health Services Research,  55, 56-57. https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13406

Glazener, A., & Khreis, H. (2019). Transforming our cities: best practices towards clean air and active transportation.  Current environmental health reports,  6, 22-37. https://link.springer.com/article/10.1007/s40572-019-0228-1

JD, D., & Alan, S. (2023). Right to Health under International Human Rights Law.  Available at SSRN 4316428. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4316428

Singu, S., Acharya, A., Challagundla, K., & Byrareddy, S. N. (2020). Impact of social determinants of health on the emerging COVID-19 pandemic in the United States.  Frontiers in public health,  8, 406. https://www.frontiersin.org/articles/10.3389/fpubh.2020.00406/full