Social determinants of health and health equity

Compared with any other country in the Organisation for Economic Co-operation and Development (OECD), the United States spends more money on health care and still has the highest poverty rate measured by the OECD, the greatest income inequality, and some of the poorest health outcomes among developed countries (Escarce, 2019). For a variety of reasons, low-income individuals, people of color (POC), and residents of rural areas in the United States experience a significantly greater burden of disease and lower life expectancy relative to their higher income, White, and urban counterparts, and this gap has been growing over time . The roots of these inequities are deep and complex, and understanding them can help elucidate how nurses who currently serve a highly diverse population play a pivotal role in addressing social determinants of health (SDOH)—the conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks—to improve health outcomes and reduce health inequities. To further that understanding, this chapter provides background on SDOH and highlights social factors that disproportionately affect some communities more than others; Chapters 4 and 5, respectively, describe the role of nurses in addressing these inequities in health and health care. This chapter also describes the impact of the COVID-19 pandemic in exacerbating the negative effects of SDOH and health inequities among low-income communities and POC. (author introduction)