University of Tasmania CNA151: Social Determinants of Health Analysis

This report examines the case of Carla, a 54-year-old woman from a rural mining town, to analyze the impact of social determinants of health (SDOH) on her life and family. The report identifies key SDOH such as employment, education, and income, and explains their interconnectedness and impact on Carla's access to healthcare and overall well-being. The analysis highlights the challenges faced by individuals in rural areas, including limited employment opportunities and access to education, leading to poorer health outcomes. The report proposes population-level strategies to address employment disparities, such as social protection measures and policies targeting labor market disadvantages. Furthermore, it explores the role of healthcare professionals in addressing SDOH by incorporating social history assessments, providing referral advice, and advocating for patient needs. The report emphasizes the importance of trauma-informed care in improving access to health services for marginalized populations, offering a comprehensive overview of SDOH and their impact on healthcare.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Social determinants characteristics:
The case study is about Carla, a 54 year old woman who was born in a small coastal
mining town. She married John in her teens and had two children by the age of 21 years. Due to
the separation of her husband after the birth of their second child, she has constantly struggled to
balance her work responsibilities and caring for her children. Looking at her demographic
characteristics, it can be said that living in small own is a major barrier for her in getting
adequate unemployment. Unlike her other friends, she could not move to the city. According to
Australian Institute of Health and Welfare (2018), about the 29% of the Australian population
were living in rural remote areas in the year 2017. The main challenges facing this group of
Australian population is poor health and welfare outcomes compared to people living in cities
due to geographic isolation. This issue was clearly evident for Carla as shefaced many challenges
in getting access to proper income and work. People living outer regions are at high risk of daily
smoking, physical inactivity and obesity (AIHW, 2018). Carla is at similar risk too. The main
causes behind such outcomes are poor employment opportunities in rural areas and its impact on
other determinants of health. Hence, the socio-demographic characteristic of rural location and
poor income puts Carla at major risk of poor health.
Key social determinants of health:
From the review of Carla’s case study, the key social determinants of health (SDH) that
are evident in the case study include employment, education, health and income. Carla and her
children have struggled in all these areas because of living in rural location as well as being
challenged by their life stressors. For example, employment is a major SDH and it is an
independent predictor of depression, chronic disease and poor physical functioning in an
individual (Hergenrather et al., 2015). This is clearly evident in the case study as John, Carla’s
husband developed depression after losing his job. He used to help Carla financially by working
in a mine. However, when their younger child was five years, the mine closed and John could not
find consistent employment. Thus, employment issues and John’s accidence resulted in
depression for him. The impact of employment was seen in the life of Carla too. Due to the need
to care for her children and poor employment opportunities in town, she was struggling with
income too. The report by AIHW (2019) indicates that Australians living in rural and remote
areas have shorter lives, high risk of disease and poor health outcomes because of differences in

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lifestyle and decreased range of employment and career opportunities. They also have lower
income compared to people living in cities. For this reason, it was becoming harder and harder
for Carla to raise her children and make ends meet.
Education is also an important SDH as educational attainment is linked to better health
and better informed health related decisions. The most important aspect is that higher education
is a major determinant of economic resources. The changes of unemployment rate are lower for
more educated individuals compared to those who have low level of education. However, the
challenges facing students from low income background is that they face various barriers in
pursuing higher education (Shankar et al., 2013). This issue was faced by Carla’s children too.
Her son Robbie could manage to finish only Grade 12. He failed to study further because of lack
of financial capital, transport problems and poor income of his parents. Carla’s children socio-
demographic characteristics might be contributing to his poor educational attainment too. The
report by AIHW (2019) mentions that Australian people living in rural and remote areas were
less likely to have completed year 12 compared to people living in major cities. Hence, the
impact of educational attainment on Carla’s children overall well-being is clear.
The third SDH is housing or area of living in rural area. Living in rural areas has not only
affected Carla’s ability to get employment, but it also prohibits her from meeting her children.
After his children grew up, they moved to the city. Her daughter Annie became pregnant and
developed gestational diabetes. Carla wanted to be with her daughter however the cost of visit
and transport barriers prohibits her from doing so. This problems show the impact of
geographical location on overall health and well-being for Carla’s family.
Population level response
One SDH that has been chosen is the employment determinant. There is a need to
implement population level approach to address this determinant because all people living in
rural areas face similar types of disadvantage in terms of employment opportunities. The first
strategy is to implement social protection measures so that people’s capacity to enter
employment is increased. The main purpose of a social security system is to help all population
get access to basic standard of living and increase social and economic participation. These
measures can lead to the implementation of the unemployment protection schemes. The

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advantage of this scheme is that it compensates for the loss of earnings due to temporary
unemployment by providing partial income replacement. The advantage of such social security
scheme is that it helps the beneficiary to get a certain standard of living and update and develop
their skills to get decent employment (G20, 2017). Hence, such form of measures can be
successful for Carla and her son, who could not get decent employment because of poor
educational attainment. By getting access to employment related training, their chances of getter
better employment can increase.
Another population level strategy is to implement policies and programs that target
labour market disadvantage and address issues like discrimination and transport related barriers.
As unemployment rate is higher in regional or remote areas of Australia, implementing actions
like more incentives to work and investment in regional jobs can diversify the income of rural
population and stimulate long-term economic growth (McKenzie, 2011).
Health care professionals addressing social determinants of health:
Health care professionals also have the duty to focus on addressing SDH instead of
focusing just on physical health outcomes. They can reduce negative health outcomes linked to
SDH by asking patients about their social history, identify their social challenges and providing
them with referral related advice to get local support and assistance. Being aware about social
challenges is associated with a better diagnosis of patients too. Their skills in asking social
challenges related questions from patients can increase their ability to help the patients in social
areas too. Health care staffs are often encouraged to engage in social prescribing so that patients
are connected to various support resources such as employment agencies or housing advocacy
organization. Such strategy can help to eliminate health issues occurring due to social life
stressors such as unemployment and lack of housing. They can also advocate for the well-being
of patient by systematically screening patient for basic needs such as child care, food security
and housing. This action by the health care professional can increase patient strength and
resilience and lead to better health outcomes too (Andermann, 2016). In the area of practice level
change, implementation of trauma informed care can help marginalized people get better access
to health services (Levine, Varcoe & Browne, 2020).

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References:
AIHW (2019). Rural & remote health. Retrieved from: https://www.aihw.gov.au/reports/rural-
remote-australians/rural-remote-health/contents/profile-of-rural-and-remote-australians
Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: a
framework for health professionals. Cmaj, 188(17-18), E474-E483.
Australian Institute of Health and Welfare (2018). Rural and remote populations. Retrieved
from: https://www.aihw.gov.au/getmedia/0c0bc98b-5e4d-4826-af7f-b300731fb447/
aihw-aus-221-chapter-5-2.pdf.aspx
G20 (2017). Employment Plan 2017 Australia. Retrieved from: https://docs-
jobs.govcms.gov.au/system/files/doc/other/g20-2017-employment-plan.pdf
Hergenrather, K. C., Zeglin, R. J., McGuire-Kuletz, M., & Rhodes, S. D. (2015). Employment as
a social determinant of health: a systematic review of longitudinal studies exploring the
relationship between employment status and physical health. Rehabilitation Research,
Policy, and Education, 29(1), 2-26.
Levine, S., Varcoe, C., & Browne, A. J. (2020). “We went as a team closer to the truth”: impacts
of interprofessional education on trauma-and violence-informed care for staff in primary
care settings. Journal of Interprofessional Care, 1-9.
McKenzie, F. H. (2011). Attracting and retaining skilled and professional staff in remote
locations of Australia. The Rangeland Journal, 33(4), 353-363.
Shankar, J., Ip, E., Khalema, E., Couture, J., Tan, S., Zulla, R. T., & Lam, G. (2013). Education
as a social determinant of health: issues facing indigenous and visible minority students
in postsecondary education in Western Canada. International journal of environmental
research and public health, 10(9), 3908–3929. https://doi.org/10.3390/ijerph10093908