Understanding Social Determinants of Health: Promoting Health at Community Clinics
By Salwa Choucair
As health care in the United States moves from hospital-based treat and release to patient-centered wellness care, the School of Nursing at UT Health San Antonio is strengthening community clinic partnerships and reemphasizing the impact social and behavioral determinants of health have on individuals in vulnerable populations.
“I believe that nursing can make a huge difference in vulnerable populations,” says Cindy Sickora, D.N.P., RN, vice dean for practice and engagement. “Health care is changing from an illness model to a wellness model. We need to address integrated coordinated comprehensive health care delivery in community-based settings and translate that into educational experiences for students.”
Nursing students have several opportunities to experience community-based clinics with the School of Nursing’s long-standing partnerships in the community. These partnerships include teaming up with the Healy-Murphy Center on the city’s east side to support at-risk teens; AVANCE-San Antonio for pediatric care and immunizations; and the Center for Refugee Services at the San Antonio Refugee Health Clinic which is an interprofessional effort with the medical and dental schools of UT Health.
“These community-based clinics address health care issues using a professional integrated model where we work with multiple disciplines to deliver health promotion, disease prevention, and, of course, treatment of illness,” Dr. Sickora says. “I think we are demonstrating that we can make huge differences when we get out into the community, develop relationships, build trust and then serve.”
Students who stay in the classroom or hospital setting without venturing into the community, Dr. Sickora explains, may never learn why a patient doesn’t take his medications or listen to discharge orders. After spending some time in the community, students begin to understand how a patient’s environment and background—also known as their social and behavioral determinants—affect their health and the decisions they make concerning their health.
For instance, a patient may not have taken his medication because at the end of the week, he only had $1 left of his paycheck; or when he got off work, the pharmacy was closed; or English is not his first language, and he didn’t understand the directions on how to take the medication or why it was important to take it in the first place. These determinants of health are the lessons that can’t be taught in the classroom, says Dr. Sickora.