Growing research suggests that social determinants of health (SDOHs) are the primary cause of health equity gaps in care, not race or ethnicity. Several studies estimate that SDOHs affect as much as one-half of county-level variation in health outcomes. Oncology nurses are in a critical position to obtain relevant information about SDOHs, such as the patient’s work, economic, and living situations and their social network. With this information, oncology nurses can collaborate with the interdisciplinary team to help identify and minimize potential barriers to cancer care.
What Are SDOHs?
According to the US Department of Health and Human Services’ Healthy People 2030, SDOHs are “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” It groups SDOHs into 5 domains:
- Economic Stability: Steady employment, income (above poverty), food (fresh fruits and vegetables), housing, and childcare support help people to improve their health and well-being.
- Education Access and Quality: This domain focuses on interventions to help students in all aspects, including eliminating social discrimination; improving school performance, literacy, and language; enhancing early childhood education; and providing support for vocational training and higher education.
- Health Care Access and Quality: Often, people don’t receive the health services they need because of a lack of insurance or underinsurance, lack of a primary care provider, or geographical or transportation issues.
- Neighborhood and Built Environment: Safe and affordable housing, clean water, parks, playgrounds, transportation, and walkability have a major impact on health and well-being.
- Social and Community Context: People’s social networks, support systems, community engagement, and stress affect health outcomes.
High-Priority Areas to Improve Health Equity in Cancer Care
Many organizations, such as the National Academy of Medicine’s Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, focus on a more robust, diversified workforce to address inequities and improve health and well-being. This initiative includes the oncology team.
Healthy People 2030’s aim is cancer prevention. Their goals include:
- Increase the proportion of adults getting lung cancer and colorectal cancer screening and females getting cervical cancer and breast cancer screening
- Increase the proportion of people who discuss cancer prevention strategies with their providers
Many organizations, such as the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO), focus on cancer disparities with a particular emphasis on clinical research. For example, the AACR Cancer Disparities Progress Report 2022 offers a state-of-the-union type report on inequalities in clinical research, cancer treatment, and cancer survivorship. In addition, they discuss the factors that perpetuate cancer health disparities, including a discussion of the intersection nature of SDOHs. For example, the lack of access to and financial resources for healthy foods leads to poor nutrition that, in turn, can lead to health conditions such as obesity, which is a risk factor for many types of cancer.
Resources to Help Oncology Nurses in Discussing SDOHs
To talk about SDOHs, oncology nurses must first understand their different aspects. Here are just a few suggestions:
- ASCO provides several free podcasts, including “Social Determinants of Health – Beginning the Conversation – Social Determinants of Health and Cancer Care.”
- Your oncology nurse navigator colleagues are experts at SDOHs within the interdisciplinary care team. Even if you are not an oncology nurse navigator, consider joining the Academy of Oncology Nurse & Patient Navigators (AONN+) to access its many resources and continuing education offerings.
Cancer Support Community’s website offers patient/caregiver education and resources about health equity. Their video called “Social Determinants of Health” explains the term and how important it is to discuss SDOHs with the care team. It states that SDOHs is a concept that refers to where people are born, live, learn, work, play, and pray. It includes access to jobs, quality schools, safe communities, high-quality care, and social support networks. Oncology nurses may use this explanation or show the 2-minute video to encourage a discussion with patients that may help them locate resources to guide them along their cancer journey.
Gaining awareness of SDOHs can better prepare oncology nurses to close the gap of health inequities by more holistically addressing patient needs. SDOHs can affect the patient’s stage at the time of cancer diagnosis, adherence to their plan of care, and ability to navigate the health care system, with a direct impact on social and physical well-being.
Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts
Healthy People 2023: Social Determinants of Health
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
Health Equity: ASCO’s Equity, Diversity, and Inclusion Action Plan
AACR Cancer Disparities Progress Report 2022
Social Determinants of Health – Beginning the Conversation – Social Determinants of Health and Cancer Care
Academy of Oncology Nurse & Patient Navigators (AONN+)
Healthy Lifestyle Behaviors: Nursing Considerations for Social Determinants of Health