Toward an understanding of social determinants of health

The current featured article in ANS, titled “Using an Intersectional Approach to Study the Impact of Social Determinants of Health for African American Mothers Living With HIV,” addresses the very difficult challenges involved in ameliorating social determinants of health that result in health inequities.  The authors, Courtney Caiola, MSN, MPH, RN; Sharron L. Docherty, PhD, PNP-BC, FAAN; Michael Relf, PhD, RN, ACNS-BC, AACRN, CNE, FAAN; and Julie Barroso, PhD, ANP-BC, APRN, FAAN use an example based on Courtney Caiola’s research to explore ways in which an intersectional approach can be used to better understand social determinants of health

I came to doctoral studies in my forties after a fairly solid stint of working as maternal/child health nurse both domestically and in a limited resource setting. My writing skills were rusty and forming a paragraph longer than a typical email was a challenge, but I felt strongly about the health inequities I was observing as a frontline health worker and learning to co-create research seemed like a logical approach to addressing such social injustice.

So, I entered a doctoral program and set about the task of reading the works of giants. The words of intersectional scholars resonated with me immediately.

Their work gave me a framework to examine the structural inequities and power dynamics I had been observing in the clinical setting for years. They helped me to develop my own thoughts on how social determinants, social location and intersecting identities of race, class, gender and other social roles like motherhood generate health outcomes. Additionally, I have come to appreciate and embrace the important role nursing scholarship can play in the social transformation.

I have received very important critiques from mentors, colleagues, study participants and reviewers during this process – the kind of critiques that sting, critically and rightfully exposing my assumptions often steeped in my whiteness. I am extremely grateful for all of the feedback and thankful to have the most patient dissertation committee on the planet. I realize this manuscript is a work in a progress – work that I imagine will take a lifetime of study, introspection, partnerships, critical dialogue, and thoughtful actions to develop.

We welcome your feedback and appreciate ANS for providing a forum in which such critical dialogue can occur in a dynamic and timely way – so, please, let us know your thoughts! – Courtney

You can download this article while it is featured on the ANS web site  – visit the site today and return here to share your ideas, feedback and questions!