Defining the Social Determinants of Health as according to Healthy People 2030 are:
“…the conditions in the environment 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” (Social Determinants of Health – Healthy People 2030, n.d.)
The five domains are listed as economic stability, education access and quality, healthcare access and quality, neighborhood-built environment and social community context (Centers for Disease Control and Prevention [CDC], 2021). Adverse Childhood Experiences or ACE, according to the CDC is defined as “are potentially traumatic events that occur in childhood (0-17) (Centers for Disease Control and Prevention [CDC], 2022). These experiences can include violence, abuse neglect, substance abuse, mental health issues in the family, instability due to family separation, etc.
In application of these concepts to the region of central Appalachia, there are several items that stand out. First, the central Appalachian region is predisposed to have a higher population of unhealthy people based upon the poor indicators of the Social Determinants of Health. The “connections between history, the social determinants of health (e.g. poverty), and health inequities are conspicuous” (Health Disparities in Appalachia: Social Determinants, 2017). Research has noted that the central Appalachian region has a dramatic increase in midlife mortality rates owing to drug overdoses, suicides, alcoholic liver disease among others (Health Disparities in Appalachia: Social Determinants, 2017). Another study notes that “there are significant differences between Appalachian and non-Appalachian Ohio in terms of socioeconomic, health, and environmental indicators” (Morrone et al., 2014) Here are some facts:
The median household income in the Appalachian Region is 19 percent less than the national median
The Median household income in all five Appalachian sub regions is below the national figure. The median is especially low in Central Appalachia, where it is 38 percent less than the national median (Health Disparities in Appalachia: Social Determinants, 2017).
The implications of such figures have a direct correlation to health disparity. Higher income usually translates to better benefits, thus access to healthcare. Higher incomes are also “associated with lower incidence of disease and premature death (Health Disparities in Appalachia: Social Determinants, 2017).The implications also are clear in that in this culture of poverty and unhealthiness, ACE is likely to be high. There is a strong relationship between the Social Determinants of Health and ACE. As ACE follows the Social Determinants of Health trajectory.
What does this mean for the PMHNP? In short, extra work. There is a tremendous need arising out of the health impoverished Appalachian area for not only healthcare, but mental health care as well. The Appalachian area suicide rate is higher than that of the rest of the country. The American Psychiatric Association reports that outside of alcohol use, the Appalachian region has a disproportionately high mental health problems when compared to the rest of the nation (Mental-health-facts-for-appalachian-people, 2018). Being a PMHNP in this area is perhaps more important than in any other part of the nation so that much needed assistance can be provider to an underserved area.
Incorporating faith and hope through a sense of transcendent spirituality will be very important. I suspect that the current trend of poverty and health disparity will continue for some time. It is therefore important to instill a sense of hope in the future in spiritual terms.
Some prompting thoughts:
I observe in my local area a lack of access to healthcare. I just received a text this morning from a young lady needing to find behavioral health services. First, her insurance has changed, and the current provider does not accept her current insurance. Secondly, when she has contacted the limited number of behavioral health providers, none are accepting new patients.
The main components of trauma informed care. The Buffalo Center for Social Research outlines the components as safety, choice, collaboration, trustworthiness, and empowerment (What Is Trauma Informed Care?, n.d.). The ACE screening is valuable in all patients because as part of the assessment process needs can be identified that can facilitate the most needed services. The screening in children can identify problems area and provider the possibility for early interventions. Screening in all populations can be valuable for assessment, education and interventions.
References
Centers for Disease Control and Prevention. (2021, March 10). About social determinants of health (sdoh). https://www.cdc.gov/socialdeterminants/about.html
Centers for Disease Control and Prevention. (2022, August 18). Preventing adverse childhood experiences. https://www.cdc.gov
Health disparities in appalachia: Social determinants [PDF]. (2017). https://www.arc.gov/wp-content/uploads/2021/02/Health_Disparities_in_Appalachia_Social_Determinants_Domain.pdf
Mental-health-facts-for-appalachian-people [PDF]. (2018). https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Appalachian-People.pdf
Morrone, M., Kruse, N., & Chadwick, A. (2014). Environmental and health disparities in appalachian ohio: Perceptions and realities. Digital Scholarship@UNLV. Retrieved August 23, 2022, from https://digitalscholarship.unlv.edu/jhdrp/vol7/iss5/5
Social determinants of health – healthy people 2030. (n.d.). https://health.gov/healthypeople/priority-areas/social-determinants-health
What is trauma informed care? (n.d.). Buffalo center for social research. https://www.socialwork.buffalo.edu/
Sowers Pouch 