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Organizational Systems and Structure

The World Health Organization defines social determinants of health as the conditions in which people are born, grow, live, work, and age. Social determinants of health influence the health of a community, and in turn they also influence what is needed from healthcare organizations.

Discuss how economic, environmental, social, and demographic factors contribute to the evolution of healthcare organizations located within communities that have vulnerable populations.
How are nurses and nurse leaders uniquely positioned to foster positive relationships between healthcare systems and local communities?
Consider a healthcare organization within which you currently work or have previously worked. Did that organization develop community partnerships that addressed the needs based on social determinants of health? If so, what were they? If not, what partnerships would you recommend?

Full Answer Section

- Unemployment/Underemployment: Lack of stable employment impacts health insurance coverage and disposable income for health-promoting behaviors. Healthcare organizations might need to partner with workforce development programs or provide job counseling services to address these upstream factors.
- Economic Revitalization: Conversely, an improving local economy might bring new residents, increase tax revenues, and allow for investment in better infrastructure, including healthcare facilities and services. Healthcare organizations might then focus on expanding specialized services or adopting new technologies.
- Evolution: Healthcare organizations in economically disadvantaged areas often shift from purely curative models to include community health worker programs, mobile clinics, and social service navigation to address immediate needs, and increasingly, engage in advocacy for policy changes that improve economic conditions.
Environmental Factors:
- Housing Quality: Substandard housing (e.g., lead paint, mold, overcrowding) contributes to respiratory illnesses, injuries, and mental health issues. Healthcare organizations might need to partner with housing authorities or provide education on healthy home environments.
- Access to Green Spaces/Safe Play Areas: Lack of safe outdoor spaces impacts physical activity levels and mental well-being. Organizations may support community initiatives to create parks or safe walking paths.
- Exposure to Pollution/Toxins: Proximity to industrial zones, contaminated water, or poor air quality leads to higher rates of chronic diseases. Healthcare organizations in such areas might need to specialize in respiratory care, cancer screenings, or environmental health education.
- Food Deserts: Limited access to affordable, nutritious food forces reliance on unhealthy options, contributing to chronic diseases. Healthcare providers might initiate or support community gardens, food banks, or healthy food access programs.

Sample Answer

Healthcare Evolution

The economic, environmental, social, and demographic factors within a community profoundly shape its health landscape and, consequently, drive the evolution of healthcare organizations located there, especially in areas with vulnerable populations. These factors highlight the need for healthcare to extend beyond clinical walls and address the root causes of poor health.

Economic Factors:
- Poverty and Income Inequality: High rates of poverty lead to limited access to nutritious food, safe housing, transportation to appointments, and health insurance. Healthcare organizations in these areas must evolve to offer sliding scale fees, financial counseling, and assistance programs. They may need to absorb more uncompensated care or seek grant funding.