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NRS 428 Topic 2 DQ 1

DQ 1 What are social determinants of health

What are social determinants of health? Explain how social determinants of health contribute to the development of
disease. Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an
example of the steps a nurse can take to break the link within the communicable disease chain.

The social determinants of health are the conditions of birth, development, employment, living, and aging. They include income, education, housing, and work (Social Determinants of Health, 2018). The social determinants of health are linked to health outcomes and health disparities. A growing body of research has shown that addressing the social determinants of health can improve health outcomes and reduce health disparities. There are many ways to address the social determinants of health. Some approaches include policy changes, community-based initiatives, and individual-level interventions. It is important to note that no one method is suitable for everyone and that different approaches may work better in various settings.

There is growing evidence that social determinants of health play a significant role in disease development. For example, studies have shown that factors such as poverty, poor housing, and lack of access to healthcare can lead to a higher incidence of disease (World Health Organization, n.d). In addition, social determinants of health can also affect the course of an illness and make it more challenging to manage. Therefore, it is a crucial issue to consider, as social determinants of health can significantly impact human health and well-being. Thus, ensuring everyone has access to the resources they need to maintain a healthy lifestyle is vital.

The communicable disease chain model illustrates the transmission and control of infectious diseases. The pathogen, reservoir, portal

DQ 1 What are social determinants of health

DQ 1 What are social determinants of health

of exit, method of transmission, the portal of entry, and new host are the six different linkages that make up the model. According to Study.com (2019), each link in the chain plays a specific role, and each one can be broken or interrupted in various ways. For example, a nurse might perform multiple actions to break the chain of infectious diseases. Some of the most popular steps a nurse may use include, but are not limited to, adequate hand washing, wearing PPEs, using all necessary safety precautions, and using the proper sterilization and cleaning methods.

In conclusion, social determinants of health significantly impact individuals’ well-being. Therefore, nurses should understand them and incorporate better practices to prevent the spread of diseases.


Social Determinants of Health. (November 30, 2018). Social Determinants of Health. Healthy People. Retrieved from https://www.healthypeople.gov/2020/topicsobjectives/topic/social-determinants-of-health

Study.com. (2019). Chain of Infection: Definition & Example. Retrieved from https://study.com/academy/lesson/chain-of-infection-definition-example.html

World Health Organization (n.d). Social determinants of health. Retrieved from https://www.who.int/social_determinants/sdh_definition/en/

Social Determinants of health can be political. Our political temperament and governmental structure play heavily into the healthcare resources that are available to the citizen. It was interesting to learn that healthcare for all, in the United States, was proposed as early as 1904, and was for a time pursued by Franklin D. Roosevelt’s administration. When the doctor’s association of the time protested he pulled back to pursue the Social Security Act. Post-WWII Europe embraced healthcare for all as a deterrent to communism, while the United States felt that “socialized” medicine promoted communism. The American Medical Association, comprised of MDs, has continued to lobby and exert political power against healthcare reform, including the ACA. For years it was the pressure that they exerted on Medicare that prevented those in rural communities from being able to seek care from advanced practice nurses and NPs. While at the same time not being able to attract MDs to their rural communities to serve their people. To be more precise Advanced Practice RNs and NPs could provide care Medicare would just not pay them for it. The AMA’s pressure was to protect power and revenue for their constituency, disappointing. In most areas of inequity if you follow the money or the power the true nature of things will be revealed. Thankfully the Affordable Care Act addresses some of these past hurdles.


Gilligan, H. (2018, May 23). Socialized medicine was coined in the US, not Europe. Timeline. Retrieved September 10, 2022, from https://timeline.com/socialized-medicine-was-coined-in-the-us-not-europe-30438fad9d69


Rangel, C. (2010, March 23). H.R.3590 – 111th Congress (2009–2010): Patient Protection and Affordable Care Act. Congress.Gov | Library of Congress. Retrieved May 26, 2022, from https://www.congress.gov/bill/111th-congress/house-bill/3590

Read Also: DQ 2: Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes.

The chain of infection for influenza begins with influenza or Orthomyxoviridae genus Alpha influenza virus, species Influenza A. There are A_D strains. It is a viral infection of the upper respiratory system which can become deadly with secondary complications of pneumonia. In the US the flu is seasonal peaking in December thru February. The CDC provides updated vaccine formulations based on their surveillance starting in September. In more temperate climates there is no seasonality to the infection cycles. Our seasonality may be related to the chain of infection. Exit portals are coughing and sneezing. Modes of transmission are droplets and contact with surfaces harboring droplets. The flu is typically spread through coughing, talking, breathing, or contact with items like phones, doorknobs, soiled tissues, and linens. Portals of entry are the eyes, nose, and mouth. In colder months people spend more time indoors in close contact with portals of exit, entry, and modes of transmission. The receiving host must be susceptible to the pathogen. Individuals who are at increased risk are the very young, under 5, the very old, over 65, especially the 75 yrs+, women who are pregnant, and people with chronic conditions.

The significance of understanding the chain of infections is that it allows for the chain to be disrupted and avert

infection or diminish its effects. The best defense is the annual flu shot available starting in September.  If exposure has occurred antivirals can be initiated within the first 48 hours of exposure and effectively disrupt the chain at the prodromal stage.  Effective antivirals include Oseltamivir, Zanamivir, Peramivir, and Baloxavir.  Portal of exit can be impeded with frequent hand washing, good respiratory hygiene of coughing into an elbow/tissue, wearing of a mask,  properly disposing of contaminated objects (tissues), sanitizing high contact objects like door handles/phones, proper social distancing, and frequent washing of clothing.  High-risk individuals should get vaccinated, avoid large crowds, and boost their immune system with vitamins, good hydrations, and good sleep patterns.  It should go without saying but also avoid sick individuals.




People at High Risk of Flu. (2022, August 25). Centers for Disease Control and Prevention. Retrieved September 2, 2022, from https://www.cdc.gov/flu/highrisk/index.htm


Influenza (Seasonal). (2018, November 6). The WHO Health Topics Influenza. https://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)

  • Jackeline Leon Castillo

replied toDian Bowes

Sep 8, 2022, 10:24 PM

Hello Dian,

Great points regarding patient teaching. I feel it is sometimes easy to forget our patients are not clinical experts and our version of common knowledge is not the same as theirs. Reinforcing teaching on proper hygiene techniques can also reinforce a sense of confidence and independence in their role regarding their own health care. With respect to the poverty rates in the US, I would challenge nurses to look beyond the determinants and help patients to find solutions to social determinants that may be harming their health. With cardiac related deaths being the number one cause of death in the US, we may look at the patient’s dietary practices, like you mentioned. Of course we can say all day long that the patient should eat a more balanced diet, but if the patient has cost or accessibility issues, they will not be able to make the changes necessary.


Green, S. (2018). Community and Public Health: The Future of Health Care. Community & Public Health: The Future of Health Care (gcumedia.com)

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