The Role of the Social Determinants of Health in Rural Health Equity

Abstract

Background: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts.