Introduction

Health People 2030 (HP2030) define social determinants of health (SDOH) as conditions (nonmedical factors) within environments where people are born, reside, learn, work, play, worship, and grow old. These environments impact a wide range of health and quality of life outcomes and risks.¹ Some examples of SDOH include social and community support, neighborhood and built environment, education and access to quality education, health care access and quality, and overall economic stability.¹Additional examples of SDOH that may specifically impact wound healing include the following:

• Safe housing
• Transportation to and from appointments
• Clean/running water
• Income
• Access to nutritious foods and opportunities to be physically active
• Air and water quality
• Health literacy
• Presence or absence of a support system

Research has shown that social stressors impede wound healing, and the patient’s environment is responsible for up to a 50% variation in healing. This variation may be positive or negative, depending on the environment.² Furthermore, the Centers for Disease Control and Prevention (CDC) adopted a broader definition from the World Health Organization (WHO) to describe the wider set of forces and systems that shape the conditions of daily life. These forces and systems include economic policies, development agendas, social norms and policies, racism, climate change, and political systems.³ It is important to note that SDOH are one of the 3 priority areas for HP2030, along with health equity and health literacy. HP2030 outlines data-driven sets for national objectives in the 5 key areas discussed above: health care access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment.³

Public health actions certainly influence SDOH, and addressing differences in SDOH makes progress toward health equity or the state in which every person has the opportunity to attain their highest level of health. The CDC also explains that SDOH have been shown to have a more significant impact on health than either genetic factors or access to health care services, illustrating that inequities place people at a higher risk for poor health outcomes.³ The CDC has multiple resources for at-risk populations, including programs to reduce the rates of chronic diseases in higher risk populations since many chronic illnesses place people at a higher risk for chronic or non-healing wounds.

The Meaning Behind “Treating the Whole Patient, Not Just the Hole in the Patient”

After exploring the background of SDOH and its significance in wound management, the concept of treating the whole patient, and not just the hole in the patient, is crucial. In wound management, it is important to not only look at the wound and etiology but take into account the SDOH that may impact healing, specifically:

• Housing: Is there a consistent, safe, and reliable housing environment with clean air and water available to the patient?
• Ethnicity: Does race or ethnicity place someone at a higher risk for chronic or non-healing wounds in the presence of a chronic disease that may impact healing (diabetes, heart disease, etc)?
• Income: Are the medical treatments and products recommended/prescribed within the patient’s budget? For example, can the patient afford topical therapy? This detail is important as many wound care products can be costly, especially if not covered by insurance.
• Access to nutritious food: Does the patient have reliable transportation to the store? Can the patient afford nutritious foods? Are they able to independently prepare these foods, or do they have a support system in the home who can help?
• Language and health literacy: Does the patient or caregiver understand the health care team’s instructions? Are clinicians examining the patient and caregiver’s health literacy and understanding of the condition/wound prior to providing education? Understanding and adapting to learning styles and the patient’s health literacy level is a significant piece of the plan of care.

Conclusion

It is essential to note that SDOH affect nearly everyone in some way. When looking at wound management, including adherence to the plan of care, we should examine the SDOH and patient perception in addition to the clinical presentation of the wound. Wound care professionals should provide resources to patients who may be in need. HP2030 and the CDC clearly address SDOH as significant factors in overall health and have explained what is needed to progress toward health equity.

The CDC has been coordinating efforts to focus resources on areas where federal public health investments can accelerate progress and make the most difference.³ SDOH is a public health problem on many levels and presents opportunities for collaboration amongst many sectors, such as in education, health care, housing, transportation, public industry, private industry, and community-based organizations.³

It is critical to take a patient-centered approach to wound management and evaluate any SDOH that may influence the care plan and overall healing. Resources and support are available for patients. Knowledge sharing, collaboration, and public awareness are key concepts in assuring all patients receive the care they deserve.

References

1. Healthy People 2030. Social Determinants of Health. HHS. Accessed December 28, 2022. https://health.gov/healthypeople/priority-areas/social-determinants-hea….
2. Sen CK, Roy S. Sociogenomic Approach to Wound Care: A New Patient-Centered Paradigm. Adv Wound Care. 2019;8(11):523-526. doi:10.1089/wound.2019.1101
3. Social Determinants of Health at CDC. Centers for Disease Control and Prevention.. Updated December 8, 2022. Accessed December 28, 2022. https://www.cdc.gov/about/sdoh/index.html.

About the Author

Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse specialist at VA Northeast Ohio Healthcare System in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately ten years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.