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Chapter 7 ■ Health Disparities and the Social Determinants of Health
through these relationships.” 41 Social capital further de- scribes “trust in individuals and organizations within the community, number and strength of ties to the neighborhood and community organizations, extent of civic engagement, voting patterns, trust in healthcare providers, etc.” 41 Essentially, as people or groups in- crease the number of trusted relationships within their community, their social capital, and ultimately their health, increases. 42 This improvement in health can re- sult from gaining access to higher education and finding higher-income employment, both of which are SDOH. The Safe Aging Coalition is an example of how a group addressed elder abuse. Community members, including social workers, a bank manager, a county sheriff, an ED nurse manager, a county assistant prose- cutor, and several older adults, convened monthly over the course of a year. During those monthly meetings, the coalition members developed trusting relationships with one another. They accomplished this through sto- rytelling about their experiences witnessing elder abuse and wanting to be proactive in its prevention and mit- igation. Each coalition member agreed to bring three additional persons to attend a regional symposium on elder abuse prevention. Symposium topics included fi- nancial, emotional, and physical abuse of older adults. The coalition officially became a 501(c)(3) not-for-profit organization and established formal partnerships with the Council on Aging, regional bank, sheriff’s depart- ment, prosecutor’s office, and regional health system. Over time, the coalition was able to develop program- ming, which was regularly attended by older adults and their family members, and implement an intervention to provide emergency sheltering for older adults identified by police officers, social workers, or emergency nurses as victims of physical abuse. The coalition was effective based on the social capital developed among the coali- tion members and their leveraging of their relationships with other agencies. Social Justice Addressing health disparities comes under the umbrella of social justice , defined by the Merriam-Webster dic- tionary as “a state or doctrine of egalitarianism.” 43 In other words, because health disparities represent a lack of equality in health outcomes among groups, it is im- portant to adopt a doctrine of social justice related to health and to strive to promote equitable opportunities to maximize the health of individuals and communities. The Commission on the Social Determinants of Health convened by the WHO in 2005 concluded that “social
fact quickly adopting the use of smartphones and tab- lets to access health information via the Internet. 39 This access to e-health information allows older adults to ob- tain information on disease symptoms, trajectories, and treatments. Thus, older adults as well as younger persons can increase their access to health care through the use of telehealth services, particularly if they live in remote areas with few to no primary care providers. Although the adoption of technology through apps, smartphones, and tablets has increased, some groups still experience a “digital divide.” 40 Unfortunately, there are still com- munities, particularly in rural areas, where the access to Wi-Fi is limited. This prevents people in those commu- nities from obtaining information only available online. Another concern is that persons with limited English literacy may experience a greater challenge following directions when attempting to access telehealth ser- vices. Public health nurses can help promote access to telehealth by providing telehealth directions in multiple languages, fundraising to obtain free telehealth devices to be used by low-income persons, and ensuring that other barriers to the use of telehealth are mitigated. 40 ◆ HEALTHY PEOPLE 2030 Category: Social Determinants of Health Area: Health-Care Access and Quality Goal: Increase access to comprehensive, high-quality health-care services. Objective: Decrease the proportion of adults who report poor communication with their health-care provider. Level, Baseline. HC/HIT-02 Topics Covered: Interpersonal Communications, Health Information Technology, Social Marketing, Informed Decision Making. Using Healthy People 2030 in Your Work: Identify needs and priority populations. 1. What communication methods are used routinely? 2. Are electronic health systems available for commu- nication with health-care providers? 3. Is health-care providers’ use of communication methods adjusted to the needs of patients? 4. Are communication methods age and culturally appropriate? Social Capital Social capital , defined by Puro and Kelly, is “the pres- ence and strength of social networks and relationships between people or groups, and the resources obtained
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