NRS 428 Topic 2 DQ 1

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. 

Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question 


Social determinants of health are anything that affects an individual’s health that is not in his or her control, whether by economic standing, social and cultural exposure, or the environmental factors that impact health. Studies have shown that higher income, better social status, higher education, and more significant social support have better access to health care and have better health conditions (WHO, 2017). Poor sanitation or contaminated drinking sources alone exposes the community to illnesses and diseases (Grand Canyon University, 2018). This social determinant of health is also considered a reservoir in the chain of infection model wherein the disease-borne organisms are just waiting for a mode of transmission to enter a host or carrier of the disease (Grand Canyon University, 2018). A break in this chain will help prevent the spread of infectious diseases that may cause an outbreak in the community. Nurses are equipped with evidence-based tools and knowledge and can provide the necessary education to break this infection chain. Florence Nightingale was a revolutionary nurse who emphasized the importance of cleanliness during her time (Nightingale, Florence., 2018). Her ideologies on public service and the nurse’s role in promoting health are still influential today. Nurses can promote education on the importance of cleanliness to prevent the potential entry of the disease to the host. 



Grand Canyon University (Ed). (2018). Community & public health: The future of health care. Retrieved from 


Determinants of health. World Health Organization. (2017) Retrieved from: 


Nightingale, Florence. (2018). Funk & Wagnalls New World Encyclopedia, 1; 



As humans, we need to stay healthy and strong to be functional in life. But sometimes despite all the efforts we put in as individuals to stay healthy, we still face health challenges caused by some external factors that we cannot control. For example, when we eat the right food (healthy food), exercise/stay active, get our immunizations, and avoid smoking/drinking alcohol we can positively influence our health. However, the presence of some socioeconomic and environmental factors can positively/negatively influence our health and wellbeing These factors are usually natural or manmade factors that bring about health disparities/inequalities in our communities. They are known as the social determinants of health (SDOHs). 

According to the Centers for Disease Control and Prevention [CDC] (2021), SDOHs refer to the socioeconomic and environmental conditions in our places of work, play, worship, and our homes and schools, that affect our health and wellbeing. Healthy People 2030 outlines five key areas of SDOHs: Health and Health Care, Economic Stability, Education, Social and Community Context, and Neighborhood and Built Environment (CDC, 2021). 

As earlier mentioned, these factors contribute to health disparities, which explains why some Americans are healthier than others or why Americans more generally are not as healthy as they could (Office of Disease Prevention and Health Promotion, 2022). Also, when compared to other industrialized nations, it rather unfortunate that Americans pay much for health care but get poorer results, and certain communities in our country still experience the worse health outcomes than others even with the ongoing efforts to improve cost and quality of health care (FamilyUSA, 2019). This is because certain factors like poor health care access, inadequate health systems, social exclusion, insufficient and lack of knowledge about healthy food sources have been given little or no attention. 

According to Green (2018), living under conditions of poverty, poor-ventilated housing, poor sanitation, and contaminated water predisposes one to malnutrition, low immunity, and communicable diseases such as tuberculosis (tb). Green defined communicable diseases as diseases that can be transmitted through direct contact with an infected person (tb) or indirectly through a vector (Malaria from mosquito’s bite). He also described how the infectious disease chain can be used by health care professionals to prevent the spread of communicable diseases. 

The communicable disease chain model is used to explain how a disease can be transmitted from one person to another, and how a break caused by an action taken by a healthcare professional (e.g., handwashing) at any point in the chain can prevent the spread. This chain is made of the following six elements: infectious agent (must be present for disease to occur, e.g. bacteria/virus, etc.), a reservoir, port of exit from the reservoir, mode of transmission, port of entry into a susceptible host, and a susceptible host (rlewis:AWS, 2013). For example, in the spread of malaria, the parasite (infectious agent) that causes malaria lives in contaminated/dirty water/environment. These dirty areas(reservoir) are breeding grounds for mosquitoes which later come in touch with the malaria parasite. Mosquitoes are the vectors that transmit malaria parasite to human(host) through a bite (mode of entry). 

Healthy People 2020 highlights the importance of addressing the SDOHs to close the gap in health disparities among nations and communities. This involves creating social and physical environments that promote good health for all (ODPHP, 2022). Nurses and other healthcare professionals can also bridge this gap by promoting good hand hygiene and sanitation measures, education on healthy eating/exercise, immunization against disease, and encourage use of appropriate personal protective equipment (PPEs) (Green, 2018). Today, we have seen how measures like handwashing, use of mask and social distancing have been used to curb down the spread of Covid-19. 


Centers for Disease Control and Prevention. (2021a, March 10). About Social Determinants of 

Health (SDOH). Retrieved March 7, 2022, from 

Green, S. Z. (2018a). Epidemiology and Global Health. Community & Public Health: The Future 

of Health Care. Retrieved March 6, 2022, from 

Families USA. (2019, December 16). The Center on Health Equity Action for System 

Transformation. Retrieved March 6, 2022, from 

Office of Disease Prevention and Health Promotion (ODPHP). (2022, February 6). Social Determinants of Health – Healthy People 2030 | Retrieved March 7, 2022, from 

rlewis:AWS. (2013). CHAIN OF INFECTION. 2013 Grand Canyon University. Retrieved March 

6, 2022, from 



Social Determinants of health (SDOH) are conditions of living that stem from circumstances that they were born into. They include, housing, transportation, economic status, social environment, were we work, play, education, racial/ethnic and religious. These conditions set populations into groups which can be seen as an affect on our health (Falkner, 2018). 

Social Determinants of health (SDOH) contribute to disease because of limitations in health care and access to it. Unfair barriers to practice healthy behaviors (CDC, 2021). Human made surroundings contribute to the community as a whole and individual behaviors that determine health. Acceptance to education and being compliant understanding their actions will affect improved health. Cost for care and treatment, nutrition, and the ability to access quality and quantity of needed food to meet nutritional needs are all part of the fallout from SDOH. 

The chain of infection shows how the cycle continues; each part plays a major role in transmission. Within a community it can spread very quickly, and this community will suffer within the SDOH due to lack of healthcare accessibility. Nursing education on basic infection control practices in these communities can break the chain and decrease the number of those becoming ill. Handwashing is the most effective way to break the chain, covering a cough or sneeze, disposal of garbage and the use of disinfectants can be taught in schools (school nurse), community centers (nurse on site) and at all health care visits. Families can make this an activity that they can do together (CDC, 2022). 

Center for Disease Control CDC (2021, September 15th). Achieving Health Equity by Addressing the Social Determinants of Health. Social Determinants of Health. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). 


Center for Disease Control CDC (2022, February 23rd). Handwashing in Communities: Clean Hands Save Lives. 


Falkner, A. (2018). Health Promotion in Nursing Care. In Grand Canyon University (Eds.). Health & wellness across the continuum. 


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