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Social Determinants of Health

Manon Dodson

Bon Secours Memorial College of Nursing

3316- Population Global Health

Dr. Angel Daniels

October 17, 2020

I pledge
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Introduction

The Fawcett model is an influential model developed by Jacqueline Fawcett and Carol

Hall Ellenbecker (Fawcett & Ellenbecker, 2015). It is a huge hallmark in reform of the health

system. This model is intended to bring together nursing and population health. It shifts the view

of health of an individual patient to that of the population of the patient (Fawcett & Ellenbecker,

2015). The purpose of this paper is to blend ideals taken from the Fawcett model and develop a

deeper understanding of the health of specific population. This done through a self-conducted

interview. I contacted my friend Rachel for the interview. Rachel personally identifies as a

“questioning non-binary lesbian”. She thought this was important for me to include in this essay,

as this is how many of her opinions have been formed. Having an undergraduate degree in

psychology and sociology, and currently studying for her master’s in counseling, I thought that

Rachel would be a very interesting person to speak to on this topic. She preferred to not use her

real name, which why I will be referring to her as “Rachel” through out this essay.

Upstream Factors

Socioeconomic environment

When I asked Rachel about her socioeconomic factors growing up, she stated that her

family financial status was “complex” (R.Chantree, personal communication, October 14, 2020).

After her parents’ divorce, she was raised by her single mother for a good portion of her life. She

said, “we had issues with health insurance and other benefits because my mother couldn’t always

keep up with the payments” (R. Chantree, personal communication, October 14, 2020). This

made it much harder for Rachel to receive her medications for her asthma. At this point in life,

her family’s status was in the lower middle class. There were many financial struggles,
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especially since her father didn’t pay child support for her and her sibling (R. Chantree, personal

communication, October 14, 2020). However, once her mother remarried, they were once again

the “upper-middle class”. Her stepfather put her family under his insurance, and they moved to a

“classy upper-middle class suburbia,” (R. Chantree, personal communication, October 14, 2020).

Currently, living independently, Rachel said she struggles once again financially. She must work

4-5 days a week to keep up with higher education and bill payments. She said her current degree

“doesn’t make much difference in hourly pay”, so she relies on financial aide to help support her

living (R. Chantree, personal communication, October 14, 2020).

Physical environment

Rachel stated that she moved from Washington state to Virginia when she was very

young. Once in Virginia, she grew up in the southern half of Chesterfield county (R.Chantree,

personal communication, October 14, 2020). She said there was a surprising amount of economic

inequality between north and south Chesterfield. Having had all her schools fall into the southern

district, she stated “there was a lack of resources” for her schools (R.Chantree, personal

communication, October 24, 2020). There was less opportunities and less funding for education.

Having grown up in a lower socioeconomic/ physical environment, Rachel got involved in the

use and distribution of drugs, and unfortunately, was involved in instances of abuse from former

boyfriends. She said “I got involved with the wrong crowd, but now I’m doing much better”

(R.Chantree, personal communication, October 24, 2020). Now in grad school at Virginia

Commonwealth University (VCU), she realizes her classmates have knowledge of things she

never learned. For example, she stated her grammar and understanding of comprehension and

writing is less than of her peers (R.Chantree, personal communication, October 14, 2020).

Despite the hard times growing up, Rachel enjoys her current job as a hospital technician and
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lives in a “nice” apartment in Richmond city (R.Chantree, personal communication, October 24,

2020).

Population Factors

Genetic factors

Despite being overall in good health, Rachel suffers from several diseases that have run

in her family. Mental illness is one of the biggest genetic factors in Rachels family (on her

father’s side). Bipolar disorder, Obsessive compulsive disorder (OCD), anxiety, and depression

have been passed down to her (R.Chantree, personal communication, October 24, 2020). Her

anxiety and OCD make her do things like knocking on wood three times every time she says

something that holds superstition. To most people this might seem like the typical joke of

knocking on wood, however for Rachel, she MUST do this to cope (R.Chantree, personal

communication, October 24, 2020). She also suffers from other genetic factors like scoliosis,

asthma, and PCOS (from her mother’s side).

Behavioral factors

When I asked Rachel about her behavioral factors, she jokingly retorted with “Well…

I’m mentally ill,” (R.Chantree, personal communication, October 24, 2020). Then she went on to

say “all jokes aside” she does have certain behaviors that can be associated with some of her

mental illness. As previously stated, she compulsively knocks on wood. She also compulsively

scratches her scalp and pulls hair out due to her anxiety (R.Chantree, personal communication,

October 24, 2020). Despite this, she does have many healthy stress relievers. She exercises, loves

knitting, making candles, being social with friends and family, and playing with her cat

(R.Chantree, personal communication, October 24, 2020).

Physiological factors
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Rachel is a physically strong and healthy individual. She is a healthy weight and

regularly partakes in strenuous activities to keep her muscle tone. The only thing that can be

physically debilitating is her “horrible periods” due to her PCOS (R.Chantree, personal

communication, October 24, 2020).

Health factors

Overall, Rachel describes herself as a “thriving” individual (R.Chantree, personal

communication, October 24, 2020). Sometimes she has problems sleeping, but then she simply

utilizes white noise machines and melatonin. She has many healthy coping techniques for her

anxiety and other mental illnesses. She is usually able to complete her daily living activities with

little disturbance.

Health Care System Factors

Providers

Rachel had a lot to say about health providers. She said, “As someone who is in graduate

school for counseling, I prioritize social factors and the wellness model over pathologizing

people,” (R.Chantree, personal communication, October 24, 2020). She thinks that the medical

field often takes things from a purely biological standpoint and doesn’t often include social and

environmental factors; this was interesting because her views lined up with the Fawcett model

(R.Chantree, personal communication, October 24, 2020). In her opinion, every medical

provider should take sociology classes to become more culturally aware. She believes that the

medical field reinforces racist, binary, sexist, and homophobic systems (R.Chantree, personal

communication, October 24, 2020). She also doesn’t think that physicians should take mental

health from a purely medical standpoint, and that they can cause a lot of damage through over

prescription of psychotropic drugs. In her studies, she has also found a lot of medical research
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done by providers to be very biased. She states, “medical professionals need to be more aware of

social problems and peoples intersectional identities,” (R.Chantree, personal communication,

October 24, 2020).

Organizations and institutions

Rachel is a self -identified “communist” and hates capitalism (R.Chantree, personal

communication, October 24, 2020). She believes that within capitalism there will always be

inequality because there is such an emphasis on competition for resources, and the primary focus

is on having more money than everyone else. She thinks this affects hospital institutions and all

other institutions because it has led these people to focus on money over quality care and

wellness (R.Chantree, personal communication, October 24, 2020). She also thinks that this

outlook affects employees’ viewpoints as well. However, she does appreciate community health

centers like planned parenthood. She states, “it is good to have health centers where people can

get free education and health services,” (R.Chantree, personal communication, October 24,

2020).

Policies

A lot of Rachel’s opinions on policies aligned with what she had stated earlier about the

medical field. She believes there needs to be more polices that are created to make medical help

more accessible and also to diminish/ stop biases in the medical field (R.Chantree, personal

communication, October 24, 2020). She stated, “for example, a lot of medical professionals still

hold a lot of binary, homophobic, and racists ideals…medical professionals have led to the

deaths of these patients,” (R.Chantree, personal communication, October 24, 2020). One event

she brought up in relation to this was when UVA students believed that black women had a

higher pain tolerance. They thought that black women had a biological predisposition to having a
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higher pain tolerance, this is in fact no true. (R.Chantree, personal communication, October 24,

2020). Rachel also stated that there is a lot of transphobia against people who do not conform to

the societal binary. She said, “I have seen this discrimination in my place of work. A lot of the

time, in the medical field hospital will ignore the persons gender identity and will try to diminish

it to a purely biological standpoint,” (R.Chantree, personal communication, October 24, 2020).

In the end, she believes a lot of reform and education had to be done.

Payers

When I asked Rachel about payers, insurance immediately came to her mind. She thinks

that insurance companies are just concerned with money and not actually helping people. She

believes that restrictions on individuals with preexisting conditions is outrageous. She stated that

it is inhumane to put restrictions on people with those conditions, and everyone should have

access to health insurance regardless of their life status (R.Chantree, personal communication,

October 24, 2020). She stated that insurance can also being very confusing and unclear, which

makes it easy to take advantage of people. She believes that insurance education should be

provide in a way that everyone can have a well-grounded understanding of it. Also, she stated

that the separation of vision and dental insurance from general health insurance is just for the

gain of money.

Conclusion

Prior to our interview, Rachel had a basic understanding of the Fawcett model. She had

learned about in her previous education. Through our interview, I gained a much deeper insight

of the health care field through the eyes of an individual outside of the system. It was very

interesting to hear her opinions and thoughts. It seems that the current system is much more
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focused on money and the health of the individual, rather than the population. Having grown up

struggling with her own identity and varying illnesses, Rachel believes there needs to be much

reform. After reexplaining the Fawcett model to Rachel, she seemed much more supportive of it.

She loved the idea of focusing health on the population. I also believe that the implementation of

the Fawcett model into modern health would be incredibly beneficial. The health of the

population is important, and more focus on population health will surely increase the health of

the individual as well.

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Reference

Fawcett, J., & Ellenbecker, C. H. (2015). A proposed conceptual model of nursing and

population health. Nursing Outlook, 63(3), 288-298. doi:

https://doi.org/10.1016/j.outlook.2015.01.009