Research Article| Volume 70, ISSUE 1, P10-27, January 2022

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Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing

Published:October 08, 2021DOI:


      • Representatives of five expert panels came together to establish conceptual clarity and consensus for what social determinants of health mean for nursing.
      • We define the social determinants of health as having six key dimensions: economic stability, education access and quality (including health literacy), health care access and quality, neighborhood and the built environment, social and community context, and planetary conditions.
      • We provide a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health.
      • We underscore the crucial need to eliminate systematic and structural racism if equity in planetary health-related quality of life is to be attained.
      • Our conceptual framework addresses the particular importance of nursing actions at the individual, family, and population levels to promote health policies that advance health equity, anti-racism, and planetary health-related quality of life.



      The 2019-2020 American Academy of Nursing (Academy, 2019) policy priorities document states that “they have a clear and distinct focus on social determinants of health and uses this lens to advance policies and solutions within each of the three overarching priorities”


      This consensus paper seeks to establish conceptual clarity and consensus for what social determinants of health mean for nursing, with emphasis on examples of health policies that advance planetary health equity and improve planetary health-related quality of life.


      Volunteers from five Expert Panels of the Academy met via videoconference to determine roles and refine the focus of the paper. After the initial discussion, the first draft of the conceptual framework was written by the first three authors of the paper and, after discussion via videoconference with all the co-authors, successive drafts were developed and circulated for feedback. Consensus was reached when all authors indicated acceptance of what became the final version of the conceptual framework.


      A conceptual framework was developed that describes how the social determinants of health can be addressed through nursing roles and actions at the individual, family, and population levels with a particular focus on the role of health policy. The paper provides a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health.


      Nursing actions can support timely health policy changes that focus on upstream factors in the six key areas of the social determinants of health and thus improve population health. The urgent need to eliminate systematic and structural racism must be central to such policy change if equity in planetary health-related quality of life is to be attained.


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