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Authors’ response to Dr. Padgett

      We welcome Dr. Padgett's engagement with our paper and his critique of the policy examples offered within it. We offer two points of clarification in response.
      First, as we detailed in our paper, social determinants of health “…encompass structural, system, and social components that cause inequities and are understood to be inclusive of the natural and built environments and incorporate planetary conditions such as extreme weather events and loss of biodiversity that affect human health.” (
      • Kuehnert P.
      • et al.
      Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing.
      , p.11) Due to the unique and central role that racism has, and continues, to play in all aspects of U.S. society, we argue that our understanding of social determinants of health must explicate both the systemic and structural aspects of racism as manifested in each of the six key dimensions of the social determinants—economic stability, educational access and quality, health care access and quality, neighborhood and the built environment, social and community conditions, and planetary conditions—if we are to effectively change these conditions for the better and provide fair and just opportunities for all community members to thrive.
      Secondly, in efforts to improve population health through policy changes, we agree with
      • Castrucci B.
      • Auerbach J.
      Meeting individual social needs falls short of addressing social determinants of health.
      that policy interventions are needed that have impact on both services and systems at the individual, family, community, and society-wide levels. Further, interventions that address upstream, midstream, and downstream causes and manifestations of inequities in all six key dimensions of the social determinants are needed to change social systems and structures. Our examples were chosen to illustrate a variety of both service and system policy interventions and are not exhaustive.
      Given the diversity of nursing specialties and practice settings, we believe that nursing can and should advocate for an array of specific, evidence-based, and evidence-building policies that aim to improve population health. We welcome the examples offered by Dr. Padgett in his letter and encourage others as well that will move our society toward the goal of eliminating racism as we strive toward a high level of planetary health.

      References

        • Castrucci B.
        • Auerbach J.
        Meeting individual social needs falls short of addressing social determinants of health.
        Health Affairs Blog. 2019;
        • Kuehnert P.
        • et al.
        Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing.
        Nursing Outlook. 2022; 70: 10-27