Examining Social Determinants of Health: A Student Project

by Colette Allen, SON student, published in “Insight Out” http://bios.unc.edu/~ebutter/IOspring10.pdf

“If all of us are going to be healthy, everyone has to have a chance to be healthy…”

These were the simple but wise words of one resident interviewed as part of the 2009 North Carolina Community Health Survey (CHS). Students and faculty from the University of North Carolina at Chapel Hill’s Schools of Nursing, Public Health, Social Work and the Division of Physical Therapy led the CHS alongside staff from the Guilford County Department of Public Health (GCDPH). We spent the first three days of our trip in Guilford County working closely with the GCDPH conducting face-to-face, door-to-door health needs surveys as part of the Guilford County Healthy Carolinians 2009 community health assessment process. Dressed in vests of blue and gold, we traversed the streets of Greensboro and High Point in groups of three to interview local residents. The survey consisted of 49 questions that provided a snapshot of the health status, access to healthcare, social support and need for services in households located within the highest poverty areas of Guilford County.

In the end, we completed 210 household surveys. I was humbled by the openness of the residents, who voiced anger over crimes and drugs in their communities and frustration over the limited access to quality health care, the lack of affordable fresh produce, and the need for more safe parks. Guilford County will use this information to identify community health priorities and plan health promotion activities. On the third day of our trip, we said “goodbye” to Guilford County and headed to the coastal community of Alligator, a small, primarily African-American town located in Tyrell County. Here we partnered with the Conservation Fund of North Carolina on a pair of environmental conservation projects.

The Palmetto-Peartree Preserve is being developed into a public park and the surrounding waters into part of a paddle way. We embarked on a coastal cleanup of trash and crabbing pots that were blown ashore from the Albemarle Sound. In a single day, we loaded two huge dump trucks with trash. For our second project, we helped with the restoration of a Rosenwald School. Philanthropist Julius Rosenwald financed some 5,000 Rosenwald schools in the south to improve the education of African Americans during the early twentieth century. This particular school in the Alligator community was chosen by the Conservation Fund to be restored as an environmental center for park visitors and a community center for local residents. Within a few hours, we cleaned up the small one-room schoolhouse. Complete with a large blackboard spanning the length of one of the walls, the scene was reminiscent of Laura Ingalls Wilder’s school in Little House on the Prairie. After some hard work and a great history lesson, we gathered in the schoolhouse with residents of Alligator community for a feast of hamburgers and hotdogs. The atmosphere was lively, and the residents shared their experiences of rural living. In turn, our group asked about their health concerns and suggestions for future service projects. We hope to return to Alligator next spring break and partner with residents on a community-led health project.

Looking back on this experience, the words echo over and over in my head: “… the chance to be healthy…” As a future family nurse practitioner, what this means is that I must consider all the factors that are influencing my patient’s health. This phrase also means I must self-reflect: What social determinants am I competing against and what role is it playing in my patient’s health? Factors like access to healthcare, the availability of fresh produce, safety and environment all impact health.

This spring break, for the residents of Guilford and Tyrell County, I feel that we took a step in the right direction. I feel that we took a step toward giving them “the chance to be healthy.”

Colette Allen is a 2010 graduate of the UNC School of Nursing. She is now a full-time family nurse practitioner. She may be contacted at allencs@email.unc.edu.