Health. The World Health Organization's constitution (adopted 1946, in force 1948) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The definition is valued for its holistic view and criticized as an ideal few people ever reach.

Social determinants of health (SDOH). Healthy People 2030 defines SDOH as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Healthy People 2030 groups them in five domains:

Medical care alone accounts for only a modest share of population health; behavior, social and economic factors, and the physical environment together have a larger effect. Upstream interventions (policy, income, housing, education) address root causes; downstream interventions treat disease after it appears.

Key equity terms

Healthy People 2030 is the US national framework of 10-year health objectives. Its overarching goals include attaining healthy, thriving lives free of preventable disease, disability, injury, and premature death; eliminating health disparities, achieving health equity, and attaining health literacy; creating social, physical, and economic environments that promote health for all; promoting healthy development and behaviors across all life stages; and engaging leadership and the public across sectors. Selected objectives are designated Leading Health Indicators to track progress.

Frameworks for SDOH and equity

• WHO Commission on Social Determinants of Health (2008) — "closing the gap in a generation": improve daily living conditions; tackle the unequal distribution of power, money, and resources; measure the problem and evaluate action
• Social-ecological model — individual, interpersonal, organizational, community, and policy levels (Topic 2)
• Health in All Policies — health considerations built into decisions in transportation, housing, education, agriculture, and other sectors
• Cultural competence and cultural humility — competence is the knowledge and skills to care across cultures; humility is lifelong self-reflection, recognizing power imbalances and learning from each client as the expert on their own life

Global health focuses on health issues that cross national boundaries, emphasizes equity among all people worldwide, and uses cooperation across disciplines and countries.

Leading causes of child death worldwide remain largely preventable: preterm birth complications, pneumonia, diarrhea, birth asphyxia, and malaria, with malnutrition as an underlying factor. Low-cost, high-impact interventions include immunization, exclusive breastfeeding, oral rehydration solution with zinc, safe water and sanitation, insecticide-treated bed nets, and skilled birth attendance.

Screening and addressing SDOH in care

1. Screen routinely and respectfully using a validated tool (e.g., the CMS Accountable Health Communities health-related social needs screening tool or PRAPARE) covering food, housing, transportation, utilities, and interpersonal safety
2. Document needs in the record; ICD-10-CM Z codes (Z55–Z65) capture social needs such as housing instability or food insecurity, making them visible for planning
3. Refer and link — SNAP and WIC, housing assistance, community health workers, legal aid, transportation benefits; use closed-loop referral to confirm the need was met
4. Adapt care — lower-cost medications, flexible appointment times, telehealth, medication plans that do not require refrigeration for a client without stable housing
5. Advocate upstream — support policies on affordable housing, paid sick leave, food access, and safe neighborhoods

Health literacy practices (universal precautions) — assume every client may have difficulty understanding: use plain language, limit to a few key points, use pictures and demonstration, and confirm understanding with teach-back. Use a qualified medical interpreter for clients with limited English proficiency, not family members or children.

Nursing in global health includes disaster and humanitarian response, capacity building with local health workers, research, and policy work. Effective programs are culturally appropriate, led or co-designed by local partners, and sustainable after outside support ends.

• Assess SDOH at individual, family, and community levels
• Provide culturally humble, linguistically appropriate care
• Connect clients to resources and follow up on referrals
• Collect and use disaggregated data (by race, ethnicity, language, income, disability, geography) to identify disparities
• Advocate for equitable policies and for fair distribution of resources
• Participate in coalitions and community partnerships
• Examine one's own biases and support organizational equity efforts

• Title VI of the Civil Rights Act (1964) prohibits discrimination based on race, color, and national origin in federally funded programs; Section 1557 of the ACA extends protection to sex, age, and disability in federally funded health programs. National-origin protection is the basis for providing language assistance to people with limited English proficiency
• Americans with Disabilities Act — reasonable accommodation and effective communication (e.g., sign language interpreters)
• Confidentiality — social needs data (immigration concerns, intimate partner violence, substance use) are sensitive; share only as needed with consent
• Ethics — the ANA Code of Ethics calls nurses to integrate social justice into policy and to address social determinants; principles of justice and beneficence apply at the population level
• Global work — respect host-country laws, licensure rules, and local leadership; avoid short-term projects that do harm or create dependency

Case 1 — Downstream vs. upstream. A clinic sees repeated asthma visits from children in one apartment complex with mold and pests. The nurse treats the children, teaches inhaler use, and also works with a legal aid partner and the housing authority on remediation. Why: medical care alone will not solve a housing-related cause.

Case 2 — Equity vs. equality. A health department sends the same flyer to every neighborhood, but vaccination rates stay low in one area without a pharmacy or bus line. The PHN proposes a mobile clinic there. Why: equity allocates resources according to need.

Case 3 — Interpreter. A Spanish-speaking mother brings her 10-year-old to translate discharge instructions. The nurse calls a qualified medical interpreter and uses teach-back. Why: children and untrained family members are not appropriate interpreters, and language assistance is a legal requirement in federally funded programs.

Case 4 — Global health measure. A student asks which measure combines premature death and disability. The answer is the DALY. Why: it sums years of life lost and years lived with disability.

• Using "disparity" and "inequity" as if identical — inequity implies avoidable and unjust
• Treating equity as equal distribution
• Believing UHC means all care is free — it means access without financial hardship
• Assuming a vertical program strengthens the whole health system
• Confusing SDG 3 (health and well-being) with other goals
• Assuming a client understands because they nod or say "yes" — use teach-back
• Relying on family members, especially children, as interpreters

• WHO health definition (constitution in force 1948): complete physical, mental, and social well-being, not merely absence of disease
• Healthy People 2030 SDOH domains: economic stability; education access and quality; health care access and quality; neighborhood and built environment; social and community context
• Disparity = measurable difference; inequity = avoidable and unjust; equity = fair opportunity for all
• Upstream (policy, housing, income) interventions address root causes
• Screen for social needs, document with Z codes, refer, and follow up
• Health literacy: plain language, teach-back, qualified interpreters
• DALY = YLL + YLD; UHC = needed care without financial hardship
• IHR (2005) is the legal basis for a PHEIC; SDG 3 = health and well-being
• The US withdrawal from WHO took effect January 22, 2026
• Vertical = disease-specific programs; horizontal = health system strengthening