Many factors combine to affect the health and well-being of individuals and communities. It has long been recognized that whether people are healthy or not, the outcome is entirely dependent on their circumstances and environment. The social determinants of health represent the conditions in which people live, learn, play, and work which affect their health outcomes (Islam, 2019). These determinants include factors like where people are born, what they eat, how well they are educated, and the resources available among many others. Overall, social determinants of health (SDOH) are linked to poor health outcomes and investment in interventions to address them can yield positive outcomes.
Social determinants of health is a topic that has received considerable attention as a foundational concept for the health of children, adolescents, and adults. These determinants are often categorized into five groups including economic stability, level of education, neighborhood and built environment, social and community context, and healthcare access. Evidence gathered over the past years suggests that most factors that affect population health outcomes are not linked to medical care delivery (Daniel et al., 2018). In fact, social determinants of health are rooted in the allocation of resources at the local, national, and global levels. Factors like low education levels, social segregation, poverty, and income inequality are the leading cause of poor health outcomes globally (Daniel et al., 2018). Addressing the social, economic, and environmental factors can help to improve the health of individuals and communities.
Determinants of Health in a Setting
To reduce the negative effects associated with SDOH, it is important to understand the settings in which these factors interact. The living environment is a great influencer of population health outcomes because it represents social, economic, and political challenges faced by people. In the United States, most attention has focused on the social environment and its influence on the lives of adults. However, research demonstrates that most SDOH often takes root in early childhood making the shift of focus to children and adolescents equally important (Lowry et al., 2022). Unlike adults whose determinants are spread across a range of contexts, the lives of children are dominated by the home and school environments. The school environment is the most vital setting for children because it represents where they play, eat, learn, and exercise. For this reason, modifying the school environment can achieve more positive health outcomes compared to family approaches.
Children spend a considerable amount of time in school and this setting influences the children’s intellectual, spiritual, cultural, and moral development. The increasing population growth in the country means that most people pass through the school environment and their health can be shaped right from childhood. The school setting is observed to affect the health of children in a myriad of ways. For instance, the quality of the school children enroll shapes how they perceive their health and the support available to promote positive health outcomes. Children who enroll in poor-quality schools will certainly face issues like fewer resources, more violence, and a distressed environment that eventually worsens their health outcomes (Huang et al., 2013). Racial and minority groups are the most affected by this challenge making the interventions population-focused rather than an individual.
A healthy school environment is characterized by the physical, biological, and socio-cultural well-being of students. These factors reflect a consciously organized, planned, and executed effort to ensure children stay in a safe environment with healthy living conditions. The World Health Organization estimates indicate that about 25% of the global disease burden is a result of environmental risk factors (Lowry et al., 2022). Consequently, about 40% of the disease burden affects children meaning that their home and school environments contribute greatly to the observed problem. Increased cases of diarrhea, respiratory infections, mental health issues, and other illnesses all trace back to unhealthy school environments (Jamal et al., 2013). In other instances, lack of safety measures in schools and poor education increases the risk of injuries and violence which affect the health of children. Tailoring simple interventions like hand washing, close supervision, and the involvement of parents can help to address some of these issues.
Schools have a significant effect on children’s spiritual, intellectual, moral, and cultural development. Investigations about the school predictors of the child’s health have yielded various determinants that must be addressed to improve individual and population health outcomes. The first group of health determinants in the school setting involves the physical and structural environment (Huang et al., 2013). This group encompasses things like the amount of space for playing, air quality, physical safety, and the presence of other health hazards. For example, a school with little space increases the transmission of respiratory infections and can limit play time for students. The second group deals with health policies which include institutional, local, and federal policies. For example, institutional policies can affect the safety of children by influencing the role of caretakers, transport to and from school, and intruders at school.
The quality of health programs available in schools can affect the health outcomes of students. These programs include those directed toward nutrition, physical education, and preventive and promotive health service initiatives. Research has linked the health outcomes of children, especially physical activity and substance abuse to the quality of programs available at school. For example, it is established that differences in the school climate and policies account for up to 40% of variances in physical activity and substance abuse among children (Lowry et al., 2022). Another crucial group involves the availability of health resources in schools. Institutions that lack adequate nurses, mental health professionals, and specialists see their students suffer from various health challenges. Other factors include things like the school climate which influences behaviors like bullying, moral values, and relations with people.
Childhood and adolescence are critical stages in life that can be tailored to improve population-level health and reduce health inequalities. One of the emerging health issues among children that can be shaped by focusing on the school setting is obesity. Childhood obesity is a grave issue that needs to be addressed to reduce the future burden of chronic diseases and psychosocial issues in children. Recent studies show that childhood obesity is reaching epidemic proportions and it has resulted in an increase in conditions like type 2 diabetes that was almost unheard of among children (Yuksel et al., 2020). Reports from international organizations like the WHO indicate that approximately 17% of children and adolescents aged 2 to 19 years are obese (Yuksel et al., 2020). These individuals spend most of their time in school making this setting the most appropriate to improve upon the issue of obesity.
Modifying the school health environment is a process that requires specific interventions for particular groups of health problems. To solve the challenge of obesity, the first part involves understanding the determinants of health that influence the development of this condition. For most children, weight gain is just an imbalance between energy intake and energy output. Although the pathogenesis of the disease portrays an interplay of genetic and environmental factors, lifestyle choices account for the majority of the cases. To begin with, a child’s diet influences how much weight they gain. The presence of high-fat content foods in the school cafeteria promotes weight gain. The type of meals consumed at school must be challenged to achieve a stable diet that doe not promote weight gain among students.
The physical environment at school is a strong pillar of the physical and psychological well-being of students. The level of physical activity that the student engages in school influences weight gain. An increasing body of evidence links the pressure put on schools to reduce the amount of physical activity to the observed weight gain among students. Unlike adults who need 30 minutes of moderate to high-intensity exercise per day, children need at least 60 minutes of vigorous exercise per day (Yuksel et al., 2020). The increased use of smartphones and computers at school is observed to consume play time leading to weight gain issues. The socio-economic status of children and obesity show an interesting dichotomy. Children from low socioeconomic classes can be affected by the type of diet consumed which leads to obesity. Those from well-off families may face challenges like sedentary lifestyles which also promote obesity.
Health Promotion Initiative
The proposed health promotion initiative deals with improving physical activity among children in schools. Schools are an easy setting to provide accessible physical activity to children and adolescents (Mak et al., 2021). This initiative is supported by organizations like the WHO which recommends all children and young people be physically active with the support of schools. The inclusion of games, recreational facilities, physical education, and planned physical activities should be a priority for all schools. According to the United Nations Children’s Fund (UNICEF), about 1 billion students attend school on any given day of the week (World Health Organization (WHO), n.d.). This makes schools an ideal environment to implement physical activity interventions to address the challenge of obesity among children and adolescents.
An active school day involves quality education and physical activity to improve the physical and mental well-being of students. Schools can help to promote physical activity by communicating positive physical activity messages to children and the community. Apart from improving the physical well-being of students, research suggests that physical activity is a strategy to improve the educational outcomes of students (Yuksel et al., 2020). Schools are an easy setting to implement physical activity strategies because it is part of the educational curriculum across the globe. The global action on physical activity recommends more positive experiences and opportunities for active recreation, sports, and play among children. All pre-primary, primary, secondary, and tertiary educational institutions should reinforce life-long physical literacy among students. Apart from this recommendation, the Commission on Ending Childhood Obesity requires schools to ensure there are adequate facilities available to promote physical activity in schools.
The first health promotion approach to address the issue of obesity includes providing physical activity through quality physical education. This approach begins with teaching students physical competence and confidence about the behaviors that improve their health. Physical education should be taught in all schools to ensure students understand the broad range of physical activities they can engage in to keep healthy. This intervention is based on the evidence that developing confidence and competence in physical activities will increase the likelihood of children choosing activities on their own (Yuksel et al., 2020). Physical education should be provided according to the legal and mandatory obligations. To effectively implement this strategy, the school should have trained teachers that know how to assess students’ performances individually rather than discouraging them via comparison with others.
School-based policies are another approach that can be used to address the challenge of obesity among children. Most schools rely on the national guidelines that deal with physical activity forgetting that the local environment provides other alternatives. For example, private schools operate using different approaches that may limit the number of hours required for physical activity and contact with the outside environment. Policies should be set to ensure that all students engage in physical activity during the required hours (Lowry et al., 2021). It is also necessary for schools to review the number of hours allocated to physical education and play time for students. Formulating policies to fix insufficiencies in the number of hours for exercise can help to fix weight gain issues among students.
Promoting exercise and physical activity among students may require schools to work with parents and other institutions. One of the most effective approaches to address obesity is the implementation of strategies to encourage active travel to and from school (WHO, n.d.). Although this intervention is dependent on many factors, its implementation can help students to compensate for physical activity hours lost at school due to various circumstances. For example, those students who cannot do vigorous activity because of medical conditions can walk to school and equally benefit from physical activity. Additionally, active travel can help students to create a daily habitual physical activity program (WHO, n.d.). Local governments can help to promote this initiative by auditing the environment and assessing the safety of active traveling modes like bicycles.
Out-of-school hours can be re-examined and tailored towards the promotion of physical activity for children and adolescents. As part of the home-based interventions that combine with school efforts, it is recommended to organize activities for children outside school hours (Mak et al., 2021). To some extent, the local community should be involved in implementing this intervention because no child can play alone to their full extent. Schools can organize staff that can lead the out-of-school activities available to pupils for free or at a small fee. The local community playgrounds should be used to engage students actively during evening hours and weekends instead of staying home and watching television. In addition, linking with other neighboring schools can help in organizing clubs to create a competitive physical activity for students.
Motivation during physical activity is an important aspect that can help children and adolescents to improve compliance with active sessions. Children require variety in their activities to avoid boredom and other adversities like declining physical activity. Schools should implement modern play equipment and modify the physical environment. For example, playground games should have adequate tools and equipment to ensure every student gets an opportunity to play. Providing variety can help to attract students and ensure that play time is enjoyable. One challenge with this intervention is that it will require institutional policy changes and it will add costs to the current curriculum. However, successful implementation of this strategy can have a great impact on physical activity levels in children.
Creating recess and recreation time plans for students is a strategy that can strengthen the physical activity initiative. Most schools have daily recess time that ranges from 20 minutes to 100 minutes per day (WHO, n.d.). During this time, students get to engage in different activities apart from learning. In children, recess means extra time to play and this can improve their physical activity levels. Because most institutions may not have an organized recess and recreation schedule, it would be important to define and communicate standards for a regularly structured recess plan. Providing recess during the day can help to break boredom, inactivity, and a sedentary lifestyle observed in most students. This health promotion approach should define the indoor and outdoor activities that students can engage in to prevent time wastage. Lastly, teachers should utilize active learning strategies to engage students during class time (Mak et al., 2021). Things like breaking the class into discussions and calling upon students to present can ensure some form of movement during learning.
Daniel, H., Bornstein, S.S., Kane, G.C. and Health and Public Policy Committee of the American College of Physicians*, 2018. Addressing social determinants to improve patient care and promote health equity: An American College of Physicians position paper. Annals of Internal Medicine, 168(8), pp.577-578. https://doi.org/10.7326/M17-2441
Huang, K.Y., Cheng, S. and Theise, R., 2013. School contexts as social determinants of child health: current practices and implications for future public health practice. Public Health Reports, 128(6_suppl3), pp.21-28.
Islam, M.M., 2019. Social determinants of health and related inequalities: confusion and implications. Frontiers in Public Health, 7, p.11.
Jamal, F., Fletcher, A., Harden, A., Wells, H., Thomas, J. and Bonell, C., 2013. The school environment and student health: A systematic review and meta-ethnography of qualitative research. BMC Public Health, 13(1), pp.1-11. https://doi.org/10.1186/1471-2458-13-798
Lowry, C., Stegeman, I., Rauch, F. and Jani, A., 2022. Modifying the school determinants of children’s health. Journal of the Royal Society of Medicine, 115(1), pp.16-21. https://doi.org/10.1177/01410768211051718
Mak, T.C., Chan, D.K. and Capio, C.M., 2021. Strategies for teachers to promote physical activity in early childhood education settings—A scoping review. International Journal of Environmental Research and Public Health, 18(3), p.867. https://doi.org/10.3390%2Fijerph18030867
Yuksel, H.S., Şahin, F.N., Maksimovic, N., Drid, P. and Bianco, A., 2020. School-based intervention programs for preventing obesity and promoting physical activity and fitness: A systematic review. International Journal of Environmental Research and Public Health, 17(1), p.347.
World Health Organization. (n.d.). Promoting physical activity through schools. https://apps.who.int/iris/rest/bitstreams/1426074/retrieve
- Module 01 Discussion – Preventative Care / Care Of Women And Children
- Mr. P Is A 76-Year-Old Male With Cardiomyopathy And Congestive Heart Failure Who Has Been Hospitalized Frequently To Treat CHF Symptoms. He Has Difficulty Maintaining Diet Restrictions And Managing His Polypharmacy.
- Case Study: Epidemiological Measures Of MMR Vaccine
- Benchmark – Outcome And Process Measures
- Reflective Journal: Financial Management Measures
- Quality Measures To Improve Patient Safety 1 DQ 2
- Measures of Quality
- Assignment: Module 07 Written Assignment – Interdisciplinary Communication
- Assignment: Module 09 Written Assignment – Differences Between Acute And Chronic Pain Worksheet
- Application: Adaptive Response
- Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
- What are the financial resource implications of expansion, contraction, and maintenance of scope adaptive strategies?
- Describe Carpers (1978) ethical knowledge development pattern of knowing. Briefly define the pattern and discuss its application to the development of advanced practice nursing roles
- Logical and creative thinking in the analysis and application of a theory to nursing practice.
- Describe, evaluate and discuss application of a nursing grand or mid-range theory
- Application of Concept Analysis to Clinical Practice Custom Essay
- Home Care Application
- Application: Implications of Regulation in Health Care
- Application of International Law