Social Determinants of Health: Claire Pomeroy at TEDxUCDavis

[@sarahschlatter5054]

To start off, I just want to say that Claire Pomeroy was tremendously inspiring to listen to and it was very brave of her to discuss her past in front of the audience. I personally believe that she is absolutely correct when she says that one’s life experiences define their priorities.

[@kourtneyhahn4241]

I believe Claire Pomeroy’s story is very inspiring. Sharing her personal story shows how someone from a bad environment facing a lot of social determinants can change her life, go to medical school and help others who are facing some of these same determinants to health care. One of the quotes that stood out to me was when she talked about providing enough for the people who have little. She talked about how she was healthy because she was an educated white girl. She said she saw people who weren’t as lucky as her and they were not in good health. It is these people that are not educated and have fewer resources that we need to be sure we are providing enough for so they can be healthy as well. If we do this then we will be addressing the social determinants of health. Another thing that stood out to me in this video is when she talked about how we only care for people once they get sick instead of finding ways to prevent them from becoming sick in the first place. She suggested that to solve this problem we need to switch from hospital-based care to population based care. If we focus on population based care we can make people healthier and prevent them from needing to go to the hospital. An example of population-based care would be providing an educational class on healthy eating to children that are obese. Teaching children that are overweight how to eat healthy at a young age can prevent many problems for them in the future like the development of type II diabetes. According to Allendar, Rector, and Warner (2014), to get communities to change nurses need to get the members of that community to participate in the interventions. The interventions the nurse selects should be achievable, sustainable, and should increase the wellbeing of everyone in the community. Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins

[@alicianewton2794]

In my opinion, Dr. Pomeroy's TED talk is extremely moving and powerful. Her inspirational story of growing up through foster care offers a glimpse into her experiences and insight into the experiences of children growing up in the foster care system today. I loved when she stated that we offer "sick care" in America instead of health care. Preventative health care absolutely should be the focus of health care today with all of the knowledge and resources we now have. I also liked how Dr. Pomeroy discussed how in the U.S., we are financially able to provide preventative health measures to our citizens which is exactly what we should be doing. We should not be spending billions of dollars every year to treat illnesses that could have and should have been prevented at a much lower cost in the first place. I feel that Dr. Pomeroy's wish is for not only quality preventative health care to be provided to all U.S. citizens, but also for appropriate health education to be provided to all citizens. Education is an extremely powerful tool in the health care world and could potentially prevent billions of dollars of spending on healthcare which could have been prevented with a little education. Government websites such as Healthy People 2020 offer such health information, but more emphasis on utilizing such tools must be placed. I know I personally can not remembering hearing anything about Healthy People before entering the nursing program and I feel this is a major part of the problem. Finally, I liked how Dr. Pomeroy ended her talk by discussing disparities in health care regarding socioeconomic status among other factors. I especially liked how she talked about being a teenager with no healthcare and feeling the only place she could go to receive any type of treatment was the Emergency Room. According to Healthy People 2020, barriers which affect people of all socioeconomic status in regard to obtaining healthcare include high costs, lack of availability, and lack of insurance (Healthy People 2020). Also according to Healthy People 2020, these issues can lead to delays in receiving appropriate treatments, health needs which are unmet, and inability to receive preventative services (Healthy People 2020). All of these issues can eventually lead to much greater health problems and therefore much greater costs. For these reasons and many others, greater access to healthcare and healthcare services absolutely must be provided to all citizens no matter what socioeconomic status. I have known many people who have gone without health insurance and avoided doctor's visits because of high costs of healthcare. For example, I had a friend who developed a hernia two years ago and avoided seeking treatment for fear of medical costs because he did not have insurance at the time. Because he waited so long, his hernia continued to grow and he eventually had to have surgery in order to remove the hernia because it was causing him so much pain. Now had he had access to health care, my friend would have been able to seek treatment much sooner, and avoided the pain and anxiety he had to cope with. Preventative health care should be the focus of healthcare in this country and we would all do well to join Dr. Pomeroy in her mission for this to happen. References: Healthy People 2020. (November 2009). Access To Health Services. HealthyPeople2020. Retrieved from: www.healthypeople.gov

[@elizabethhahn230]

Dr. Pomeroy’s speech is very inspirational. As a child, she had so much working against her, and today she is a doctor who had the opportunity to speak at such a renowned conference. She gives current, real-life examples in which she has lived through, survived, and overcome in order to be an advocate so others do not have to have those experiences. What struck me the most about this beautiful speech was Dr. Pomeroy’s new paradigm. I am one who only goes to the doctor when I am ill, and even then I put it off until it becomes unbearable. I tell myself I do not really have the time to wait, and then speak with the healthcare team, and then go get medications if they are needed and then wait some more for them to begin working. Our healthcare system is failing, as she pointed out, and that is part of the problem. I have always seen the system as reactive and not proactive. The country is beginning to see a slight shift in this with advertisements that discourage smoking, and encourage a healthy lifestyle; however, not many people then take the proactive steps in order to avoid illness. Healthy People 2020 is one government resource that is also trying to change the paradigm. For example, one of the 2020 objectives is health related quality of life and well being. The identified outcomes for this objective are to improve the amount of adults who identify themselves as being in good health and good mental health. In order to do this, people have to think about everything in their life and consider if they would identify themselves in good health. Reflection upon this can then open up the lines of communication to encourage yearly exams as a preventative measure, to encourage the people to stay in a state of good health. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. HealthyPeople.gov. (2014). Access to health services. Retrieved from www.healthypeople.gov/2020/topics-objectives/2020-Topics-and-Objectives-Objectives-A-Z

[@TiffM216]

I believe that addressing social determinants is so significant to improve health for all, and Pomeroy does an excellent job of sharing her experiences to educate and empower the audience to make changes and take action. Healthy People 2020 advocates that “all Americans deserve an equal opportunity to make the choices that lead to good health”. I believe that the lack of access to care, discussed by Pomeroy, is one of the most detrimental barriers to achieving this goal.

[@makebethnotmeth]

This video by Claire Pomeroy carried a very powerful message, not only as a health care worker but as a consumer. It was amazing to hear about the first hand effects of the social determinants that were discussed in the textbook. According to Allender, Rector, and Warner (2014), social determinants of health constitute as many different things such as socioeconomic conditions, social media, environment, exposure to conditions, and several other influences. These determinants often impact how people view and accept health care and preventative measures. It is very important for health care professionals to identify and realize these several different areas as barriers to health care in order to overcome them and assist populations to access appropriate care. This video applies the definition of social determinants in real-life situations. Claire Pomeroy talks about the several foster homes affected her life and allowed her to experience the feeling of being “left out” among other issues. I thought that it was amazing how much the United States spends on medicine, but yet has such poor health. This was startling as I did not realize how big this issue was. It was also amazing to hear about the differences in health disparities between African Americans and Caucasians. Finally. I thought that the most powerful message that Pomeroy brought up was the fact that health care is viewed as “sick care”, where we care for people after they become ill. She pushes for a different system that is more “proactive than reactive” which pushes for more preventative care. This applies to this semester especially as community nursing relates directly to prevention and teaching. We will be spending time to teach and inform populations in order to gear towards preventative care, which is part of Healthy People 2020 as well. References Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia: Lippincott Williams & Wilkins.

[@carlynahrwold4342]

Such an inspirational and thought-provoking video! Dr. Pomeroy begins by taking us through her childhood and her story of survival. She was 14 years old, homeless and faced several social determinants against her. She went to a teen counseling center and from there was put into the foster care system. It was very hard for her to trust her caregivers. Just as she was beginning to build a relationship, she was moved to a different home when she would have to begin the process all over. Her story about her experiences with HIV patients helped illustrated the flaws in our healthcare system. It’s moving to see how her past has shaped her future as she continues to impact people. Dr. Pomeroy clearly identifies some of the many problems that exist within our health care system. She makes a fantastic argument is saying that our flawed healthcare system should take a proactive rather than passive approach. Instead of waiting for sickness in our community we need to do everything we can to prevent illness. This is a costly expense and provides very little benefits. Money is being spent on the wrong things! A better governmental system need to be implemented that allows a healthy standard of living where no one falls below due to conditions beyond his or her control. One should not receive better health than someone else because they have more money, power, educational status, or resources. The social determinant in which on was born should not be a factor. Health should be a community wide priority. Like Dr. Pomeroy, Healthy People 2020 aims to improve healthcare access to ALL Americans despite their race, educational level, or socioeconomic background. They aim to encourage collaborations across communities and empower Americans towards making informed health decisions (Healthy People, 2014). Health should be about communities rather than individuals (Allendar, Rector & Warner, 2014). EVERYONE matters! Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. HealthyPeople.gov. (2014). Access to health services. Retrieved from www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

[@abbypfaff6301]

I found this video on the social determinants of health to be very enlightening. I thought she did an excellent job of relating to her audience and the topic she was addressing by describing her rough childhood. While I do not personally have experience relating to this situation, I am a substitute teacher at an elementary school and deal with several students who are placed in foster care and have had a difficult childhood. It is heartbreaking to know the situations that children especially are placed in and as time goes on, these children have a hard time becoming successful through the adversity they face. I found the message in the video to be incredibly helpful as a healthcare provider. I am beginning to realize the importance of being proactive about healthcare with patients and trying to prevent sickness from happening. Not only does this tend to a person’s physical needs, but it also can assist with mental and emotional issues as well. I thought Dr. Pomeroy did a good job of describing how there is a misconception that the government does not have the money to change the direction of healthcare to a more preventative approach as compared to treating symptoms. She stated that we are spending too much money on treating illness and the way to change this is to put more emphasis and funds into preventing illness, which will in return reduce the cost of treating illnesses. With the use of Healthy People 20/20, we have a better grasp of what issues need to be addressed and treated. This gives a great starting point for finding ways to prevent illnesses and provide education to the community on seeking out healthcare for more than just treatment. While it has been noted that lower income groups are mostly in need of health promotion and disease prevention, the community as a whole could show improvement with more development of health promotion (Allender, Rector, & Warner, 2014). Ultimately, regardless of the funding that is received, it is the responsibility of any healthcare provider to provide as much information as possible to the patient about how they can remain healthy. While ideally healthcare would shift to a more preventative approach, in the meantime it is important to take responsibility to provide as much for the patient as we can. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

[@abigailorlowski3989]

Claire Pomeroy speaks with much passion and experience. She speaks from the heart and inspires others to compassionately care for the vulnerable population. Pomeroy brings light to many difficult topics involving social determinants and a failing American healthcare system.

[@chelseynicodemus7033]

This video on the social determinants of health is inspirational. I feel that there should be equal healthcare for everybody regardless of socioeconomic level. I liked her idea of having a more proactive healthcare system, rather than a reactive system. In the last several years there has been an increase of disease prevention through education. I think people are becoming more aware of risk factors and are trying to live healthier lives. The teaching has resulted in a shift towards a more proactive healthcare system. A lot of times I don't go to the doctor unless absolutely necessary, but a few weeks ago I decided I just needed a full physical exam since I have not had an actual physical since seven years ago. I needed to be proactive in my health rather than wait until I was sick. Another example of a proactive healthcare system would be going to the dentist every six months to get my teeth cleaned and evaluated.

[@mariahmcmillen3134]

Dr. Pomeroy did an excellent job getting her point across. Her personal experience of hardship and deceit as a young child gave her a great transition to describe how someone such as herself can turn their life around and better their self. I found it very powerful that she kept repeating that she was trying to recruit individuals to help better health care. I found it very disturbing, yet very true that socioeconomic status has a huge impact on our country's health status. No individual should ever have less or worse health care than an individual of a higher socioeconomic status, and Dr. Pomeroy made it very clear that we currently are facing this problem in the United States, and it is unacceptable. For example, if there are two individuals from different levels of socioeconomic status, they should both receive the same level of care at an individualized care. The care the patient receives should NOT be based on what their socioeconomic status is. We need to realize that everyone is human, and should be treated equally regardless of their socioeconomic status.

[@jasongraf9226]

I completely agree with Pomeroy's idea that social determinants play a role in a person's health. I had the opportunity to have a clinical at a local health clinic that provides free healthcare to individuals that can't afford it due to job loss, no insurance, or limited insurance. I think that this clinic is a great example of helping people whose social determinants make it hard for them to get access to health care due to financial problems.

[@kristie0593]

Let me just say that Claire Pomeroy is an excellent speaker. As she was giving the example of the 14 year old girl leaving her home of abuse to live on the streets, I wondered what happened to that girl, and then when Dr. Pomeroy said that girl was her, I was amazed. It’s awe-inspiring to see someone make the best of her situation and rise up above it. I found it to make me want to listen more because here is someone that actually knows what it is like. One point she made was that healthcare today is “sick-care” because we care for people when they are sick, instead of providing them with services to prevent the sickness in the first place. And because of this “sick-care” more money is spent than should be, and more people are in the hospital from conditions that could have been prevented. I believe that health care providers need to remember to not solely focus on caring for the sick, but caring for the healthy, as well. If healthy people are not taught how to keep themselves healthy, than they will end up sick, too. Over and over again, Dr. Pomeroy would say social determinants of health, but what exactly are those? Allender, Rector, and Warner provide an excellent definition by stating that “social determinants of health reflect social factors and the physical condition in the environment in which people are born, live, learn, play, work, and age” (2014). Basically, this means that anything in a person’s environment that affects them could be considered a social determinant of health. I believe health care providers need to be aware of these social determinants of health and how it affects their patients to better understand how to care for them. Allendar, J., Rector, C., & Warner, K. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott, Williams, & Wilkins

[@candacerogers1154]

I found Dr. Pomeroy's speech inspirational. Her life experiences have given her a unique perspective on how social determinants can influence one's health. Her story and her passion bring awareness to the public that there is more to good health then just diet and exercise. I really like that she pointed out that we need to change our model of health care from treating illnesses after they develops to preventing them from ever developing. In my experience as nurse I have also seen the real affects of social determinants on the quality of life and health in individuals. I have seen countless patients through the emergency department that have been victims of social inequality and poor living circumstances. These social determinants are multigenerational in many cases, and are also caused by social norms that influence their behaviors leading to poor health. I commonly see are children who live in homes with parents who smoke. These children develop asthma and frequent upper respiratory problems. As these children grow up they have poor lung function and they are susceptible to chronic respiratory infections, and malignancy. The chronic infections may lead to permanent lung damage and many other health problems. Allender, Rector, and Warner (2014) state "health starts - long before illness - in our homes, schools, and jobs. They describe social determinants of health as conditions in the environment that affect a person's health, functioning, and quality of life outcomes and risks. Conditions such as where a person was born, lives, works, plays, worships, and age can all effect their health. Many other factors such as education, energy, housing, trade, and transportation can also be a social determinate of health. With this being said it is important that we look carefully at all policies, including those outside of health, since many non healthcare issues can be social determinants to one's health (Allender, Rector, & Warner, 2014). Allender, J. A., Rector, C., & Warner, K.D. (2014). Community and public health nursing promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@pamila.adikari]

While reading on social determinants of health to my MSc I accidentally found this video. It provides an excellent summary of SDH.

[@maeganoberley2437]

Ms. Pomeroy’s speech about social determinants of health and her life was very interesting and moving. She talks about change and the need for new ideas and ways in order to achieve this change. Her story was inspirational, going from an abused child exploring the streets and living in many foster homes to a successful woman. She talks about how her experience of foster care taught her about how past life events can affect people their whole life. Through her life she has noticed many issues with the health care but one that she stresses the most is the need for primary interventions, interventions that prevent illness. We as future nurses need to stress the importance of health promotion. As stated in out book, health promotion is “behavior motivated by the desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness ” (Allender et al., 2014). She stressed the importance of care and the need for everyone to come together to help improve the health of the community. We need to do it because we care not because it is our job. It’s essential to help improve health for our generation and for the next. We need to take advantage of opportunities and use resources to prevent poverty, improve education, and create jobs. Without change, things will not get better. For example if we keep waiting for people to get sick to treat the world will have many more illnesses than there should be. In order to prevent illness we need to educate, teach, use our resources available, and be a support person for these individuals. Improving health is important and it’s essential that we prevent illness before it occurs. It may save a life or two. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing promoting the public’s health. 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@orlaspring363]

Nine years after this talk, so much of it's still relevant. Pomeroy's story is inspirational.

[@veronicadiano3384]

11 years later and more relevant than ever.

[@LocdInChrist]

The statistics presented are so on point. Sadly, this country is money-driven and not health-driven. God bless this woman!

[@laurenfulk8482]

Dr. Claire Pomeroy’s TED Talk offers a powerful look into a bad situation turned into a positive outcome. Her life experiences and lessons learned offer insight into a situation that few can fathom; a situation of powerlessness and need. Many points made throughout this talk stood out, but one of the most crucial points to take away is the idea of repaying injustice with kindness. The “dismal” health status of the Unites States would be greatly adjusted by incorporating Dr. Pomeroy’s concepts of “proactive, not reactive” care, “coordinated care”, treating society instead of waiting to treat the sick, and, above all else, helping those that need help with kindness. Social determinants will always be an inescapable aspect of healthcare, but Dr. Pomeroy is correct in stating that America would be much improved by treating more issues such as lack of access, funding, and opportunity for healthcare than funneling more money into resources that only benefit certain populations or are hard to attain. Dr. Pomeroy makes the point that until members of society feel valued or feel like they have a purpose, social determinants will continue (in conjunction with misguided healthcare policies) to negatively affect much of the American population. This sense of purpose leads directly to a sense of empowerment. Allender, Rector, and Warner (2014) discuss the role of a community health nurse, and specifically note that promoting wellness within a community, including teaching, may only be completed when the audience is able to learn and adjust. Specifically, teaching about the social determinants of health are essential to helping a population understand how they can initiate positive change and which policies are leading to impaired prevention of certain diseases and health problems (Allender, Rector, & Warner, 2014, p. 361). One such example of a social determinant that effects citizens of Fort Wayne is the ban on teaching sexual education in Fort Wayne schools; Fort Wayne is quite conservative and as a result only abstinence is taught. Although this social determinant effects both genders, all socioeconomic statuses, and all races of students in Fort Wayne schools, the students that suffer the most from this knowledge deficit are those who lack access to needed information and options. By limiting the access to quality information and resources for students to make responsible decisions, the precedence for reacting as opposed to being proactive about life-altering decisions is created. In coordination with Dr. Pomeroy, American citizens will continue to experience a “dismal” overall health status if steps towards educating and altering health status do not take place before hospitalization and required treatment. And, in conclusion, this step towards preventative health care will not take place until it can be taken together, regardless of any social determinant. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins

[@Castleman811]

Claire Pomeroy is an exceptional speaker and this is a phenomenal video. My favorite line from Pomeroy is when she asked the audience if they want to live in a country where social deprivation defines your health status. This statement is a strong statement because it forces the audience to place themselves in a situation where they can start to view what their life would be like if they were not given equal health care because of a social determinate that they have. Examples of social determinants of health include but are not limited to the following: socio-economical status, resources, opportunities for employment and education, transportation, safety, social support, and environmental factors (Allendar, Rector, & Warner, 2014). I also liked Pomeroy’s quote, “You don’t have to go to medical school to make a difference, you only have to care” This is powerful because it empowers citizens to try and make a difference in any form of contribution. Pomeroy explained that by reducing poverty, giving educational opportunities, and creating job opportunities we can make a difference in our health care. All of those three areas for improvement can be impacted by every day citizens who care and are willing to donate their time and efforts towards this cause. A great example of how social determinants affect an individual’s health care is seen all of the time in Medicaid patients. For example, I used to work in private practice and the doctor refused to see Medicaid patients due to having difficulty getting paid for services. It is understandable that the doctor wants to be paid for giving care but I feel that this is social discrimination. It is not the patient’s fault that they are on Medicaid. I wonder if the doctor placed himself in the patient’s shoes if he would still feel the same way. I respond to this real-life example with Mrs. Pomeroy’s quote with emphasis on the word care, “You don’t have to go to medical school to make a difference, you only have to care.” References Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing Promoting the public’s Health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins. ISBN - 13: 978-1-60913-688-8

[@megandaniels5215]

David, Dr. Pomeroy is a great public speaker. She mentioned many strong statements that caught my attention as well. Having the audience place themselves in the situation really enforces her points. In order to create a community that we want to live in, we must all come together. She mentioned it is important to consider diverse objectives and life experiences. Your example is interesting, and really supports the fact that in order to make a difference all a person really has to do is care.

[@BeastieLC731]

Dr. Claire Pomeroy’s speech was very poignant and to the point. She raised the issue of a very real crisis in health care-socioeconomics in relation to the provision of health care and treatment. What made her speech more powerful was that she was not just giving a presentation on something that she may or may not be passionate about as many individuals do, but that she gave us a glimpse into her past life and just how what she’s educating us all on directly affected her. Sometimes we know there are issues and/or misdeeds present in our lives, especially as health care professionals, but I feel we can only be as empathetic as our experiences allow. That’s not to say we don’t want to be or that we don’t strive to be, but sometimes when we are not directly affected by a problem we don’t fully understand the significance until we delve deeper. As years have progressed we've all heard about different changes in political bills/laws to help with the issue of health care and health insurance. Some changes have been for the better and others not so much, but it still remains evident that there are individuals like, Dr. Pomeroy, who are fighting for those who are facing health disparities. With Healthy People 2020, education systems, clinics, and numerous other sources of representation and support I believe that it is possible for us to eventually find a way to face all of these problems head on and eventually find a means to provide a resolution. Yes, this will take time and a lot of effort, but we need to provide for the generations to come as well as the current generations. We need to protect and advocate for all of those individuals who believe they have no voice and/or no means to an end. One individual should not have more health care opportunities than another just because he or she makes more money, etc. We all are created equal and we all deserve to be given equal treatment, especially with health care. All of this is just fuel for the fire of which is Community Nursing. We are going to come into contact with those patients who don’t have all the opportunities and finances to acquire health care and treatment. We need to find ways to provide these opportunities to them by working towards fixing the health care system as well as putting them in touch with agencies that can help lessen the burdens they may face with their need for health care services. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. HealthyPeople.gov. (2014). Access to health services. Retrieved from www.healthypeople.gov/2020/topics-objectives/2020-Topics-and-Objectives-Objectives-A-Z

[@lindseyyeiter2210]

Ms. Pomeroy’s discussion on social determinants of health is very interesting and accurate. She discusses how our system is failing as evidenced by poor health outcomes and because the United States provides “sick care” as opposed to health care, which proves that money is spent on the wrong things. Our healthcare system needs to focus more on primary prevention by providing access to quality care. Ms. Pomeroy describes that in this country social deprivation defines health status, and although it is shameful, I completely agree and inequality is a huge problem. Listening to this discussion has really allowed me to see how things work in our country and I believe, that as nurses we have the best opportunity to fix this problem and provide quality care for everyone. Examples of our flawed healthcare system are seen every day. Patients without insurance are limited to providers that have a sliding fee scale like the Neighborhood Health Clinic. It is wonderful there are places that can do this for low-income, uninsured patients but low-income and not having insurance definitely limits where an individual can obtain care. I believe an example of us being proactive, is our service learning projects. The Black Barbershop Initiative is an attempt to educate the black male community about health issues relevant to them. Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health, 8th edition. Philadelphia: Lippincott Williams & Wilkins.

[@jaymischinbeckler8645]

I found Ms. Pomeroy’s discussion and opinions on social determinants of health to be extremely eye opening, insightful, and somewhat astonishing. I was actually surprised that 51 million individuals in the U.S are uninsured and that approximately 25 million are underinsured, and even more shocked that income and socioeconomic status is the number one determinate of health. It is something that I never really thought about, but after watching this, it completely makes sense. It is sad to think that each individual’s health status is basically determined by their income. Everyone should be able to have equal healthcare access and should be given choices to live long, healthy lives instead of allowing care to be determined by income, education, and ethnic background (Allender, Rector, & Warner, 2014). Just from listening to this video and from experiences, it seems that those who have the least income, if any, are the ones who may need the most care. I completely agree with Ms. Pomeroy that something needs to change and that a new paradigm needs to be put into place, one that is proactive and more focused towards the social determinants of health. She mentions things that are wrong in the healthcare system and what needs to be changed, but my question is how? How exactly do we decrease poverty? How do we increase and provide more opportunities for education? How do we provide better healthcare access to all? How do we ensure safe neighborhoods and adequate housing? It comes down to money and how are we going to get the money to be able to improve these areas to help ensure individuals of adequate, equal health care. I agree that these things need to change, yet I’m not so sure if I agree that the remaining citizens should fork that money out of their paycheck (via taxes, etc.) to provide healthcare for these individuals. Something else needs to be done, but what and how? I feel she makes it sound so easy when in reality it doesn’t seem to be. Ms. Pomeroy mentioned that that individuals who are uninsured or on Medicaid have the worst health status and that feeling unvalued is likely to result in poorer health. From my own experience, I see how this can be true. For example, I have seen Medicaid patients be turned down or away because of being a Medicaid recipient, therefore prolonging necessary treatment, resulting in poorer health status. I have also seen people turned away because they had no insurance. Ms. Pomeroy discussed that we are spending too much money on the wrong things or in the wrong areas when it comes the healthcare and I can understand that and agree with the fact that “we focus on sick care not health care.” Rather than being proactive and focusing on preventative measures, it is apparent we focus on times when we become ill. But then comes the question that comes to my mind is how do we re-evaluate and re-focus on where that money should be spent. To me, all of this seems to be a very complex situation that is going to take a long time to fix. Education is key. An emphasis on education to possibly change behavior will allow for advancement of healthy practices in the community (Allender, Rector, & Warner, 2014). Nurses, especially community and public nurses play a huge roll in this. By reaching out to the community and providing necessary education as early as possible is extremely important. For example, by providing health related education to children as soon as they start school and reiterating this information as well as building upon it may have a positive impact on them as they grow up. Also by nursing and other health care personnel being more willing to go out into the community and discover what education needs to be provided and then following up on that with the necessary education, it may change the lives of individuals. Lastly, providing more resources and preventative measures is also extremely important. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing promoting the public’s health. 8th Edition. Philladelphia: Lippincott Williams & Wilkins.

[@kristawalker9288]

As nursing students, we have an opportunity to not only help a community in need but identify social determinants and encourage us to seek change in the way health care is delivered for the future. My example of a social determinant is social norms and attitudes formed by HCP that limits quality healthcare. In Marion,the quality of service you recieve at a doctor's office depends on what side of town you're on. People should be able to go anywhere for healthcare and receive the same service.

[@johnoo9734]

Health status of the people depend on how they are born, raised, work, live, and age. In order to improve these stages, social determinant plays an important role. Clair Pomeroy's input on social determinant was powerful guide for the given community, since people are affected by social determinant since the first year of their lives. Disparity as a child affect how he or she grow up, and negatively affect the health status. That will go in vicious cycle to their offspring's health status.

[@kaiazelt6478]

Dr. Claire Pomeroy is a very passionate speaker that has overcome many life obstacles, to not only better her health and lifestyle, but also advocate for the need for preventative care. Upon reading the comment section, I have to agree with Lindsey Thomson when she wrote, “that money is spent on the wrong things.” It is sad to think that our health care is based on a person being treated for sickness, than focusing more on well care. Knowing personally how expensive health care is and the importance of well visits with the doctor, benefited my child to be able to receive the help she needed as a special needs child. Not having the ability to afford or the ability to utilize preventative care could be detrimental to her overall health and well-being. I have to agree with Dr. Pomeroy that the United States is failing when it comes to preventative care, and that the vast majority of Americans only go to see the doctor when they are already ill.

[@sigfridshayo4715]

"Our life experiences define what we prioritize", correctly said

[@Kitmus73]

Pomeroy brought so many important points about social determinants to light. We must start by caring, taking notice of the disparities amongst us and joining to bring about change. Community health is about collaborating and helping one another to make our societies a better place for everyone to live in (Allendar, Rector & Warner, 2014). I met a parent at a health fair once who did not want free vision screening for her kids, because no health insurance if the kids had any issues.

[@carriealles3092]

Ms. Pomeroy is an excellent speaker. I was really impressed by her opening visualization process. It was very dramatic and attention getting. Her points on the social determinants were right to the point. There are so many social circumstances such as resources, employment, and education the lead to inequality in the health care system. She talking about how the health care system is reactive versus proactive and I think this is seen especially when these social determinants are affective the patient. One example would be someone with low income getting the flu. It they were to visit the ER because they did not have health insurance, and therefore could not go to a doctor, the ER is going to treat them and send them on their way. There will most likely be no discussion of the flu vaccine or getting the vaccine to others in the home. As Ms. Pomeroy stated “We must address the social determinants. Challenge the inequality and disparities of health.” As a nurse we must seek the vulnerable populations and become a voice for them. These efforts need to focus on prevention and promotion of health (Allendar, Rector, & Warner, 2014). I like how she challenged everyone in the audience. She did not limit that change to only those in the healthcare field. As she stated “Reaching out in kindness can save a life.” Allendar, J.A., Rector, C., and Warner, K.D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams and Wilkins

[@abbeybunnell7352]

I agree with Pomeroy; a person’s economic statues, environment, social standing, education, and access to healthcare all impact and are determinants of wellness. The clinical location I have been working at serves a population that has no healthcare insurance. The free clinic provides dental, eye-care, minor surgeries, and medications at no cost to the clients This free clinic is a good example of what Pomeroy is asking us as healthcare provider’s to do.

[@lashawndawilliams3721]

The video edited by Claire Pomeroy is uplifting in that it teaches us as individuals that social determinant of health are of utmost importance as it deals primarily with economics and social conditions. Ms. Pomeroy speaks of her experience in foster care within various cultural backgrounds. I think these situations taught Ms. Pomeroy the differences in cultural and the importance in understanding cultural differences. Claire Pomeroy speaks on the lack of coverage or the lack of sufficient coverage for the American people. In essence she speaks of the disparity based on race, ethnicity, geography, socioeconomic status, orientation, etc. It is my opinion that health care or the provision of health care should not be based on any superficial characteristics. What was most interesting in listening to this video is that The United States spends twice the amount as any other country of comparable means, yet the United States, according to Ms. Pomeroy has the worst healthcare outcomes. I agree with her statement that health care should be primary care based and not acute intervention. It would seem if healthcare was more proactive than reactive, it would be possible to meet the objective of a better healthcare outcome. A real life situation I can relay to this situation is my uncle who passed this last year of hepatitis C and cirrhosis of the liver, it is my opinion, because of his socioeconomic status, the care he received, despite the fact that he was schedule and visited his physician regularly, was not optimal. Including the morning he presented himself to the emergency room where unnecessary surgeries were performed on an exploratory level rather than one based on previous patient records which should have been readily available to the emergency room staff.

[@patriciaezeakudo6388]

This is a moving and powerful testimony. Dr. Pomery’s rough childhood now an inspirational story of growing up through foster care offers a glimpse and insight into the experiences of children growing up in the foster care system today. She looked at it in such a positive way and now able to make a positive impact on others through her life experiences. She emphasized the awareness that health disparities exist across the country despite huge capital investment in healthcare. It is obvious that our healthcare system is a sick care with the providers taking care of the sick and not preventing sickness. A reactive and not proactive system. This correlates well with (Krumeich & Meershoek, 2014) conclusion.

[@cortnie01]

Dr. Pomeroy definitely made her point in this video. She mentioned great points about children in the foster system and people living in poverty. She can honestly say she knows what living on the streets and in poverty feels like. I am impressed with how far she has came in her life. One statement that she made caught my attention. The statement was about prevention and how the community needs to work on preventing illness and problems rather than treating diseases or problems after the fact. Another statement I liked was when she said more people need to feel that they have a place in the society. A support system is very important. Pomeroy even mentioned that people who do not have a support system or feel unvalued have poor health. I agree with her completely. There are so many people in our society that do not have a support system. Dr. Pomeroy discussed the Social Determinants of Health. According to Allender, Rector, and Wagner, the Social Determinants of Health is a goal that will develop social and physical environments to initiate good health for everyone. This includes homes, workplaces, neighborhoods, schools, and communities. All of these factors influence health, including access to healthcare (Allender, Rector, & Wagner, 2014). For example, my clinicals are at the St. Martin's Healthcare Clinic and so many people in that community are unemployed and uninsured. The clinic only cares for patients that are uninsured and these patients do not have to pay a dime for the care they receive nor the medications that are provided. I believe this is a step towards achieving the goals of Healthy People 2020 especially the goal of the Social Determinants of Health. Allender, J., Rector, C., & Wagner, K. (2014). Community & public health nursing: Promoting the public's health. (8th ed.). Philadelphia, PA: Lippincott Williams & wilkins.

[@mindeeconey855]

I too was extremly impressed with how far she has came in her life. She may many valid points in her speech about our healthcare today that literally opened my eyes. One statement that really stuck out to me was about the African American population and how their lifespan is lower than Caucasians because of their race/status in society and communities. In my eyes, I believe everyone should receive the same healthcare no matter race/sex/status etc. I also like how Dr. Pomeroy stated that, "An act of kindness can literally save a life." She is living proof of this statement. Acts of kindness can be as easy as volunteering time at homeless shelters, and food banks. Great Post Cortnie!

[@lisakolkman3067]

Not only is this video and Ms. Pomeroy's point of view inspiring, but her personal story is also inspirational and has clearly impacted her so greatly that she is genuinely passionate about health care reform. Instead of feeling sorry for herself and playing the role of victim in a nonchalant world, she has decided to allow her own shortcomings to guide her in her quest in improving health care services. I personally agree wholeheartedly with Claire Pomeroy's views on the healthcare system and believe changes need to be implemented. Like Claire, I was shocked by the fact that out of the 30 countries represented on the health services and social services expenditure graph, The United States was the country that spent the most amount of money on health services, but placed 25th on the amount of money spent on promoting social services. We are supposed to be the most developed country and we are always represented as a country that cares about mankind; however, after seeing this graph, it makes me question how much we as a country truly wish to promote the growth of our fellow man if we are purposefully choosing not to spend money on social services. Furthermore, a different graph Ms. Pomeroy shared showed that 17% of Americans live in poverty. This is heart wrenching because the average poverty level for developed countries is 10.2%. We, the USA, are obviously in need of a much needed change. "You don't need to go to medical school to improve health, you need to care", was a comment made by Claire. I understand and appreciate the point she's trying to make, but I disagree with this statement. There are those that went to medical school, but who do not care. How many times have you asked a health care provider a question and in turn were given a rushed answer and felt like you were wasting their precious time? I think an appropriate statement would be you need to go to medical school AND care in order to improve health. It is pertinent that health care providers take the time to share information with their patients to teach them the appropriate levels of disease prevention. Knowledge is power and people have the right and deserve to know measures they can take in order to preserve their health, versus waiting until they are ill and telling them what they need to do to get back to optimal health. Living in Fort Wayne, I can see there is a definite need for prevention measures. Both our Spanish and Burmese communities are rapidly developing, and these populations are both susceptible to low-quality health care services. In order to allow for reduced health disparities amongst these populations, preventative measures need to be implemented, for instance hypertension and diabetes education for the Hispanic population, and immunization awareness for the Burmese population. By providing education, we are true patient advocates.

[@TheCedilia]

THANK YOU. I am myself trying to work my way up the social ladder to hopefully make a change. To help those who need it most. Your speech just inspired me to work even harder to get there. My exams in sociology are coming up where health is a big topic. This was so helpful.

[@kitzzzzeditzzzz3964]

Dr. Pomeroy substantiated the importance of addressing social determinants of health through prefacing her speech with a personal story. Her passion on the topic was clear and was inspiring for me as a viewer. She made several points that resonated with me, but one of her most poignant was when she spoke of transitioning from a "sick care" model to a true "health care" model. I believe so much focus, energy, and funding is dedicated to fixing those who are already sick. I agree with Dr. Pomeroy that we should be transitioning to a culture of primary prevention and proactive versus reactive healthcare. Let's spend more of our healthcare dollars on educating about healthy lifestyle choices and the adverse effects of unhealthy lifestyle choices that are likely to result in health disparities. According to Allendar, Rector, and Warner (2014), it is of utmost importance for a community health nurse to provide health education to encourage behavioral changes in the community. If community members effectively learn about healthy lifestyle choices, they are likely to assimilate these changes into their lifestyle permanently. Another point that stood out for me was when Dr. Pomeroy said that too many people don't even have access to our failing healthcare system. I have been without health insurance in the past and it was a matter of hoping nothing happened to me where I required medical care during that time. Now that I have insurance again, I feel much more at ease and see the doctor much sooner and more frequently than I ever did without insurance. Having access to affordable healthcare now has made me much more proactive about my own health and I feel like I avoid unnecessary suffering physically and mentally because of it. In order to address the social determinants of health, healthcare representatives must band together with community members involved in education, public safety, and business to bridge the gap between poor circumstances and poor health. Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins. ISBN-13:978-1-60913-688-8

[@carriealles3092]

I also agreed with her funding goals. It is interesting through community nursing how much you see the money of the health care system. In the hospital setting the nurse has a hard time seeing this funding at work, but in the community it is first hand for all those involved. I also agree that health care reps. must band together. This is a problem in society as a whole and we must all work together to create a better healthcare environment in our country.

[@Meg122109]

Dr. Claire Pomeroy is an inspirational speaker who is passionate about the social determinants of health. When she presented the slide that stated 51 million Americans are uninsured, it did not surprise me. However, not all of these people live in poverty or are uneducated; there are people who choose to be uninsured. One aspect of her speech that really struck me was that our healthcare is based off "sick care," meaning we treat those who are sick instead of trying to prevent the illness. I agree that preventative measures should be implemented to try to reduce the amount of sick patients that need hospitalized for something that can be prevented. Looking around though, there are many chances for education and healthcare whether it is clinics, support groups, healthcare functions, etc; people choose not to participate or seek out help to try to take control of their health. Socioeconomic status as the number one social determinate of health was not surprising. Nurses need to help educate patients about the social determinants that may be present in their lives (Allender, Rector & Warner, 2014). I do not agree that everyone should be insured if it means that the middle/upper class needs to pay for the insurance of those less fortunate. As heartless as that sounds, there are many people who collect various kinds of government assistance that are too lazy to earn livings for themselves or are taking advantage of the system and getting a "free pass" for things they can easily afford. I work in a hospital doing billing for the Medicaid clinic. There are children that are on Medicaid, paying nothing for their healthcare services, whose parents both work, have a nice house, expensive phones and clothes, yet have their children on Medicaid so they do not have to pay for their healthcare. That does not seem right to me and they are taking advantage of the system. The same goes for WIC. I have a friend that lived with her parents (who are well off) at the time she was pregnant and she enrolled for WIC saying she had to pay for everything herself and she was single (both lies) all in order to avoid paying for things such as formula. Should we as a nation take steps to help prevent disease instead of treating it after it occurs? Absolutely; however, there are plenty of preventative resources available that people choose not to take advantage of. Allender, J.A., Rector, C., & Warner, K.D. (2014). Community and public health nursing: Promoting the public's health, 8th ed. Philadelphia: Lippincott Williams & Wilkins.

[@danikabanter8632]

For one...WOW! Very inspiring. This is something that people, including myself, don't really think about. The fact that healthy people start from the community and their home, education and resources. Without some of these specific things that Claire Pomeroy stated, we would be spending far more money then what we already are! I hope to see change and I hope to be apart of that change!

[@monique1588]

I found Dr. Pomeroy’s talk regarding the social determinants of health interesting. She identified many flaws in our current health systems and social structure in general. I agree 100% that the focus of health should be preventative and not just reactive, after the fact care. I also agree with Dr. Pomeroy about taking the focus of health care out of the hospital setting and into the communities. I feel this is already starting to happen, with many health clinics opening up in pharmacies run by CNP. Education really is the key to prevention. Her ideas for reducing health disparities involve decreasing poverty by educational and job opportunity, creating social and national policies for change, safe neighborhoods, changing the allocation of the funding. When I hear her ideas, I see that much of her change will be done through lawmakers in Washington passing legislation and through lobbies and interest groups. Job creation has been on many American’s minds especially in the recent recession. Dr. Pomeroy asked, “What are you going to do?” I feel that as a nurse, my best action to create change regarding the social determinants of health is through education. Allendar, Rector, and Warner (2014) indicate that the Community Index is a tool that can be used in practice and for data purposes to help assess a persons socioeconomic indicators that can lead to differences in health. Though implementing this tool as a standard protocol to screen for areas an individual maybe at risk for may not be the best answer. I feel I can best make change by getting involved in the community, listening to my patients, and being an advocate. Where I can create the most change is connecting individuals to the resources available in the community. I have found to really know where a person needs help is to listen to their concerns, such as quitting smoking, getting a education, and wondering how to feed their family. I can assist persons with information on smoking cessation, resources available to complete a GRE, and the steps needed to apply for SNAP. Allendar, J. A., Rector, C., &Warner, K.D. (2014). Community and public health nursing Promoting the public’s health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins. ISBN-13: 978-1-60913-688-8

[@kelseygrawcock3347]

I enjoyed watching this video of Claire Pomeroy’s presentation and think that she is a phenomenal speaker who wants to empower people to make a change in their country. I was drawn in shortly into the video when Ms. Pomeroy said that “we have to think in a new way” to create and healthier world and we need to “address the underlying social determinants of health.” It seems that many people are static and are resistant to change, especially big change. It’s easy to think about creating a healthier world, but it’s a different thing to actually go out and do something about it. It’s inspiring that this lady is doing just that. Her personal story was also inspiring and it is great how she is using her experience in a positive way and a way that will hopefully help the country and its people. I completely agree that “medicine is failing our country” and that we have a system of “sick care” rather than health care. Rather than preventing, we are simply treating. I believe that nurses have a big role in this through prevention education. Nurses should educate clients/patients with regards to their social determinants of health (Allender, Rector, & Warner, 2014). For example, if you have a client that lives in an area without clean water, you need to educate them on filtration systems/boiling their water and resources where they can get clean water. We do need to be proactive rather than reactive. Claire Pomeroy also briefly talked about social justice. Allender, Rector, and Warner (2014) mention that social justice is an increasing concern in our country “because of the growing inequity in the distribution of disease, illness, and wellness across our society (p. 361). This is evident by the lower age expectancy for African Americans that Ms. Pomeroy mentioned, as well as her statement that lack of access to care translates into worse health outcomes. I often take for granted how blessed I am when it comes to health care and social determinants. I grew up in an upper middle class home and my social determinants of health were mostly good. I got a real idea of social determinants of health (although I didn’t know they were called that at that time) when I went on a mission trip to the Dominican Republic and saw they horrible conditions and multiple health problems. However, I didn’t realize that some of these disparities also existed in the U.S. and even in my city. It’s easy to remove yourself from the problems around you, but I’m glad that I’m in nursing and can see the problems in this city and country and how they affect health and hopefully I can help do something about it. Overall, there must be a collaborative approach by many people who care to help create social policies ensuring better care for all in our country. Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@sarahschlatter5054]

I think every one of us can admit that much of what we focus on is determined by what is important to us. I also believe she is correct in needing health to be a part of all policies. This is something that is also brought into light through Healthy People 2020.

[@morganwise3851]

Ms. Pomeroy’s explanation of the social determinates of health are very agreeable. I was not shocked to hear the number one social determinate was socioeconomic status. These statuses can be helpful, but they can also hinder a person depending on what level they happened to be born into. A person’s health is absolutely linked into their socioeconomic status. This is unfortunate because many of the people without funds suffer from great health strife and have to no means to take of themselves. Health should not be based on income, education, or ethnicity. It should be rooted in that fact that every person has a right to seek care and overall well-being for their body (Allender, Rector, & Warner, 2014). Pomeroy also puts perspective into the way this country focuses on its healthcare. There is a need for more community- based care because we focus so much on the hospital. The point is that with care in the community there is a chance that hospital visits and emergencies could be reduced. Educating individuals allows them to be more attuned with the needs of their body. This education can be easily set into motion by community and public health nurses. These nurses promote immunizations, preventative testing, education on diets, exercise programs, and the assist people in quitting the use of tobacco and alcohol. The way we are raised, the money we have, and the way we treat ourselves affect our health statuses (Allender et al., 2014). We need to strive to educate and provide the best care for every person in a community, no matter where they fall on socioeconomic spectrum. Reference Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing promoting the public’s health. 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@brookebuchanan4905]

Dr. Claire Pomeroy is a dynamic speaker who engages the audience with her emotional and real-life experiences. She illustrates, "a life of trauma that has lasting impacts." I found her story inspiring and perspective on social determinants to health care that doesn't always make the media. A perspective of a now prominent physician who lived her adolescent and young adult life in the system of foster care, uninsured, and poor. The message she has is one of action and change within the thinking of American people regarding outcomes to social disparities and living within the Healthy People 2020 objectives. According to Allendar, Rector & Warner (2014), social determinants are health disparities including those related to orientation, socioeconomic status, race, education, occupation, and violence. I agree with Dr. Pomeroy that by having a lower socioeconomic status, education or poor employment conditions can lead to increased health issues related to behavior and enviromental concerns. For example, someone with a GED or high school diploma living in a lower income neighborhood might be limited to the local rubber factory that has an increase in environmental carcinogens, might limit the amount of weekly income which in turn; limits that amount of money spent on preventative health visits and well checks. Also, the amount of money limited on the job due to their education can limit the amount of money they can spend on the outer aisles of the grocery store. Community and public health nursing needs to work with physicians, case managers, and other healthcare professionals to change the system from reactive to proactive. As stated by Pomeroy and a quote from Franklin D. Rooselvelt, "the test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little." I inspire to be a healthcare professional who does my part to impact a change in the way Americans think about healthy living. References: Allendar, J.A., Rector, C., and Warner, K.D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams and Wilkins.

[@kristipussehl4968]

I agree with you about the huge extent that education can play on health outcomes. By not having adequate education you are more likely to have a job that does not allow you to keep up with the costs of living. Because of this there would be a lack of access to healthier foods and proper healthcare and living condtions. I liked you example about living in a lower income neighborhood that may be positioned in an area with heavy air pollution. By living in these areas people develop chronic lung issues and then lack the resources to get treatment.

[@maddisonmoore1982]

I really enjoyed this talk. The woman Claire Pomeroy was very passionate in her speech and kept you interested in what she was saying. Now as to her content I very much agree with her. Social detriments do have an effect on how healthy a person is. If a person is poor and cannot afford education or any other necessities how are they supposed to gain the right knowledge or items needed to maintain good health. I really was interested in Pomeroy’s statement of how our health system is reactive instead of proactive. This is something I definitely believe. If we are to wish and hope for a health society how are we supposed to attain it if our citizens are not knowledgeable? Again how we even think to ask for this change if society does not provide the means? Allender, Rector, and warner, explain the stages of change which are unfreezing, changing, and refreezing. Unfreezing involves the realization of a want for change occurs. In this stage something that does not work is found out and people want to begin the process of change. During the changing stage a movement is made. People will research the source of the problem, begin to make a plan, and put that plan into place. The last step, refreezing, occurs when the change is found to be a good one and the change is here to stay (Allender, Rector, & Warner, 2014). If this process could occur within our communities programs may be able to develop to educate people about their health. Less expense would go to treating sick people and more to primary means of treatment. Allender, J., Rector, C., Warner, K. (2014). Community and public health nursing: Promoting the public’s health. Market Street, Philadelphia: Wolters Kluwer. Maddison Moore

[@chelseahannie2277]

The message Dr. Pomeroy delivered was powerful and inspiring. She started the presentation by calling her audience to action. It was different getting a physician’s perspective on community health. I liked that Dr. Pomeroy shared her childhood experiences with social determinants of health. She explained that we need a healthcare system that is proactive rather than reactive. Education is the key to preventing disease and illness. This would help to become a more proactive healthcare system. Dr. Pomeroy also explained that it is important to move from the medical model of health care delivery to the social determinants of health model. She explained that there are multiple factors other than healthcare provided in the hospital and physician office that influence an individual’s health. Allender, Rector, and Warner (2014) described that addressing the social, physical, and economic factors can have a positive impact of health behavior changes and can influence community health overtime. Dr. Pomeroy provided many examples in her presentation that represented the effects of multiple factors on health and well-being. She explained that individuals who did not finish high school were more than five times likely to have a poor health compared to individuals who graduated from college. Individuals living in poverty were eight times more likely to have poor health. These are just few examples of how factors other than healthcare delivery impact an individual’s overall health. Once we understand that social, behavioral, physical, and economic factor influence a patient’s overall well-being, we can begin to provide holistic care. Allendar, J., Rector, C., & Warner, K. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott, Williams, & Wilkins

[@autumnfear3444]

Social determinants of health exist and have an impact on health and care. She makes the valid point that our health care system should switch its focus from individual based care to community based care.This focus is in line with what community and public health nurses strive to do every day. As Claire states, this is a proactive rather than a reactive basis of care, which betters the overall population. This will help those with less than optimal social determinants.

[@aliciachristman8732]

Ms. Pomeroy explains the social determinants of health in her speech. She addresses the fundamental issues in America’s healthcare system and explains the role these determinants play in the health of our nation. Her key point was that socioeconomic status is statistically linked to health. This does not surprise me. I think that Dr. Pomeroy did a great job at painting a very real picture for the audience, and that using herself as an outlier to the statistics provided us with a powerful message. She shows how simply being educated makes a difference in the health of an individual, and she uses this point to call unto others to help her in her quest. Dr. Pomeroy explains that the physicians cannot nurse the nation back up to health alone. She says that our system must be proactive instead of reactive, and that we can do this by spending healthcare dollars essentially on public health instead of on treatment of existing health issues. Policies and programs should be implemented to provide children with education, to ensure that all races have equal access to housing and healthcare, and to provide jobs with adequate coverage and income so that these people will have the ability and power to grow to be a healthy individual. Addressing these social determinants of health will help create an environment that is conducive to healthier people and better quality-of-life (Allender, Rector, & Warner, 2014). Being born into a certain socioeconomic status shouldn’t be so powerful as to determine the individual’s future health. For example, a child born in poverty should not be unable to attend a good school because the child’s parents cannot pay for it. This is not the child’s fault, and it is now the community’s responsibility to address the child’s need of an education. This could be done by education -cost assistance programs, free school lunches and included transportation to local good schools, thus providing a formal education for the child. By addressing social determinants of health we can improve the social and physical environments, leading to improved health in our communities over time (Allender, Rector, & Warner, 2014). Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@timsteece8414]

Dr. Pomeroy brings to focus the issue of social detriments to health. Her personal testimony speaks volumes about the system. I was drawn to her commentary about creating a system that was proactive rather than reactive. Much of what is done in health care is reactive to disease processes that could have been acted upon before they became an issue. I felt that her video was a call for a more prominent focus on the community aspect of nursing instead of individualized care. I am a strong supporter of education and feel that health education needs to become a more social aspect of our lives. Many health issues could be avoided if prevention and screenings became widely available across the socio-economical spectrum. I think greater programs could be done about obesity and healthy eating. As someone who has struggled with weight, I wish I had been educated more on these topics when I was a teenager. After losing a substantial amount of weight and keeping it off, I feel strongly about preventing this issue. With the growing issue of childhood obesity, it is becoming even more essential that nurses educate the community on eating healthy and exercise.

[@sarahschlatter5054]

Her experience focus certain topics and my experience focuses me more on the financial and other barriers that individuals have to getting the help or healthcare they need and want.

[@stevieshane2312]

Dr. Pomeroy is an excellent speaker as she conveys such an inspirational message. It was captivating to hear about her humble, and somewhat tragic, beginnings and how she changed her life in such a positive direction! I believe that her unfortunate childhood is what motivated her to serve those who may not have a voice and advocate for health equity while reducing health disparities. She discusses that our country has the most deaths from treatable diseases among 18 industrialized countries as she goes on to mention that too many Americans are unable to seek preventive services. She made a profound statement when she spoke of initiating care before the onset of illness rather than after the patient is ill. Our healthcare system should be prevention-based so that we can prevent patients from facing the difficulties of illness. Community health nurses aim to prevent health problems from happening while encouraging a higher level of health (Allender, Rector, & Warner, 2014). For example, educating the public on the importance of vaccination, diet, exercise, and infection prevention are great ways in which we can reach out to our communities to help reduce the rates of illness. Dr. Pomeroy said it best when she stated that education improves health. When we provide education to our communities, individuals will feel empowered to take control of their own, personal health. The health of our communities is everyone's responsibility and we need to work together in eliminating barriers to healthcare to promote optimal health for all, regardless of adverse social determinants! Allender, J., Rector, C., & Warner, K. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott, Williams, & Wilkins

[@allissadever4883]

What a powerful and motivational speech. The more people that know and understand the concept of social determinants of health, the healthier our world will be as a whole. She did a great job explaining the importance of social justice and its impact on the community. Telling the story of the little girl and her journey into greatness was inspirational. According to Allender, Rector, and Warner social justice is described as “the view that everyone deserves equal economic, political and social rights and responsibilities” (2014, pg 106). This description can be better understood with the real life situation she was placed in and the social justice she was given through her foster parents which allowed her the ability achieve anything possible. Allender, J., Warner, K. & Rector, C. (2014). Community and public health nursing : promoting the public's health. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

[@sarahwebb2943]

It’s surprising to see how much our society views healthcare as only a narrow term rather than the more complex one that it is. When you really think about it, all of the components of social determinants are what aid in better health for all. I believe that if all health care providers really did show initiative as she shows in this video, our healthcare system and overall health and wellbeing of everyone would greatly improve and give everyone more opportunities for a healthier life.

[@ignaciogarcia6877]

This video certainly inspires me to support the change in our healthcare system. Enough is enough, time to act

[@millicentokeiyi5543]

This was an incredible presentation. she spoke on all aspects concerning the social determinants of health. thanks a lot.

[@madilynnscorner8401]

I thought it was really awesome that Dr. Pomery had such a rough childhood, and she looked at it in such a positive way and is now able to make a positive impact on others through her community work. "Widespread awareness that health and health disparities are the outcome of complex pathways of interconnecting social determinants of health" is a very important statement that I found in the literature that correlates with the mission that Dr. Pomery has (Krumeich & Meershoek, 2014). This can also be related to the statement Dr. Pomery made about how more money is being spent on helping people when they are sick than just preventing disease in the first place. This is very powerful and sadly very true. Krumeich, A., & Meershoek, A. (2014). Health in global context; beyond the social determinants of health?. Global Health Action, 71-8. doi:10.3402/gha.v7.23506

[@bernadetteipfw8200]

Claire Pomeroy gave very detailed insight discussing the corruption of healthcare. Social determinants should not determine your health status. What has ever happened to justice, equality and doing what is plain or simply “right”. I truly respect her opinion and the value that she holds in society today. She started as a vulnerable fourteen year old girl in foster care, saw the mistreatment of others that were not like her (blue eyes and blonde hair), and had a front view of their health status deteriorating before her eyes. Due to her experiences in life she decided to become a doctor and help others discover the impact of social determinants on healthcare and the community/population as a whole. We do need to come together as a community of PEOPLE and not just a community of healthcare workers to make a change. There are so many stories of the United States being in so much debt and unable to make changes, but news came to my ears when she stated that “there is enough money, but it is not being spent properly”. To know that the country we live in spends more money on healthcare than many other countries, but have the worst outcomes is just mind boggling and discomforting. People have become so stuck on the basis of “making money” and has totally forgotten about their soul. As Ms. Pomeroy stated, there is a lot of money being spent on “traditional” medicine and disregarding social services. We need to spend more time on primary prevention and overall health/wellbeing of individuals rather than focusing on the illnesses. We all know that it is more costly to treat an illness than preventing one from occurring. Our main goal should be creating a “healthy community”. According to Allender, Rector and Warner (2014) a healthy community is “health being more than an absence of disease, but including things that promote the maintenance of a high quality of life and productivity”. As stated before, we all must come together to make a change. So the next step should be to look at the different dimensions that make a community, which are: status/people, structure and process (2014). The “status/people” that make up a community can in a sense determine the health status (physical, mental, and social determinants) in the area. Example of these social determinants include young single mothers, high school drop outs, high homicides and death/illness (2014). This is where positive leaders within the area step in and make a change to mentor, counsel or provide resources to help. Many people forget that “health” includes the mind (mental), body (physical) and soul (feeling). I mention feeling because Ms. Pomeroy included that the feeling of not being valued went hand in hand with poor health status. So when referring to health we are not just referring to someone’s physical well-being. The next issue refers to the “structure” of a community. The structure includes what services or resources as available to the individuals within a community. Often healthcare providers abandon underserved areas because of socioeconomic status, race, education and occupation/job security, which are all a contribution to the poor health status of the people living within that area (2014). Another interesting point that Ms. Pomeroy stated was, people who are not educated are 5x’s more likely to have poor heath than someone who has college experience and/or knowledge. I do not know when it was established that your life experiences or status will dictate the nature of your health, but I do know that it is nothing less than inhumane and is in need of a change. The last dimension of community includes the process of how it functions. A community must function in accordance with education and health. It is now up to the community nurse to seek the strengths and limitations within a community and create a plan to fix the issues, actively solve the problem or try to, and evaluate its effectiveness. In a nutshell, it takes heart and not a college degree or med school to change the way your community is viewed or treated. Allender, J. A., Rector, C., Warner, K. D. (2014). Community & public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott Williams & Wilkins.

[@jennybrewer9861]

This talk by Claire Pomery puts a lot of things into perspective regarding the current health problems. I agree that as a country we need to be proactive and more community-based in healthcare and less hospital-based. We should not focus on just the ill, but rather spend more money on social programs to help be more proactive. There are many individuals in the health community that are taking that step or already have been proactive including community health nurses. These nurses can become aware and more educated about factors that affect a populations' health (Allender, Rector, & Warner, 2014). After reading some of the comments I also agree that we can push and try to be advocates, educate, and provide health services to be proactive but the individuals also have to be motivated. For example, a nurse can go to a community center and talk about options for healthier eating and how to cook healthier options. The individuals have to have some form of motivation besides the nurse to buy these food choices at the store and keep up the lifestyle. Hopefully by educating more people about Healthy People 2020, more of the general public will become aware and motivated to stay healthy or become healthier. Allender, J. A., Rector, C., Warner, K. D. (2014). Community & public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott Williams & Wilkins.

[@marcusjames9]

In this video, Dr. Pomeroy offers a unique perspective on the social determinants of health and how they are affecting the public's health. I believe she makes a great point in recognizing the amount of people who are uninsured (51 million) and discussing "unconscionable disparities," in healthcare today, such as race, ethnicity, income, education, marital status and geography. I also really enjoy her idea's on a paradigm shift from disease-based care to preventative-based care.

[@sylviasordelet5676]

Claire Pomeroy brings up many issues with the healthcare system. She brings up her own story and the story of many who go through a similar situation. Our healthcare is spending more money but not having good results. I like how she brings up the fact that we have a “sick care” system. There are many times people end up in the hospital for diseases that could have been prevented or rehospitalized because the patient did not have the resources or knowledge to fully recover. To me it seems there is a lot more money involved in the hospital/acute care setting rather than the community/prevention/rehabilitation settings. I feel like as a country we need to have more resources in these areas and have more incentives for healthcare workers to work in this type of environment. The social determinants of health do have a factor on a person’s overall health, like she said the emergency room is not the place for a regular healthcare visit. If we had a proactive verse a reactive healthcare system the healthcare costs would go down.

[@shanap25]

Pomeroy and the US Department of Health and Human Services (2013) both mention social determinants of health. After watching this video, I could not agree with Pomeroy anymore. There are so many different social determinants of health that greatly impact our health. After my clinical experience last week I realize that these factors really do affect individuals and I really hope to see and be apart of the change.

[@angiewaterson]

What an awesome and inspirational video. It is refreshing to see a physician give a speech, advocating for public health promotion. She is in a powerful position to make significant changes in communities and recruit people to help make her speech a reality. It takes passionate people about healthcare to make the changes needed. Being able to understand social determinants will help address factors that can cause health disparities which then can help the community health nurse educate the community on ways to improve their health and advocate for the patient (Allender, Rector, & Warner, 2014). I feel that as healthcare providers, we can get caught in a bubble with blinders on. It is so imperative to realize the big picture of what the cause and effect are of health problems. Dr. Pomery also stated how we are a reactive medical health care system and not proactive. By getting out into the communities and educating the vulnerable population requires us to get out of our bubbles and comfort zones. We can make a difference. I, like Dr. Pomery, was in a similar situation growing up. I was not in the best situation growing up but I was able to overcome my socioeconomic status and I realized, I wanted to change the vicious cycle. I did not want to become a negative statistic. It only takes one person to make a difference. Allendar, J., Rector, C., & Warner, K. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott, Williams, & Wilkins

[@danyelfurge5804]

It was really cool that Dr. Pomery was that child, who had all of the social determinants going against her and then for her to be giving a TED talk and inspiring others to change the face of our health care. Social determinants are the conditions we live, play and experience life in that affect our health (Allendar, Rector & Warner, 2014). Dr. Pomery gives the example of the elderly Caucasian man who had to travel 30 miles for a fresh foods market and all the areas around him were fast food and canned items with little health value. One of the Healthy People 20/20 goals is for grocery stores to be closer and more easily accessible. The food we put in our bodies has a direct correlation with our health and the ability to live a long, healthy life. If a person from a poor community eats food with low nutrition that leads to poor health and it may not be possible for this person to get good health care if they are uninsured or under insured like Dr. Pomery was saying. This is a vicious cycle that many people get stuff in, unfortunately. I also thought it was interesting that Dr. Pomery said we always hear people saying that there is not enough of the healthcare money to pay for these programs that are needed to help lower income communities, etc. but as Dr. Pomery pointed out that we are just spending the money we do have in the wrong places. I loved that Dr. Pomery did a call to action because the change starts with awareness and we the people have to push to change the outcome for the vulnerable population. I totally believe that it starts with us and we need people to understand this topic and educate on how people can help the vulnerable populations succeed amongst difficult social determinants. Allendar, J., Rector, C., & Warner, K. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott, Williams, & Wilkins

[@veronicamcfarlane8707]

What a spectacular narrative and call to action by Claire Pomeroy!!

[@allywirkus7645]

Dr. Claire Pomeroy’s lecture was very moving, humbling, and touching as she shared her personal story about how reaching out in acts of kindness can ultimately save a life. In her example, her own life was saved. I think it is truly important to reach out and help those who have little in a society to benefit public health and eliminate disparities by improving the social determinates of health. The statistics that Dr. Pomeroy presented were saddening. She stated in United States “medicine is failing”, but the worst part of that statics is that as much as 35% of Americans do not even have access to receive this “failing” benefit due to lack of access to healthcare. This is a huge social determinate health disparity. This disparity in the healthcare system should be minimized that all individual receive holistic and the same type of healthcare regardless of income, socioeconomically status. Healthcare should be a right to everyone, not a privilege. The most important perspective I have gained after watching this video is that healthcare should be based on a new, revised, achievable paradigm of improving health and social determinates of health by becoming proactive rather than reactive to our health. It is so important to implement primary prevention strategies to prevent health problems of occurring. According to Allendar, Rector and Warner (2014), if nurses were to implement more primary prevention strategies, it would reduce years of premature illness, diseases, and deaths. In regards to social determinates of health, it is crucial to implement health promotion in the homes, schools, and jobs. I believe the social determinates of health including where a person lives, where they work, socialize, or interact and even how they get from one place to another have a major contribution of a healthful lifestyle, or lack of for that matter. Transportation is a huge social determinate of health. For example, if a person lacks a means of transportation they reduce their ability to easily access food, work opportunities, and even health care access. In the United States, we have the capability to come together as a nation to reduce the disparities and improve the social determinates of health to improve our health for every person. Thank you Dr. Pomeroy for creating awareness and perspective on improving the social determinates of health! Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins

[@alyxschlotter3260]

Ms. Pomeroy put it best when she said, "we focus on sick care not health care." In this country the only way lower income and uninsured get healthcare is when they are in need and extreme need and have to visit the emergency room. They do not have access to preventative screenings or educational materials. In Indiana specifically as I am sure is the case in other states, people have to jump through hoops to even get on medicaid. Some low income people make "too much" money or are unable to miss work in order to turn the proper documents in on time. There are so many issues that I feel I could write for days. Community interventions can and should be put into place. For example local community centers could offer free screening once a month to all who come. We should focus on having more educational materials in the schools and make health choices affordable. It is sickening to me to see wealthy individuals throwing lower income citizens under the buss in saying they don't care enough about their health to make good choices. The truth is that their situation in life doesn't afford them the option of making healthy choices and that is a viscous cycle. We end up spending more on taking care of the sick than it would cost to help prevent illness in the first place. Community nurses play a major role in evaluating need and putting plans into action (Allender er al., 2014). As Ms. Pomeroy said, " every social policy in our country should consider the impact on health." Every single aspect of our daily life will affect our health in some way whether that is in a physical or mental aspect.

[@tamamberg]

While professional health care providers and social workers may initiate interventions to improve social determinants of health, any person that cares about the wellbeing of others is qualified to join the effort to create a healthier world. I applaud the challenge here to transform our mode of operation from the medical model of treating illness to a new paradigm of promoting health, preventing illness, and reaching out to others with kindness. Healthy communities encourage healthy individuals.

[@katlynarrivillaga4595]

Dr. Pomeroy’s discussion on social determinants of health surfaced many strong points. She was vulnerable to share her personal story of running away from home at such a young age. She also brought up young veterans being turned away from their own families as their health deteriorated. This statement opens my eyes to the young population in need of healthcare services. In today’s society it is common to stereotype in need people as elderly; however, young people are also in need. Her talk broadened my view of the on how much the United States spends compared to other countries, but how worse the outcomes are. The lack of access in this system is concerning and should not be overlooked. There are so many uninsured people in today’s society. I agree that major disparities such as: race, geography, orientation, and socioeconomic status exist throughout the country. These disparities should not exist and healthcare should be an equal opportunity for every person. I believe that a lack of education is also a contributor to poor system of social determinants of health. Dr. Pomeroy mentioned that those who feel devalued have poor health. From my experience, patients who are given the time for an education session and an ear to listen feel more confident and able to be compliant with their plan of care. An example of a social determinant-effecting healthcare given to a population is how the children at Timothy L Johnson have a scare supply of books to read, access to internet, and nursing aid based on geographic location and socioeconomic status. Also, the excessive amount of fast food places is an unhealthy influence to the population in that area. Allender, Rector, and Wagner (2014) state that a population is as healthy as the environment around them. Reference Allender, J., Rector, C., & Wagner, K. (2014). Community & public health nursing: Promoting the public's health. (8th ed.). Philadelphia, PA: Lippincott Williams & wilkins.

[@1brandonem]

I agree with what Pomeroy is saying in this video. According to Allendar (2014) the fact that people are born into poverty or find themselves in a situation in which they lose everything it can cause health to be poor or decline. It is the community and public health nurse job to assess this and make referrals accordingly.The fact that low income people tend to be more unhealthy is a main theme in social determinants of health. It is like Phil stated in his post that it is a powerful message.

[@jessicacalvert310]

I completely agreed with Dr. Pomeroy, especially when she said we needed to change our healthcare system to become more proactive rather than reactive. I had never really thought about it before, but after hearing that statement, it became clear that our health care system truly could be called “sick care” instead of health care because it seems to be more common for health care providers to wait and treat sick people, rather than trying to prevent people from becoming sick in the first place.

[@ferdowsa770]

Ms. Pomeroy made numerous important points with regards to healthcare in the United States. Social determinants of health such as race and social status exist and unfortunately many people including children, the elderly, and other vulnerable groups in our communities have to suffer from disease and poverty-related illnesses. Being a part of the healthcare team, I understand the importance of preventative health habits that aid in decreasing the spread of infection and disease progress. However, it is very costly to be healthy and many people suffer from preventable diseases because of lack of education, poor nutrition, or being uninsured or underinsured. I personally do not have health insurance and visiting my doctor for a simple checkup costs too much that I try to avoid going to the doctor unless absolutely necessary and by that time, it would probably be an emergency. As Ms. Pomeroy stated, the emergency room is not the ideal place to be treated. I completely agree with her regarding the need to adjust policies and that our nation needs to be proactive instead of reactive. Although government aids come from taxes, we need to focus on the common good because overall, the health of the community correlates with the health of the individual (Allender, Rector & Warener, 2014). Basic necessities of life such as food, shelter, and healthcare need to be for everyone regardless of social status. Household social status greatly impacts an individual’s education, health, and future. It may seem like we live in a nation that is full of opportunities and the poor are the ones that do not take advantage of those opportunities. In reality, being poor is very confining and limits the chances for advancement. Income affects health and poverty is greatly associated with poor health (Allender et al., 2014). I totally agree with Martin Luther King Junior when he stated that the inequality in healthcare is the most inhumane of all inequalities and I think there should be social reform acts to correct this. Healthy foods such as fruits, vegetables, milk and eggs should be made affordable for everyone as well as gym memberships, doctor visits and prophylactic measures. Reference Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th ed. Philadelphia: Lippincott Williams & Wilkins.

[@felishaziko4770]

I completely agree with Ms. Pomeroy’s opinions on the social determinates of health. I was shocked when I realized the number one social determinate was socioeconomic status (income). To think that one’s health is in the hands of their income and socioeconomic status is scary. Americans should be given choices to live long and healthy lives rather than it be determined by their income education and ethnic background (Allender, Rector, & Warner, 2014). Another great point that Ms. Pomeroy made was that in the United States we focus on sick care rather than health care. I know we have made strides toward primary care of health education and disease prevention but majority of the time people only seek help when they are very sick rather than promoting their health before they are sick. I am going to be very honest and state that I am part of that group. I do not have insurance and only seek care when I am very sick. I may be a little different though because I have received the education on how to prevent sickness through sleep, eat healthy, wash my hands, and reduce stress, but many people do not have this education. This is not the populations fault. This is healthcare’s fault for not focusing and putting much effort into reaching out to prevent disease and promote health. As stated by Ms. Pomeroy we need a new health paradigm of primary care that is population and community based. Once this is established health care rather than sick care can begin. Reference Allender, J.A., Rector, C., & Warner, K.D. (2014). Community and public health nursing promoting the public’s health. 8th Edition. Philadelphia: Lippincott Williams & Wilkins. (I could not do a hanging indent for the reference)

[@michellejohnson6075]

I agree with Ms. Pomeroy's opinions of social determinants of wellness. A person's income or socioeconomic status does play a big role in the types of food people have access too, the type of care they have access too, as well as if they will seek or participate in preventative care to stop future health issues. The purpose of Healthy People 2020 is to educate communities on the importance of healthy living, as well as provide them with the opportunity to create relationships with health care providers, seek preventative care and receive screenings that will access their current health status. I also agree with the point that the type of job a person holds, where they live, and their education are also determinants to the type of health care people receive, as well as determine how healthy a person will be due to limitations presented due to these issues.

[@michellejohnson6075]

I also forgot to mention that even living in a middle class home, there are determinants due to income. You see, organic fruits and vegetables, as well as meat, and milk are extremely expensive ($5.99 for a gallon of organic milk on sale). This makes healthy eating a choice and a sacrifice to provide the most nutrition meals and food for your family. There have been times that we have had to sacrifice nutrition for a budget, especially when the recession hit. We take for granted, in the middle class, that we are able to make that sacrifice, when others in the lower class do not have that choice or option.

[@gracemaurer7208]

I have to say, Dr. Claire Pomeroy’s video on the social determinants of health is very compelling. As she begins to speak, Dr. Pomeroy opens up about a 14-year-old girl living on the streets. As the audience, you don’t really understand where she is going with this story until she reveals the identity of this girl, being she. As that teenage girl who was thrown into foster care, she had many social factors working against her possible success. She turned her experiences into a career where she learned about race, equality, social justice, and kindness. Many people don’t acknowledge the fact that “medicine is failing our country,” in the words of Dr. Pomeroy. She further pointed out how the United States (U.S) spends nearly twice the amount of money on healthcare than other similar countries and yet we have the worst health outcomes. This fact was quite revealing to me, as this indicates our money isn’t being allocated properly. However, although our healthcare system is failing, many people who are uninsured or underinsured do not have access to it, which further leads to our country’s poor health outcomes. This boils down to the social determinants of health, as expressed by Dr. Pomeroy. Unfortunately, in our country, health is determined by race, ethnicity, geography, orientation, socio-economic status, education, and occupation among others. Dr. Pomeroy states that the health of individuals should not fall on doctors and physicians. It depends on the government and the community; it means caring for individuals. I like how she mentioned community-based care instead of hospital-based, which is what traditional healthcare is in the U.S. I can remember several instances where I have been in various Emergency Rooms and have noticed a trend in the people in the lobby. Many of these people would be considered part of the vulnerable population, the poor, the uneducated. What I have noticed is that these individuals are seeking treatment when illness or disease is already present and maybe too late, due to these social influences as previously discussed. Our healthcare system should revolve around prevention rather than treatment. The social inequalities of our country should not determine our health. Going along with Dr. Pomeroy’s idea, Allender, Rector, and Warner (2014) identify eight principles of community/public health nursing. These include focusing on the community, giving priority to community needs, working in partnership with the community, focusing on primary prevention, promoting a healthy environment, targeting the right people, allocating resources properly, and collaborating with others (Allender et al., 2014). These same eight principles is essentially what Dr. Pomeroy is trying to convey as the recipe to optimum health outcomes. Community begins with you and me, so Dr. Pomeroy, I am recruited! Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

[@adaomangari1052]

im So inspired. I want to become a Primary Care Physician and this is exactly why.

[@elizabethgriffin175]

I found Dr. Pomeroy’s speech very inspiring. I have always been passionate about expanding healthcare to reach everyone, not just the privileged. I have never been able to understand why there are some that believe it is acceptable to turn their back on someone else in need just because that person might or might not have an addiction or random problem A that makes them unlikeable. As someone who works in the healthcare field, I try to remind myself each time I walk in the door of a patient’s room that it is not my place to judge them. Sometimes it can be difficult-if the patient in question is a child molester, or it takes four people to move said patient because they have eaten their way to five hundred pounds and it seems like they just don’t want to try and take care of themselves at all, it’s hard not to judge. But everyone is shaped by their own life experiences, and it is my job to take care of them regardless. I thought that Dr. Pomeroy made an excellent point when she said that we are spending money on the wrong things-we are providing sick care not health care. If we take the time and effort to educate the public and promote illness prevention, we will improve our healthcare situation dramatically. We need to be “proactive, not reactive.” It is a job that will take the participation of everyone, not just a few people that want to help. Instead of turning our backs on people that we deem less than worthy or people that we don’t like, it is up to us as a country to find ways to bring social justice to others and improve our healthcare system so that everyone has a fighting chance at a healthy life. Pomeroy, C. (2012). Social determinants of health: Claire Pomeroy at TedxucDavis. Retrieved from: Social Determinants of Health: Claire Pomeroy at TEDxUCDavis.

[@theeagleeye27]

Social determinants put people in certain circumstances just as Claire explains through her own personal struggle. This is especially important in the aspect of healthcare, these aspects (social determinants) need to be positively influenced which will facilitate and support individual growth. A healthier individual can potentially turn into a healthy population, society, or community.

[@jordanweber8178]

I believe this TED talk took most people by surprise. In this video Dr. Pomeroy discussed how social determinants can affect health more than people have previously believed. For instance, she stated that education is what drives health. Her statistics prove that the more educated an individual is, the more likely they are going to be healthy. She focused on the fact that the United States focuses on "sick care" and we are reactive instead of proactive, and we need a system that coordinates care instead of fragments care. She stated the importance for population and community based care. I believe that spending money on education and social services like Dr. Pomeroy talked about in her video is more beneficial than treating the disease after it happens. For instance, having diabetes prevention and education workshops for those who have a family history of diabetes or are high risk could help eliminate hospital stays and be more cost effective. It is each community member's responsibility to take an active role in their community to help make it the healthiest it can be. I really appreciated Dr. Pomeroy's speech.

[@jordanweber8178]

According to Allendar, Rector & Warner (2014), there are eight steps in order to create a planned change. The first step is recognizing and assessing symptoms, second is diagnosing a need, third step is analyzing alternative solutions, fourth step is to select a change, fifth step is to plan the change, the sixth step is to implement the change, the seventh step is to evaluate the change, and lastly stabilize the change. The changes Dr. Pomeroy refers to in her TED Talk aren't going to happen overnight, we need a process to implement this change. Using these measured steps, we can identify a specific need in the community and attack it with a strategy. Overall, making a change in the community can be difficult because once a population is set in their ways, it can be difficult to deter them, however, in order to implement Dr. Pomeroy's ideas on a community, a planned change with strategic steps and interventions need to be applied to solve the overall issue. Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins

[@devonmcdaniel4581]

I agree with Mrs. Pomeroy when discussing the social determinants of health. When learning about healthcare and the patient population, “physical conditions in the environment in which people are born, live, learn, play, work and age…. Social and physical determinants of health…. Impact a wide range of health, functioning, and quality of life outcomes” (Allender, Rector & Warner, 2014, p. 467). Meaning that someone’s level of income, race, and gender influences the care that is given. Social health determinants intervene with healthcare to the entire population. Mrs. Pomeroy states very well that we provide “sick care, not health care”. This means that we spend more money when patients are sick rather than preventing the illness. If more money was spent on primary care interventions such as education about disease processes, people would be least likely to participate in activities that could increase their chances of contracting a disease. An example would be hypertension. If the government provided money to education programs in order to educate the community about the cause of hypertension, other than genetics, we could decrease the occurrence of hypertension. The things we eat, such as sodium can affect hypertension. Sodium is found in ALL foods, however making healthy food choices can help decrease the severity of hypertension. This is a simple piece of education that can prevent further heart diseases and the long-term effects of hypertension on the human body. I agree that the time is now! We should work on designing programs that allow for the low-income, uninsured, and the underinsured to attend in order to have yearly screenings for things such as hypertension, diabetes, and other screenings that are nearly free to the public. Reference Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing Promoting the public’s Health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@amandabatta1784]

I agree with Claire Pomeroy that socioeconomic status directly affects the statistics of the heath of individuals in the US, but we as individuals can't change others socioeconomic status. An example of a person's socioeconomic status and how it affects their health would be the homeless population. Homeless people are unable to afford living facilities let alone health insurance. Because of this, homeless people tend to become more ill and have more serious illness because they do not have the resources to get the help they need to prevent and/or treat illnesses. Claire talked about working with veterans that were diagnosed with HIV/AIDS. She stated that she watched the families of the veterans turn them away and refuse to have anything to do with them because they did not agree with their choices (being gay). I agree with Claire when she said that a way we can help improve the health care is to teach others to not judge others based on their personal decisions, and to not let others personal decisions affect our care for them. We need to practice and teach understanding and acceptance of others, and how important it can be in the health care.

[@allisonbratten1501]

I enjoyed this video and Dr. Pomeroy's view on social health determinants. I think she touched more than once on how our life priorities and views/goals are often shaped by our experiences. I find this to be very true and a reality I don't believe a lot of people realize. For example, when there are homeless people on the streets or people asking for extra change or dollars I have personally seen and heard many people express that they will never help or understand why people are in these situations and often insinuate that there must be an underlying problem such as addiction within this person. I will say every person I have heard share this strong view point has grown up living a relatively privileged life and has never known what it is like to really struggle or unexpectedly lose a job or have expensive health concerns. This is an example of how our views and priorities can be shaped on our experiences. Someone who was born into a situation such as poverty or even being homeless would understand that not all cases are alike and many people have not had the opportunity or help to live differently. As for the speech, my favorite part was when she shared the slide about starting a new paradigm and looking at health care differently. If there was more time and money invested into primary health prevention versus SO much money and time into the health care system after there is already a sick patient, we could possibly avoid a lot of illness to begin with. Her views were very revolutionized and I believe there needs to be more effort focused on this end of the spectrum.

[@allisonbratten1501]

If we focus more on teaching about social determinants of health and helping our communities understand it better there will be more understanding of ways to reach this primary health prevention (Allender, Rector & Warner, 2014). The world needs to look at healthcare in a new light just how Doctor Pomeroy explained, we need to be proactive versus reactive. Healthcare should start at the basis of keeping the community healthy versus just caring for the sick patient. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins

[@mindeeconey855]

I really like how Doctor Pomeroy addressed that we all need to be proactive versus reactive. If we can could focus on primary preventions such as: education, screenings; and exercise, the health in the community would increase, which is beneficial to us all. She really touched me when she stated, "reaching out in kindness can literally save a life." I was blessed to grow up in a family where all my needs are met, but there are many who are not as privileged. Instead of being judgmental, it is important to reach out in any way. This could be as simple as volunteering time at a local shelter, or food bank.

[@chidimmanwankwo5286]

Claire Pomeroy’s presentation addresses a major healthcare issue found within our healthcare system. Pomeroy makes a sad but true point in the video, that the healthcare system provides “a system of sick care not healthcare, acute intervention/crisis based not primary care based system” (2012). Before this video I didn't realize the unquestionable impact social determinate had on health such as; education, social economic status, occupation.

[@megandaniels5215]

This TEDTalks video is very interesting and directly relates to community and public health nursing. Dr. Claire Pomeroy is an excellent live speaker. She made several points that got my attention. She mentioned in order to create a healthier world, we must get away from traditional thinking. The United States provides “sick care” not “healthcare.” This is a problem. Practicing preventive healthcare is the best method to prevent disease from happening in the first place. For example, a person should practice good health throughout their lifetime. In the real-world, a person could simply start eating a balanced diet and exercising at least three times each week. Regular doctor check-ups are also good health practices that promote preventive healthcare. Preventive healthcare seems to be an easy task. However, in The United States, Dr. Pomeroy stated that less than half of the people have needed preventive care. The United States has the eighth lowest age of life expectancy at birth and the fourth highest rate of infant mortality. Like Dr. Pomeroy said, “It is shameful.” In order to change these statistics, The United States must all come together to make a change. We must look at behavioral patterns, genetic predisposition, social circumstances, health care, and environmental exposure. Dr. Pomery stated now is the time to analyze our social determinants of health and build a country that we want to live in. Healthy People 2020 defines the social determinants of health as the environment that people are born in, work in and learn in. A healthy community recognizes the variety of health problems and determines health care services to meet those needs (Allender, Rector, & Warner, 2014). A real-life example of this is in my hometown. The Matthew 25 clinic in Fort Wayne, Indiana was built downtown to meet the needs of my community. Last week in clinical I was at the Matthew 25 clinic. The very first patient I was with was an African American man who was from Chicago. He does not have any family or a support system in Fort Wayne, Indiana. He walked to the clinic when the temperature outside was only one degree. Not only did he look cold, but he also looked miserable. I realized, like Dr. Pomeroy mentioned, it is likely for the people who lose hope, to have bad health. It is important to care for the vulnerable. I took his vital signs, and then we had to wait on the Nurse Practitioner to arrive. So, I began a conversation. He mentioned to me, “I stopped taking my heart medication over a month ago. I was losing hope. Last week I started feeling terrible. I want to get my life back on track.” The Nurse Practitioner told the patient that he had an increased chance of a heart attack based on his circumstances. The importance of starting a healthy diet and losing weight were taught to the patient. This is an example of promotion of preventive care and encouragement of good health practices. This will decrease the possibility of the patient ending up in the hospital due to a heart attack. Like previously mentioned, now is the time to join together to create a healthier world. Reference Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing promoting the public’s health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@sarahschlatter5054]

One individual that comes to mind works a full-time job in the medical field and has health insurance coverage for her entire family. However, due to financial difficulties and an inability to take time off of work, she is unable to afford the copayments needed and to take her children for appointments to provide her family with the healthcare they need. I think that Claire Pomeroy did a great job of touching on changes that are needed but just as she said, focus is determined by experience.

[@NR-bd3he]

Dr. Pomeroy makes several good points in regards to how our healthcare system has been, how it currently is and how it what direction it should go. Discrimination is something that has plagued healthcare just as it had negative influence on many other aspects of our society. In the past healthcare discrimination has been more or less directed towards those who are not Caucasian, such as African Americans and other races and ethnicities. Although there are equal rights laws that are in place to protect those who are of different ethnic and racial background, healthcare still has its issues in regards to providing care to all who need it. This issue can commonly be seen with the care or lack-thereof of those who are uninsured. Those who are uninsured suffer from discrimination and a lack of compassion from healthcare providers in providing them care. This may be because there are many Americans who take advantage of the public healthcare systems and could be working and contributing to society; however, there are American’s who have illnesses that may not be physically debilitating and is not visible, such as mental disabilities. Providing holistic care in a fair and non-judgmental fashion to all who need healthcare services is the job of the nurse. Specifically speaking in regards to a community health nurse; it is the job of the community health nurse to assess communities where discrimination towards those who do not have healthcare insurance is most prevalent. The nurse must assess the healthcare facilities that are providing care to these types of patients. According to Allendar, Rector, and Warner (2014) the nurse must go through the stages of change in order to make changes to this system. There are three stages in this system and they are: 1) Unfreezing, which is where there is disequilibrium in the system and there has to be a change to this system in order to restore equilibrium. 2) Changing/Moving, which is when the nurse will provide education to the healthcare providers as well as the patients about the problem that is at hand and what changes need to be made in order to restore equilibrium. 3) Refreezing, which is when equilibrium is restored and the changes that the nurse has made become a part of the new system. I have never been without health insurance, but my uncle is a recovering narcotics abuser and he has been without narcotics for almost two years, but he does not have healthcare insurance. He has several behavioral and mental illnesses that prevent him from contributing to society in a way that he is rewarded with benefits such as health insurance. He is enrolled in a local mental health program that provides him with a place to live and food. He has applied multiple times for government supplemented health insurance, but his application has been under review for over a year, so in the meantime he has been without insurance. He was recently admitted to a local “for profit” hospital as a trauma; however, if he were not a trauma, this hospital would have turned him away because he did not have insurance. While he was there, the ED nurses did not provide him with adequate care such, primarily in pain relief along with comfort measures such as ice on his fractured clavicle and bandages or gauze for his seeping wounds and it appeared that he was not receiving this care, because of his history along with the fact that he did not have insurance. Allendar, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th Edition. Philadelphia: Lippincott Williams & Wilkins

[@cortnie01]

Nick, great job pointing out the stages for making change in the system. As a community nurse, it seems that one of their key roles is providing education whether it is to the public or other health care members. In order for change to occur, they have to get other people to work together or inform the community. I also like how you mentioned never having to be without health insurance. I haven't had to go with out it either, but I know there are so many people out there that don't have it. There needs to be more health care clinics for free access to health care. This would really improve the health of communities.

[@amandaclingerman7044]

This speech is very inspirational and definitely puts into perspective how healthcare within the US works. There is a definite need for change. I completely agree with the want to have health promotion and disease prevention. Throughout community nursing there is a great want and need to prevent disease through education. Socioeconomically there should not be predetermined health level. Everyone deserves the right to choose lifestyle choices to better their health rather than hinder. Many under educated individuals do not understand the risks of their behaviors, such as smoking. This speech definitely encourages me to want to share the education and understanding to prevent diseases that can arise from high risk behaviors. And in return lower the cost of "sick care" and increase preventative measures would benefit the community as a whole.

[@aishagerber7188]

I have a friend who was born into a lower socioeconomic status. She lives on the “bad side” of the city and her dad worked for a factory. I was born into a higher socioeconomic status, my father owned a company and my mother stayed at home with me and my siblings. As we grew up my friend tended to get into trouble and make some bad decisions. She was pregnant at the age of 14. She had her second child at 16 and then her last one at the age of 19. Along with her status were stigmas placed on her because by the age of 19 she was a mother of three. The father of the children was in prison and she was left alone to care for them. One day her oldest son was sick. My mother took a look at him and believed he had strep throat and suggest she take him to the doctor. She refused because she did not have the money to take him for a doctor visit, let alone the ER. If I was the one that was sick, my family would not hesitate to take me to the doctor to be put on antibiotics. But because my friend who was born to parents who did not have as much money, who was not taught the value of education or provided with the opportunity to excel, she already had some of her health future laid out for her the first time took a breath. Her children then begin to follow in her footprints. And since we, as a community, have not placed anything in the way to help them, the likelihood of that family having good health care is slim. Dr. Pomeroy had many strong opinions that she expressed. Through further thought I agree with everything mentioned. While I was thinking why I agree I came up with a few reasons. Besides the personal experience I had with a friend, I have seen it in other countries also. It is a common theme that money, education, job status, socioeconomic status, race, etc. will depict the kind of care you receive and can afford. We also need to focus on the idea of prevention. She mentioned several times that our health system focuses on the idea of acute care, fixing the sick, where in fact we should be focusing on the idea of preventing the illness from every starting. Allender, Rector, and Warner (2014) made a good point that each socioeconomic status has their own health problems. As a community it is our job to help meet the overall need of each of these classes to provide a healthier community. Dr. Pomeroy also mentioned that the weight of the society’s health can not be on the doctors. I agree, it cannot be on anyone job title. If you look at health of the community as a whole, instead of each individual, you will be able to see common themes emerge. These themes may be housing or income or education or obesity or hypertension. The social determinants interact with the health of the community. It takes people from every area of the community to come together, work together, and begin working on the social and health factors presented as a whole. Allendar, J. A., Rector, C., & Warner, K. (2014). Community and public health nursing. Promoting the public’s health, 8th Edition. Philadelphia, PA:Lippincott Williams & Wilkins.

[@jessicamiller6917]

Upon watching this video, I feel that Dr. Pomeroy is an excellent speaker and she is intriguing to watch. The story about her being a 14-year-old foster child was inspiring especially seeing how it affected her today and how much of an impact she is making on people. She is a true believer in making the world a better place and that starts with healthcare changes. In the video Dr. Pomeroy went into further detail explaining how our healthcare system needs to take a proactive approach. Instead of waiting for people to become sick and seeking help, we should prevent them from becoming sick in the first place. I agree with this speaker completely because it is frustrating to see people in the community who cannot go to the doctor because they don’t have health insurance or they do not have the sufficient funds to do so. It does not seem fair to me why an African American individual should not receive the same healthcare as a White individual. Just because a person did not grow up the way another person did and was not blessed with things the privileged take for granted, does in no way mean that they should not get equal health care. Why should the social determinants affect the health status of a person? According to Allender, Rector, and Warner (2014) these determining factors show not just the social aspects but also the physical circumstances in the environment and these elements “impact a wide range of health, functioning, and quality of life outcomes” (p. 469). We need to promote a healthier community and country so that people’s needs from all social classes are met. By observing these factors in a way that can have positive outcomes it could assist in changing the health of various communities over time. Community health nurses play a very important role in this topic because they are the ones who see first-hand the population of people in the community in which they work and they can address the social determinants of health, thus influencing health in a beneficial way. I feel that in my future role as a nurse, whether I am out in the community or in the hospital setting, it will be important because I feel that every person in this world should have an equal opportunity to be able to make the healthiest choices they can in order to have good health. But, it starts not in healthcare, but rather in other areas such as making the environment cleaner, providing education to those who cannot afford it, laws, etc. As in the video, Dr. Pomeroy stated that she thought healthcare funds were being spent in the wrong places, and with that I completely agree. Let’s start making the changes now to build a healthier future for everyone. Allendar, J., Rector, C., & Warner, K. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott, Williams, & Wilkins

[@mindihoffman163]

The video featuring Dr. Pomeroy was very intriguing. She began the speech in an enticing fashion by telling a story of a young girl escaping a bad situation. However, she revealed that the young girl was her. Through self-reflection, Dr. Pomeroy told a real-life story of how our country is missing major stepping stones in the promotion of a better health care system for all. I found it very interesting that the United States spends twice the amount of health care dollars compared to all other developed countries and we have worse health care outcomes. Dr. Pomeroy mentioned several times that our country has the money to have a healthier system, but we spend the money in the wrong places. We have a reactive health care system which treats diseases and illness after they have occurred, instead of a proactive system that focuses on prevention. Dr. Pomeroy stated more than once that we need a model that embraces social determinants and focuses on community and a population health, not hospital needs. Social determinants of health are conditions that people are exposed to that affect their level of functioning and their quality of life (Allender, Rector & Warner, 2014). An example could be a young teenager who lives in a big city lower income level suburb that has lots of gang violence. Social determinants could be that there is no real safe place for the teenager to spend time at, be active, or experience a different part of the world around him. Lower level income could contribute to unhealthy and unsafe areas to live, along with decreased chances of seeking medical attention for preventative measures. Dr. Pomeroy said some very intriguing words at the end of her video. She mentioned that it is not the sole responsibility for physicians to fix this country’s social health determinants. We all can make a difference by just caring. The five-step community action model is a resource provided by Allender, Rector and Warner (2014) that provides steps for all of us, not necessarily on the medical level, to help affect a positive change in relation to social determinants. Allender, J., Rector, C., & Warner, K. (2014). Community & public health nursing: Promoting the public’s health, 8th edition. Philadelphia, PA: Lippincott Williams & Wilkins.

[@cortnie01]

I was shocked when Dr. Pomeroy explained that the little girl was her. When she said it was her, I felt sad for her but yet amazed at how far she has came. I realized how important it is to have more safe places for children to go and ways to help support the poor communities. I really liked how she mentioned that people need to feel valued and need a support system.

[@kristipussehl4968]

I think this was both an interesting and enlightening speech given by Claire Pomeroy. Including real life examples about being a young girl with very little resources helps her to empower people to make a change. I like how she commented about how reaching out in kindness can save a life. This shows that not only physicans can solve health problems but everyone in the community can help to make a difference. I agree with her that medicine is failing. We spend so much money on healthcare and do not see the same amount of return in our health outcomes. I think Claire Pomeroy made a very good point when she included that we need to shift our focus from “sick care” to more of a preventative focus. If we prevented people in the community from getting sick in the first place, for example from things like air pollutants from factories or unsanitary living conditions, we could greatly reduce medical costs. I think this correlates closely with community nursing. If we could have more nurses out in the community educating and promoting health, we could see a decrease in the amount of people having to enter the hospitals and clinics. Allendar, Rector and Warner (2014) discuss social determinants of health and how they “reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age.” I thought it was interesting that Pomeroy included that 90 percent of a community is based on behavioral and social factors such as education, socioeconomic status and living status, while only 10 percent was made up of health care. Even with this, we spend so much of our focus on health care and hospital based care. I have seen first-hand how lack of education can translate into poor health outcomes. For example, I know a young woman that did not grow up under the best of circumstances; because of this she lacked proper education. Currently, she is not able to have the resources or knowledge to keep up with her diabetes causing her health to quickly deteriorate. I think Claire Pomeroy ended with a very strong message in saying that we need everyone’s help to fix these problems and to do this you do not have to be a physician or a nurse, all you have to do is care. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing promoting the public’s health. 8th Edition. Philadelphia: Lippincott Williams & Wilkins.

[@ericasawyers5888]

We need to come together to address social determinants of health to insure better health for all people. Ms. Pomeroy made her way from the streets to having education and being successful. She cares because she has been through tough times. From living in poverty and being in foster care, she learned a lot. From her experiences she decided to step up and make a change so she went to medical school. As nurses we are doing the same thing. We are all coming together to care for people to save lives. In the world, there should be access to healthcare for everyone. There are 51 million Americans that are uninsured and many that are underinsured. With this high number of people, people are forced to go to emergency rooms when they are ill. An example of social determinants of health may include the population who does not have access to internet from poverty or people who choose not have internet like some of the elderly population. This population may not have the access to the internet to gain health information, which may put them at a disadvantage to their health. With so many advances in healthcare, this population does not have access to reliable and useful resources. If people are uninsured, they may lack access to resources, such as food/clean water, safe shelter, access to healthcare, education, jobs, etc. The vulnerable population needs to feel valued and we can do this by finding vulnerable populations in the community and helping them get these resources in the community. These people do not have preventative healthcare, which means they have risk factors for poor health. We need to correct this injustice. Health has many aspects and preventative care should be a high priority. According to Healthy People 2020, social determinants of health include social and physical factors (Allender, Rector, & Warner, 2014). As community/public health nurses, we can educate and provide care. Examples include providing immunizations, helping people stop smoking and drugs, ongoing monitoring of health conditions, and health education regarding diet and exercise (Allender et al., 2014). The conditions in which we live influence our health status, so we need to make the community and the people who live in it healthier. Reference Allender, J.A., Rector, C., & Warner, K.D. (2014). Community and public health nursing: Promoting the public's health (8th ed.). Philadelphia: Lippincott Williams & Wilkins.

[@kristawalker9288]

I agree with Pomeroy’s emphasis on social determinants and the need to change the focus from “sick care” to health care. Allender (2014) discusses Nightingale’s theory and her observations that disease was more prevalent in poor environments, a social determinant that affects those who need healthcare providers who will be proactive and not reactive (p. 440). Her message was a recruitment, hopefully initiating a change in the future of health for all people in the US.

[@breannjohnson9565]

I agree with her correlations between health and social determinants. Our country works by trying to provide care after a sickness has occurred rather then using primary preventions. We need to become “proactive rather than reactive". If we take economic stability as a social determinant we can see its effect with homelessness and its predisposition to illness related to the increased risk of infection, stress, and decreased preventative measures. Exceptions exist but the susceptibility remains.

[@byronarrivillaga2084]

I completely agree that our model/system for healthcare is broken. People that are from a lower socioeconomic status are usually at a major disadvantage by not having access to preventative health care measures. When one is constantly worried about where there next meal might come or how they are going to pay for the lights to stay on, going to the doctor and ensuring what you eat is rich in nutrients is not the number one priority. I have seen it before, when a patient comes into the ED for a true emergency that could have been prevented. My own father had a heart attack in 2007 and had to have a five-bypass surgery. At the time he was unemployed and our family did not have health insurance. He never felt bad so he never went to the doctor. Even when he felt a little chest pain the week prior and the days following up to his heart attack, he never said anything because he did not want to have to go to the hospital and have the burden to pay for medical attention. Well, he ended up paying more when we had to rush him to the ED in terms of financially, physically, and emotionally. Not to mention the impact and emotional distress on the rest of the family. This type of scenario falls right in line with what Dr. Pomeroy believes to be wrong with healthcare today. Someone can not afford to go to the doctor and can not get medical treatment until something emergent happens that ends up costing much, much more. If we made primary care more accessible for everyone, this would cut back on the costs of in-hospital care for patients whose illness could have easily been prevented with the proper and timely intervention.

[@fcalligan520]

Dr. Pomeroy's personal journey gave her the ability to share her life experiences, while inspiring others to help change the healthcare system. I agree with her, we need to address the healthcare system and our declining health outcomes. Our healthcare system is full of health disparities. The access to good healthcare should not be based on social economic, educational or occupational status. Collaborating with caring individuals to improve health disparities will require assistance from everyone to ensure adequate healthcare for everyone. I do see some impact in the community that provide healthcare to the under-insured and the uninsured; Planned Parenthood, Matthew 25, Neighborhood Health Clinic and the IPFW Lafayette Street Center. These clinics are needed to provide healthcare to individuals that would otherwise be without healthcare. The preventative measures provided by these clinics, help the patient become proactive in their healthcare. To continue to run these facilities we will need people who care enough to provide funding and caring individuals to run the facilities. I anticipate that Dr. Pomeroy's video will continue to inspire others to be a part of the solution and work to change the healthcare system in our country.

[@lindseyfiechter8363]

I found Ms. Pomeroy's opinions on social determinants of health to be interesting and enlightening. Her slide discussing that nearly 51 million Americans uninsured was astounding. However, I have a different opinion regarding the healthcare system here in the United States. I do feel sympathetic for those less fortunate individuals who lack basic necessities (food, shelter, clothing, and now healthcare), yet I do not agree that the remaining citizens of the United States should "foot the bill" to provide healthcare for these individuals. My real life example is one of truth - there are many individuals who take advantage of our government aid systems, but I do agree that not everyone has this mindset. However, there are some people who take advantage of the benefits provided for the unemployed - and who's to say that there won't be people who take advantage of healthcare if it's offered to everyone, even those who cannot afford it? Policies that support Ms. Pomeroy's plans and concepts ultimately tax the rich to supply the poor - and I completely disagree with this process. Furthermore, considering the social determinants of health, I do also concur that these factors in consideration with Health People 2020 ultimately create social and physical environments that better the health for all populations and diversities (Allender, Rector, & Warner, 2014). I do believe that the healthcare systems should switch their mindset from reactive to proactive, and focus more on the communities versus the medical models. I just simply disagree with the current ideas on how to subsidize such healthcare practices. Another real life example of the social determinants is the comparison of two childrens' walk through life: one child is from a single parent home living in the ghetto with little money for food, clothing, and shelter. The second child is from a traditional nuclear home in the suburbs of a wealthy town, in a wealthy neighborhood. The first boy has difficulties in school, an unsupportive home life, and ultimately leads to a decrease in social standing and increase in health disparities (smoking, drinking, risky behaviors). The second boy remains healthy, wealthy, and becomes educated, thus furthering himself along the wellness continuum. Ultimately, the first boy will die at an early age due to healh disparities developed from poor healthcare and habits, while the second boy lives a successful, healthy, driven life. This goes to show the basic comparison of the two main types of social determinants found in this country. Reference Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public's health, 8th ed. Philadelphia: Lippincott Williams & Wilkins.

[@hannahmaxson5859]

Claire Pomeroy stated in the Ted Talks video that healthcare needs to focus more on the social determinants of health and not just curative medicine. Often, education about health is done after a patient has been diagnosed with a disease. Instead, healthcare should assess the social determinate that lead to diseases, so diseases can be prevented. For example, a good education can a big social determinants for future health because a good education leads to better jobs and therefore larger income, which allows you to afford better healthcare. Learning disorders, such as ADHD, can lead to poor academics which can impact a person's ability to afford healthcare or other things that lead to a healthy lifestyle. By raising the awareness of learning disorders in the community, learning disorders can be identified earlier, treatment can be implemented sooner, which can decrease the risk of poor academic success. Identifying social determinants of health is a big step forward for preventing disease.

[@Bubagigant]

Such a great speech and a wonderful human being!thank you for sharing!

[@revolversmoke]

Amen to this talk.

[@linziehoward7802]

Our country need to go from sick care to health care and be proactive not reactive.The main thing that she focused on was education impacting out health.The better education that one has the better health they tend to be in.I can relate to this, I used to work at a lower income healthcare facility, and most of the patients that we could see were low income, and usually very sick.Most of them said they could either not afford to see a doctor or they were uneducated that they should see a doctor.

[@KED_711]

Dr Pomery had a positive effect on my outlook towards social determinants. Her childhood experiences made me focused and intrigued. I felt compassion, love, and determination from her speech while she talked about having many social determinants against her. The inspiring part was how she used her life experiences and HIV patient interactions to gain a better understanding about the world and how to improve our system. She hit many points, such as how medicine is failing in this country, many people have a lack of access to healthcare, the US spends money on the wrong things, and preventative care, education, and income needs to be provided. "Social determinants of health are conditions in the environments in which people are born, live, learn, work, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks" (HealthyPeople.gov, 2014, pp. 1). So that leads to the question, 'What we a born into predicts our life expectancy?' For example, a child that was born to a low-income family has bad health because of no health insurance, whereas a child born to a rich family will be healthier because health insurance was provided. Dr Pomery makes a great point that everybody needs to be treated equally by the same interventions. Another real life example was about my dad being turned away from healthcare because he as no insurance. He had a tic bite that got infected, so we took him to the hospital to get treated for possible Lyme disease. But, since the hospital was for profit and he did not have health insurance due to unemployment, he was told to go to other places where they took patients with no insurance. I could not believe they turned down care. Fortunately, one of the Healthy People 20/20 goals is to improve healthcare access to everyone (Allender, Rector, & Warner, 2014; HealthyPeople.gov, 2014). Likewise, many interventions have positive outcomes, such as positive behavior changes, reduction in diseases, improved well-being and quality of life, and increase in health equality and reduction in health disparities. Dr Pomery did a great job making the audience feel that they should take action to help improve these social determinants. She is a great example on how awful life experiences can lead to positive outcomes for future health. Allender, J. A., Rector, C., & Warner, K. D. (2014). Community and public health nursing: Promoting the public’s health (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. HealthyPeople.gov. (2014). Social determinants of health. Retrieved from www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health?topicid=39 HealthyPeople.gov. (2014). Access to health services. Retrieved from www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services