Hello, I'm Karen Monson professor at the University of Minnesota School of Nursing. In this module we examine social determinants of health, ethical considerations for health systems and data. Our learning objectives for this module are to analyze ethical considerations related to social determinants of health and health systems. To inform thinking regarding interventions and their short and long term effectiveness and value. To describe ethical considerations related to social determinants of health, data related to the use of these data, to inform policy and practice. And to reflect on ethical issues related to your data, to action initiatives that need attention to promote health equity and social justice in your spheres of influences and practice. These fascinating learning activities will help you flesh out your understanding of the interplay between ethics, data and health systems in the context of social determinants of health. Consider at every level of the hourglass model. The ethical mandate for individuals and societies to engage in a massive transformation that is critical for our very survival. In this model, we attempt to make explicit some of the ethical thinking related to social determinants of health. In the context of health care systems and data, we are all engaged in ethical decision making every day. And we hope to make these decisions more transparent so that our actions can be informed and intentional. Given what we now know to be a considerable impact of social determinants on health. There has been a major push in the United States to integrate upstream social care into the delivery of health care. Clinics have started food banks and hospitals and insurers are investing in housing. Efforts to address social determinants of health show promise for improving health and health equity. And for enhancing the well being of health care professionals who find meaning and fulfillment in knowing and addressing patients underlying social needs more directly. Health care interventions aimed at social determinants of health are informed by ethical principles. While some scholars assumed that addressing social determinants of health is implicitly correct. Others emphasized the need to manage unintended consequences and asked whether social determinants of health screening should be targeted or universal. To camp and colleagues expand this ethical discourse by applying the concept of spheres of influence. To explore the ethical principles that should shape how clinicians, healthcare organizations and the broader community address social determinants of health. As you read their paper, consider the situated perspective of the authors who are all medical doctors in the United States. First, let's consider clinicians that inner sphere. The camp and colleagues assert that clinicians have a special role to play in ensuring that real world efforts to address social determinants of health truly improve individual's health and well being, promote informed choices and support health equity. This seems to be in alignment with the idea of a code of ethics which is defined as a set of official standards of conduct that the members of a group are expected to uphold. I checked specifically into the nursing code of ethics. And sure enough, two of the nine provisions provide ethical guidance related to health disparities and social justice. Take a moment and check out your professions code of ethics. How does it inform your professional approach to addressing social determinants of health. For optimal healing relationships between patients and clinicians? It is essential that social determinants are assessed and addressed. There are innumerable ways this plays out. For example, on social determinants of health screening is completed in the clinical setting. We now have data and therefore an obligation to act on that data in ways that meaningfully improve health and do not simply check the box. The second sphere is health care organizations decamp and colleagues assert that healthcare organizations are obligated to create the structures, policies, programs and priorities that support their clinicians and employees. They are also obligated to create a culture of integrity understood as true commitment to stated mission and values, Take a look at the mission and values of your healthcare organization. Do they mention social determinants of health or related concepts? Organizations that commit to social determinants of health must recognize that addressing social determinants could include obligations beyond patient care, such as meeting needs within their workforce, like paying a living wage and in their community. As we see in two video examples, cecilia's story and new Jersey's new law In the 3rd sphere, broader community and society decamping colleagues remind us that laws, policies and regulations create the fundamental social conditions that support equitable health. It is important to note that such laws, policies and regulations reflect the perspectives of regions and nations and are not independent of those perspectives properly understood, creating fundamental social conditions that support equitable health demands. Multi sector collaboration well beyond healthcare systems. Medicalization, such as providing housing or prescriptions for fresh foods may create less efficient, less effective, less equitable social solutions. Since healthcare entities tend to focus on the populations they serve rather than all in need within the community, such solutions could discourage government investment in public agencies whose primary responsibility relates to particular social needs. One way to avoid medicalizing social determinants of health is whenever possible to develop partnerships between health care and community organizations as described in the Community Medical Legal partnership video, another perspective on these issues is part of the Public Health Code of Ethics put forth by the American Public Health Association. As you read this Code of ethics, consider its perspective compared to the closely related medical perspective advanced by the decamp article. The Public Health Code of Ethics speaks to similar spheres of influence, stating that public health practitioners and organizations have an ethical obligation to use their knowledge, skills, experience and influence to promote equitable distribution of burdens, benefits and opportunities for health, regardless of an individual's or group's relative position in the social hierarchies. In addition, health justice does not pertain only to the distribution of scarce resources in transactions among individuals. It also involves remediation of structural and institutional forms of domination that arise from inequalities related to voice and power and wealth. It is difficult for public health to promote social justice at the transactional level if it does not take steps to promote it at the structural and institutional levels as well. Of course, these ideas are simplified and in real life there are many complexities decamp and colleagues acknowledge that other spheres exist and that spheres can intersect. For example, clinicians have ethical obligations to advocate for societal policies that support health. And as we see in some of our examples ways in which health care payments are structured, affect how our healthcare organizations and their clinicians behave. That's it for part one Now on to part two, in which we shall strive to further decode ethical dimensions of social determinants of health and data.