From Clinic to Community: Nurses and the Social Determinants of Health

  Histo rical Milestones of the Opioid Epidemic Pre-1800s & early use Before 1800, pain was often viewed philosophically or existentially; clinicians did not emphasize pharmacologic control of pain.  Early on, opioids and cocaine were used liberally for various ailments (toothache, diarrhea) with little regulation.  Early 20th century regulation & opiophobia The Harrison Narcotic Control Act (1914) was passed in response to rising heroin abuse and iatrogenic morphine dependency, which began to restrict opioid prescribing.  Throughout the early to mid-1900s, many pain complaints, especially non-cancer pain, were met with skepticism, and clinicians often withheld opioids due to fear of addiction. This led to “opiophobia,” an underuse of opioid analgesics even when clinically indicated.  Rise of pain advocacy and “pain as the fifth vital sign” In the 1990s, mounting concern about undertreatment of pain led to advocacy positioning pain control...

Looking Upstream: Tackling the Root Causes of Health Inequalities When it comes to health, we often focus on treating illnesses once they appear: prescribing medication, performing surgeries, or offering lifestyle advice. But what if we could prevent many of these issues before they ever reached the doctor’s office? That’s the idea behind the Upstream Theory in public health (Onie, 2018). Imagine standing by a river. People are struggling in the water, drifting downstream, and you rush to pull them out.  While lifesaving, you eventually start to wonder: why are so many people falling in to begin with? Instead of just rescuing them, wouldn’t it make more sense to walk upstream and stop people from falling in at all? That’s the heart of the upstream approach: looking beyond immediate fixes and focusing on the root causes of poor health (Onie, 2018). What Does “Upstream” Mean in Healthcare? In healthcare, going upstream means tackling the social determinants of health (SDOH) inclu...