Nursing in Washington

Social Determinants of Health (SDOH)

(From A Focus Group Toolkit for Getting Nurses Engaged in Addressing the Social Determinants of Health)

SDOH are the circumstances in which individuals are born and the conditions of the environment where they grow, learn, and live that impact their well-being and health outcomes [1]. The U.S. Department of Health and Human Services’ (2019) Healthy People 2020 initiative asserts that health is determined by the availability and accessibility of resources and support in the environment (e.g., home, neighborhood, and the community); access to social and economic opportunities as well as clean food and water; workplace safety, and social interactions and relationships. The World Health Organization also identifies these social determinants as contributing factors that influence health inequities [2].

There is more recognition that factors apart from medical care, such as health behaviors, social, genetic, economic, and environmental factors account for 90% of what influences health outcomes [3]. These determinants lie outside of medical care and may include food availability, affordable housing, and a safe environment.

The Washington Center for Nursing (WCN) has a goal to improve Washington state residents' health by engaging nursing professionals in addressing SDOH with patients at the point of care. 

WCN’s SDOH web-resource helps nurses look at the determinants of patient care in the communities they work and may answer more profound questions about why patient populations present with the same unresolved health issues. 

The web-resource looks at the connection to social and environmental factors in a nursing assessment and care plan.

The following interactive data points look at three categories of SDOH by county across Washington state, food Insecurity, violence/safety, and housing. Additional data on Washington’s nursing workforce is presented to encourage critical thinking and solution-based exploration on ways nursing can work to address SDOH in their care environments with consideration to the unique challenges faced by patients in their community. These data points provide insight into population needs by using demographic insight to inform patient care planning.

Note on “Example discussion Points”: These scenarios are by no means comprehensive. These scenarios are examples of how the data presented in these pages can help inspire critical and creative thinking by nurses to create processes that help to document, track, and address the SDOH needs of their patients at the point of care. These data should not be used to diagnose a health issue or label a community.


1. Centers for Disease Control and Prevention. (2019). Social determinants of health: Know what affects health. Retrieved from

2. World Health Organization. (n.d.). Social determinants of health. Retrieved October 8, 2019, from

3. Minnesota Department of Health (2014). Title: Advancing Health Equity: Report to the Legislature. Retrieved:

4. Remington PL, Catlin BB, Gennuso KP. The county health rankings: rationale and methods. Population Health Metrics. 2015;13(1):11.

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