HLT101: Week 3-Why Social Determinants Shape Health

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Welcome back to Weekly Wrap. I’m Ros, and I’m here with Neha and Ethan—

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Hello, you two! This week, we’re diving into how and why social determinants shape health, and honestly, it’s one of those topics that’s everywhere in nursing, even if you don’t always see it coming.

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We’ve touched on this before, especially when we talked about human development and health priorities in episode two, but today we’re really going to unpack what these determinants are and why they matter for every nurse in Australia.

Neha Kapoor

Hi Ros, hi Ethan! Yes, and I think it’s so important to start with what we actually mean by “social determinants of health.” Sometimes students hear that phrase and their eyes glaze over, but it’s really just about the conditions in which people are born, grow, live, work, and age. Michael Marmot—who’s a bit of a legend in this space—says it’s not just about who gets sick, but why people get sick in the first place. It’s about the big picture: things like early childhood, education, employment, income, the environment, and prevention. And, crucially, the difference between inequality and inequity. Marmot makes a point that inequities are those differences in health that are avoidable and unfair. That’s where social justice comes in.

Ethan Clarke

Yeah, and I reckon that distinction is key. Inequality is just the difference, but inequity is when those differences are actually unfair and could be fixed. I always think about it like the difference between a rough patch of surf and a rip current—one’s just part of the landscape, but the other’s dangerous because it pulls people under who shouldn’t have to struggle. And, you know, the evidence is clear: if you look at the six domains Marmot talks about—early child development, education, employment, minimum income, healthy places to live and work, and prevention—those are the levers we can actually pull as a society.

Neha Kapoor

Absolutely, Ethan. And I saw this firsthand during a cultural exchange in London. I was working with a family where the parents had limited education, and it was so clear how that shaped their children’s health—not just in terms of access to care, but in their nutrition, their stress levels, even how they navigated the health system. It’s not just theory; it’s real life. And as nurses, we’re right there, seeing how these factors play out every day.

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That’s such a powerful example, Neha. And it’s a reminder that, as Marmot says, setting things right is a matter of social justice, not just economics. We can’t just patch people up and send them back into the same conditions. We have to look upstream. And, for our students, this isn’t just academic—it’s about understanding the context of every patient you meet, whether you’re in a city hospital or out bush. All right, let’s keep going and look at how these determinants show up in the real world, especially around homelessness and families.

Ethan Clarke

So, let’s talk numbers for a second. According to the Australian Institute of Health and Welfare, in 2023, about 69% of people aged 25 to 64 had a non-school qualification at Certificate III or above. That’s up from a few years ago, but it still leaves a lot of people without those opportunities. And when you look at homelessness, the rate’s been pretty stubborn—48 per 10,000 people in 2021, which is about where it was a decade ago. But the actual number of people experiencing homelessness has gone up, especially in severely crowded dwellings. It’s not just rough sleeping; it’s families living in cars, couch surfing, or packed into small spaces.

Neha Kapoor

Yes, and the faces of homelessness are changing. There’s a case study from Moreton Bay in Queensland—one of the fastest-growing regions—where families and young people are now the most visible part of the crisis. It’s not just single adults anymore. I remember reading about a family with three kids, including a child with additional needs, who were living in temporary accommodation for months. The stress on the parents was enormous, and it affected every part of their health—mental, physical, emotional. And, of course, the children’s development was at risk too.

Ethan Clarke

That really hits home for me. I worked with a family in Sydney a few years back—mum, dad, two kids, and they’d just lost their rental. They were bouncing between relatives’ places, and you could see the toll it took. As a nurse, my assessment wasn’t just about the kids’ immunisations or the parents’ blood pressure. It was about asking, “Where are you sleeping tonight? Do you have enough food? How are you coping?” Sometimes, the most important thing you can do is just listen and connect them to the right support. It’s not always about a medical fix.

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And that’s why family assessment is so central in nursing. It’s not just about the individual—it’s about the whole system around them. We talked about this in last week’s episode, but it’s worth repeating: understanding the strengths and challenges of different family types helps us see what support is already there and what’s missing. And when you add in the social determinants—like income, education, and housing—you start to see why some families thrive and others struggle, even when they’re doing everything “right.”

Neha Kapoor

Exactly, Ros. And for students listening, this is why we ask you to reflect on these issues in your tutorials. It’s not just about ticking a box for an assignment—it’s about shaping your practice so you can advocate for families, not just treat symptoms. All right, let’s move on to what nurses are actually doing about these challenges, especially with some of the new initiatives in our profession.

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So, here’s something exciting: the Australian College of Nursing has a Street Health Faculty, led by Sonia Martin - Nursing Local Hero! This is the first of its kind in Australia, and it’s all about bringing nurses together who care for people experiencing homelessness. Sonia’s got global experience—she’s worked with street health teams in London, the US, and beyond. The idea is to give nurses specialised training, support, and a platform to advocate for real change. Not band-aid solutions; it’s about shifting the system.

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And our very own Dr Apil Gurung is working with Sonia, as the deputy chair of the Street Health Faculty - So if this is an area that interests you , I would give him an call!

Ethan Clarke

Yeah, and I think that’s a game-changer. Nurses are often the first point of contact for people doing it tough, and having a faculty that focuses on street health means we can share best practices, push for better policies, and actually influence how care is delivered. I’ve seen how much difference it makes when nurses are trained to look at the whole person, not just the diagnosis. It’s about leadership, but also about community and collaboration.

Neha Kapoor

And students have been asking great questions in tutorials about what our role is in all this. Can nurses really make a difference in health equity? The answer is yes, but it takes more than good intentions. It’s about using evidence, understanding the social determinants, and being willing to speak up—whether that’s in a hospital, a community clinic, or out on the street. The new Street Health Faculty is a great example of how we can lead change, not just react to problems.

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And it’s not just for those working in homelessness. The skills and mindset you develop—thinking about equity, looking at the big picture, advocating for your patients—those are relevant everywhere. Whether you end up in critical care, community health, or policy, this is the future of nursing.

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All right, I think that’s a good place to wrap up for this week. Remember, stay on top of your assessments—don’t let those deadlines sneak up on you!

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And if you haven’t checked out the iEngage career events in Moreton Bay , have a look!—Its a great way to connect with employers and see where your nursing journey could take you. The QR codes are just above the Podcast in Canvas. Its on Wednesday 27th on the Morton Bay Campus.

Neha Kapoor

Thank you, Ros. And thank you, Ethan. I hope everyone takes a moment this week to reflect on how you can be part of the change, even in small ways. We’ll be back next week with more on family health and community care. Take care, everyone.

Ethan Clarke

Thanks, Neha, thanks Ros. And to all our listeners—keep asking questions, keep learning, and don’t forget to look after yourselves too. See you next time.

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Bye for now, everyone. See you next week on Weekly Wrap.