Exploring Global Demands for Integrating Social Aspects into Community Healthcare: A Literature Review ()
1. Introduction
Aging within community environments facing crises like pandemics and climate change are global issues. The aging process affects people’s health, including physical and mental aspects, and the likelihood of needing care increases with age. Additionally, recent crises such as pandemics and climate change worldwide impact people’s health. Social and natural changes globally affect the health of communities.
Japan is a super-aging society with the world’s highest percentage of elderly people aged 65 and over (29.0% in 2023), projected to increase further [1]. Globally, the proportion of people aged 65 and older is rising as well [1]. In Japan, the Draft Act on Amendatory Law to the Related Acts for Securing Comprehensive Medical and Long-Term Care in the Community was implemented in 2014 [1]. This law aims to integrate medical care with long-term care within community caregiving services. To provide uniform community services nationwide, including housing, medical treatment, caregiving, prevention (primary, secondary, and tertiary), and daily life support, the Japanese Ministry of Health, Labour and Welfare proposed an integrated community care system. Academic institutions must develop systematic community strategies to improve the quality of life (QOL) for the Japanese elderly [2]. Particularly in gerontology, communities should be studied as significant influencers of well-being and QOL [3], because elderly people spend more time at home, rely more on local resources for a better QOL, and are more emotionally attached to their community compared to younger adults [4]. In a society that is aging and facing crises like pandemics and climate change, it has become increasingly important for healthcare providers in clinical, health, or welfare practices to support the well-being of the elderly. This includes considering the community environment to support their lives fully until the end.
The coronavirus disease 19 (COVID-19) outbreak, starting in 2019, has transformed the health landscape for the elderly and other community members worldwide. The crisis, including COVID-19 and climate change, has highlighted the connection between health and the environment [5]. The COVID-19 pandemic had economic, social, psychological, and other global effects [6]. The latest crises have affected not only the elderly but also younger individuals in the community. Further efforts are needed to pursue a systematic community strategy.
It has been suggested that to develop an integrated community strategy, social aspects should be considered alongside physical and mental aspects [7]. According to the World Health Organization (WHO) [8], social determinants of health (SDH) are non-medical factors. Therefore, in clinical care practices related to medical, health, and welfare, it appears challenging for professional healthcare providers, especially medical care providers, to understand the social aspects. In Japan, social changes resulting from the COVID-19 pandemic have been reported as irreversible [9]. In recent social changes, it has become increasingly important for healthcare providers to assess people’s health, taking into account the community environment and social aspects.
There is a sustained need for holistic and health-related approaches that address the entanglement of social and natural environments with healthy aging and creative well-being [10]. Calls for a more holistic approach have long been recognized, but the pandemic has further emphasized the importance of dismantling existing barriers in policymaking at all levels to improve the health of people, animals, and the planet. A planetary health approach was suggested [5]. The practical aim of creating a systematic community strategy is to uphold or enhance people’s well-being. As we face aging populations, pandemics, and climate crises, it becomes necessary to consider people’s health holistically and globally, taking into account the community environment and social determinants without boundaries.
The present study aimed to explore the necessary aspects of incorporating social determinants into clinical practices. This is for healthcare providers to view health holistically and with a planetary perspective, in order to facilitate the development of a more integrated community strategy through a literature review.
2. Methods
This study reviewed a wide range of academic articles related to medicine, health, and welfare by conducting an electronic search in PubMed, MEDLINE, and CINAHL databases. The search, limited to English-language articles published in peer-reviewed journals, used the terms “holistic health,” “planetary health,” and “social determinants,” with a cut-off date of July 2024. Excluded articles were identified by their title, abstract, and full text based on two criteria: 1) articles published in 2019 or earlier, and 2) articles not focused on human health, such as those on food and animals. From each article, descriptions related to integrating social determinants into clinical practice were selected, and items were created by collecting information with similar meanings.
3. Results
Eight articles were identified through the search. After excluding three articles based on their titles, abstracts, and full texts, five articles [11]-[15] were selected. The flowchart of the literature search is shown in Figure 1. An overview of the five articles related to the current study’s purpose is presented in Table 1. Three items were identified: perceiving health in ecosystems, considering health-related policy in clinical situations, and addressing health in primary care settings.
Figure 1. Flowchart of literature search.
Table 1. Overview of reviewed articles.
| Title |
Authors |
Journal |
Year of Publication |
Needed Points to Perceive Health Holistically and
Planetary Including Social Determinants |
Engaging globally
with how to achieve healthy societies: insights from India, Latin America and
East and Southern Africa |
Loewenson et al. |
BMJ Global Health |
2021 |
“Advancing ideas into policy depends on growing social, scientific and policy networks and calls for spaces to debate contesting ideas, investment in a more equitable circulation of ideas between regions in framing approaches, and transdisciplinary, reflexive and participatory ways of building knowledge that are embedded in and learn from action.”“In responding to threats posed to health by climate change, the damage to ecosystems and pandemics, how we think and act on healthy societies and how far the choices are understood and made beyond elites and states whthin society itself can lead us to significantly different futures.” |
| Translating Planetary Health Principles into Sustainable Primary Care Services |
Gonzalez-Holguera
et al. |
Frontiers in Public Health |
2022 |
“the Planetary Health perspective should be used to rethink how we define health and to redesign the organization of healthcare services, identifying new roles and activities for primary care actors, by better integrating socio-environmental determinants of health.”“Framing a new approach to health”“Focusing on primary care to integrate planetary health principles”“Integrating a planetary engagemental perspective into clinical practice and primary care” |
One Health challenges and actions: Integration of gender considerations to reduce risks at the human-animal-environmental
interface |
Cataldo et al. |
One Health |
2023 |
“One Health and risks at the human-animal-environment interface must be complemented by gender analysis and integrated into national and global prevention plans.” |
Just-relations and responsibility for planetary health:
The glbal nurse
agenda for climate justice |
Evans-Agnew et al. |
Nursing Inquiry |
2023 |
・”Identifying climate injustices in healthcare and the built environment.”“To articulate the rights of Nature and differentiate between ecnomic, ideological, political, and social domains for climate actions.”“The ecological model was identified as upstream consideration for the social determinants.” |
A Comprehensive Review of the Global Epidemiology,
Clinical Management,
Socio-Economics, and National Responses to Long COVID with Future Research Directions |
Song X., et al. |
Diagnostics |
2024 |
“Addressing long COVID requires a holistic management strategy that integrates clinical care, social support, and policy initiatives.” |
3.1. Perceiving Health in Ecosystems
Three articles [11] [13] [14] highlighted the importance of considering people’s health when evaluating ecosystems. Loevenson et al. (2021) suggested that planetary health builds on SDH approaches, integrating essential ecosystems for well-being and the necessary actions to support them. They observed that SDH approaches focus not only on risks and harms but also on the power relations and sociopolitical factors that shape problems and responses at all levels. Cataldo et al. (2023) consider gender to be influenced by social and cultural environments and advocate for gender-focused public health interventions within the One Health approach. They argue that gender norms that promote toxic masculinity and control over women obstruct the development of healthy, sustainable, and equitable conditions, particularly impacting women at the human-animal-environment interface. Evans-Agnew et al. (2023) propose ecological restoration as a social determinant and a key focus for the global nursing agenda on climate change.
3.2. Considering Health-Related Policy in Clinical Situations
Two articles [11] [15] highlight the significance of transforming ideas from clinical contexts into policy. Loewenson et al. (2021) argue that this process relies on expanding social, scientific, and policy networks, necessitating forums for debating conflicting ideas, promoting more equitable idea exchange across regions, and employing transdisciplinary, reflective, and participatory knowledge-building methods that are action-oriented. Song X., et al. (2024) advocate for a comprehensive management strategy that combines clinical care, social support, and policy initiatives.
3.3. Addressing Health in Primary Care Settings
One article [12] emphasized the importance of incorporating new roles and activities into clinical primary care contexts. Gonzalez-Holguera et al. (2022) highlighted the significance of integrating socio-environmental determinants of health into clinical practice and primary care. This approach aims to redefine health and reorganize healthcare services by identifying new roles and activities for primary care professionals.
4. Discussion
Aging conditions and changes in community environments, such as pandemics and climate change, have significantly impacted the health of people living in communities worldwide. The primary goal of developing a systematic community strategy is to maintain or promote people’s well-being. As we face further aging and crises like pandemics and climate change, it may become necessary to consider health holistically and globally, taking into account the community environment and social determinants. However, in clinical practices related to medicine, health, and welfare, it appears challenging for healthcare professionals, especially medical providers, to grasp the social aspects. This study aimed to identify key points for integrating social determinants into clinical practices, enabling healthcare providers to view health holistically and globally. This would facilitate the development of a more integrated community strategy through a literature review. Three key areas were identified for incorporating social determinants into clinical healthcare settings: considering health within ecosystems, aligning health-related policies with clinical situations, and focusing on health in primary care contexts.
The current study highlights the need for healthcare providers to adopt a holistic approach that includes social determinants in clinical practices, viewing health within the context of planetary ecosystems. It suggests that recent social events and the pandemic underscore the importance of moving towards more holistic and fluid medical and nursing practices [16]. Typically, professional medical care providers are trained to concentrate on the immediate causes of disease, paying less attention to how social conditions impact health [17]. While nurses have traditionally been taught to view patient care through a holistic lens, there is limited knowledge about their perspectives on SDH [18]. Understanding which aspects of SDH are considered important by healthcare providers, especially those in medical care, and how they integrate these determinants into clinical practices like primary care settings, is essential for developing a more integrated community strategy.
The current study highlights the importance of aligning health-related policy with clinical situations, particularly in primary care. It emphasizes the gap between health policy and clinical reality, suggesting that community health nurses, including home-visiting and public health nurses, should collaborate with both professional and non-professional healthcare providers to enhance community support. This approach could be more effective than relying solely on social workers or general practitioners, as nurses are potentially better equipped to assess health needs within community environments [19]. The study argues that ensuring access to professional care is a universal human right that requires a blend of clinical and public health knowledge [20]. In light of aging populations and global crises like pandemics and climate change, medical practice and health policy are evolving. Understanding clinical situations and integrating social aspects into healthcare through interdisciplinary collaboration among medical and public health professionals is becoming increasingly important. Future research should identify social factors in ecosystems that impact clinical situations in medicine, health, and welfare, to develop systematic community strategies through interdisciplinary efforts.
5. Conclusion
Aging and crisis situations such as the pandemic and climate around community environment are global issues. It may be more important that the dwelling people’s health-related issues are thought globally in order to consider the development of the further systematic community strategy. In the current study, the further study related to the innovative systematic community strategy including in global aging society around the community environment such as the pandemic and the climate, the social determinants, not medical aspects, will be more needed to perceive the people’s health at holistic and planetary in eco-system-based strategy, in order to act in the clinical fields related to medical, health and welfare. Further studies may be important what items as social aspects in ecosystems are needed in clinical active situations such as medical, health, and welfare, through the interdisciplinary collaborations, in order to develop a systematic community strategy for people’s well-being-life.
Fund
This work was supported by JSPS Kakenhi Grant number JP20K11007.