NR 443 Week 1 Discussion: Social Factors (Graded)

I live in a small community in Ohio, so I used the county I live in for my discussion.  Putnam County has a population of 33,861 persons, the median income is $62,000, and a poverty level of only 5.5%.  I feel very fortunate to live in a community/county that has many employment opportunities.  Putnam Co has 482.52 land area in square miles.  We have approximately four small family owned grocery stores and a Walmart super center in the county.  Using Walmart prices: gallon of 2% milk-2.78, loaf of wheat bread-1.78, bag of carrots-2.99, bag of fuji apples-3.99, container of yogurt-3.79, bag of doritoes-3.99, 2L of soda-1.69, and a bag of fudge strip cookies-2.50.  One social factor that determines where people shop and what people buy is income.  Although the median income in my county is high, there is a small population of people living in poverty.  At our local Walmart, groceries are considerately cheaper than the locally owned grocery store, more selection and generic items can be purchased making groceries more affordable.  Public health assumes that it is the responsibility of the community to help low income persons meet their basic needs (Nies, 2019).  My community offers resources for food assistance monies to low income families, especially infant’s formula.  Many people do not have the opportunity to buy the cookies, steak, or soda, they must categorize their needs vs. their wants.  Milk and bread may be a smarter buy this week and maybe some extra cash next week may allow the purchase of the soda.  Now with school starting back up and kids needing to pack lunches, this too plays into the necessity category.  “We know income and education fundamentally shape health through the life course and social and economic determinants matter” (Galea et al., 2020). 

Another social determinant in my community is transportation, especially in the elderly population.  Putnam Co. has an 18.8% population of persons aged 65 and older.  Because I live in an area considered a more suburban rural area, walking to local grocery stores is not an option.  Persons without transportation may have to chose to go without some items or only being able to buy a few items if having to rely on friends and family.  We do not have many options for taxi services or uber in my area, so many rely on neighbors or family member to help transport to grocery store or deliver items.  Community resources for transportation are area council on aging, and local services that offer transportation to and from areas of need like health care, groceries, and therapies. 

Some areas that the community health nurses could address food insecurities are by screening within the community and collaboration with local primary care physician’s offices.  By collaborating with the local medical providers, patients will get screened at their health check up or routine office visit and data collected can determine the community need of social determinants.  The main goal of community health nursing is to promote the health of the community by focusing on promotion of health and health maintenance of everyone in the community (Nies, 2019).  I work in a primary care physician’s office for a large healthcare organization, we ask social determinant questions at every visit.  If the patient screens positive, we offer resources to help provide for their need.  We work closely with the local public health staff to assure the patient’s needs are met.  We may provide info on local food banks, places offering free meals, transportation, counseling options, or any other social need.  “Public and community health nursing practice includes population-focused intervention that seek to improve the health and well-being of groups, aggregates, and communities” (Nies, 2019).  The goal is to improve the future health of communities, approaching healthcare in a preventative way. 

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Galea, S., Abdalla, S.M., Sturchio, J.R. (June 11, 2020). Vol. 17(6). Social Determinants of Health, data Science, and decision-making:Forging a transdisciplinary Synthesis. PLOS Medicine.

Nies, M.A., & McEwen, M. (2019). Community/Public Health nursing: Promoting the health of populations (7th ed.). Saunders/Elsevier.

U.S. Census Bureau retrieved from

Part A: U.S. Census Community Data

Using the latest data and estimates from the U.S. Census, Philadelphia’s statistics included:

  • Total population:
    • 2019 Estimate: 1,584,064 (USA 2019 Estimate: 328,239,523)*
    • 2010 Census: 1,520,006 (USA 2010 Census: 308,745,538)
  • Median Income (2018)
    • Philadelphia: $43,744 (United States: $60,293)
  • Percentage living in poverty:
    • Philadelphia: 24.9% (United States: 11.8%)

*Estimated 3.8% increase in population in the city of Philadelphia comparing data from the most recent decennial census 2010 to estimates for 2019 (United States Census Bureau, 2019).

Part B: Grocery Prices

Store Referenced: Acme Markets, Philadelphia, PA (Acme Markets, 2020)

  • 1 gallon of milk $4.99
  • 1 loaf of bread $1.49
  • 1 bag of apples $2.29     (1lb. bag)
  • 1 bag of carrots $2.89     (2lb. bag)
  • 1 lg container of yogurt $3.79 (32oz)
  • 1 2-liter of soda $3.09
  • 1 bag of chips $2.89     (9.5oz)
  • 1 package of cookies $4.59

Paragraph One: Utilizing the data collected, discuss a social factor that might impact what groceries are purchased.

Despite being one of the wealthiest countries in the world and a major producer of food, the United States also experiences high levels of food insecurities. According to the data collected from the U.S. Census Bureau, 24.9% of my community is living in poverty, and as one of the most populated cities in the country, Philadelphia ranks second in the United States for this statistic. Economic instability is a social factor exposing individuals to barriers, such as accessing affordable, nutritious food. Competing expenses of rent, utilities, and medications determine food choices. Deciding to purchase less expensive items and those with longer shelf life is likely their only option. Dependence on these food selections may have a negative influence on their health over time (Oliver, et al, 2020). Another consideration is whether they have adequate kitchen supplies to prepare the food along with knowledge of meal preparation. Access to emergency food banks can assist families and provide healthier food options (Aunt Bertha, 2020).

Paragraph Two: Utilizing the data collected, discuss another social factor that might impact what groceries are purchased.

Given the inequities of poverty, another factor impacting what groceries are purchased is lack of education. Lack of basic nutrition knowledge results in poor selections. Behavior and experience impact food choices. For some, purchases are made by what looks appealing and what requires little preparation. These challenges can be further compounded if anyone in the family unit has a health condition warranting special dietary restrictions (Oliver, et al, 2020).

Paragraph Three: Discuss how the community health nurse could use one of the 17 intervention categories from the Public Health Intervention Wheel to address areas of food security.

To better understand the needs, the community health nurse could utilize screening and implement case management interventions. Bridging the gaps through access to clinical-community linkages will help support families, such as Aunt Bertha. Addressing the non-medical influencers (transportation and adequate housing) can ease the financial burden allowing for better nutritional selections.


Acme Markets (2020). “Shop Acme Markets.” Retrieved on 31 August 2020 from to an external site.

Aunt Bertha (2020). “Food Pantry Search.” Retrieved on 2 September 2020 from–philadelphia-pa?postal=19115Links to an external site.

Oliver, T., McKeever, A., Shenkman, R., Diewald, L. (2020). “Barriers to Healthy Eating in a Community That Relies on an Emergency Food Pantry.” Journal of Nutrition Education and Behavior, 52(3), March 2020, pp. 299-306. DOI: to an external site.

U.S. Census Bureau (2019). “QuickFacts: United States.” Retrieved on 31 August 2020 from

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