White siding red roof house, view from front
HealthJanuary 13, 2021

Client health and wellness: What’s zip code got to do, got to do with it?

By: Heather Swift, MSN, RN
Now that we all have Tina Turner playing in our heads, in all seriousness, zip code has everything to do with a client’s health and wellness. When I mention zip code, ultimately, I am talking about social determinants of health (SDoH).

What are social determinants of health (SDoH)?

Social determinants of health can include housing, transportation, education, access to food, social isolation and more - basically, anything that compromises where a client lives and works. When I say everything to do with, I mean the impact zip code has on a client’s overall health is up to 80%.

As nurse educators and nurses, we need to consider a client’s SDoH at admission and recognize the importance and the impact one’s environment has on promoting and/or maintaining health. Addressing the social determinants of health begins with identifying a patient’s needs and measuring their impact on the patient upon admission. A client’s health outcomes are too often caused by the conditions in which they live, learn, work, and play, and healthcare providers are not routinely asking the right questions to help remedy the problems.

Let’s dig into eight key SDoH areas we should ask our clients during admission assessments and therefore adding to prelicensure nursing and medical programs. By doing so, the patient outcomes would be more positive, and the readmission rates and overall healthcare expenditure would much lower.

Why treat people and send them back to the conditions that made them sick in the first place?
Sir Michael Marmot

Housing environment

First, let’s understand our client’s housing situation. We should start by asking our clients if they are concerned about eviction or being unable to meet mortgage or rent in the next two months. We should also ask if there are concerns about mold, bugs, lead paint, nonfunctioning oven/stove, water accessibility and if there are functioning smoke detectors in the home (Savoy et al., 2019). Unstable housing situations can account for a number of health concerns, including preventable injuries, respiratory and cardiovascular ailments due to indoor air pollution, communicable diseases due to overcrowding or unsanitary conditions, and illness and death from temperature extremes.

Food insecurity

Second,ask your client if in the last year they’ve had difficulty putting food on the table and/or if they have run out of food without the resources to buy more. Why is this crucial? Food insecurity impacts both short- and long-term health outcomes, including a greater risk of diabetes and hypertension, higher risk of hospitalization in children, and excess weight gain in women who are pregnant. This can be caused by challenges with transportation, low-income levels, low-educational achievement, and limited access to healthy food options (food deserts) (Savoy et al., 2019).

Reliable transportation

Ask your client if they have access to reliable transportation. If they do not this will likely prevent them from making healthy lifestyle decisions. Savoy et al. (2019, p. 3) lists the research findings that a lack of transportation causes such as preventing individuals from accessing goods and services to include healthy foods, medication, education, employment, and initial or follow up health care visits.


We need to be asking if the utility company has threatened to turn off services in the last year? Let us find out if they have running water, heat and/or AC, and electricity currently? Utility shut-offs lead to dangerous living environments, including unhygienic conditions, temperature extremes and injuries (Savoy et al., 2019).

Employment and financial situation

Is your client employed? Steady source of income will better a client’s overall health by enabling clients to live in safer neighborhoods, afford access to better health care, provide education or childcare for their children, and buy nutritious food. (Savoy et al., 2019).

Access to childcare

Is childcare an ongoing issue? Childcare not only affects the child but the adult as well. Access to adequate childcare and early childhood education are associated with improved cognitive and emotional development, academic achievement and reduces teen pregnancy and crime rates. Lack of consistent access to childcare impacts parents as they may forgo their own health needs and can prevent educational and employment opportunities for parents (Savoy et al., 2019).


Let’s ask your client if they have a high school diploma or GED. Low education levels are correlated with lower income which are associated with higher incidence of smoking and hospitalizations and a shorter life expectancy. They are less likely to comply with medical care and/or take responsibility of their own health (Savoy et al., 2019).

Personal safety

Last, but certainly not least, is personal safety. Research shows that “exposure to violence, whether interpersonal or community violence, has lasting effects on an individual’s physical and emotional health. Utilize the screening tools to provide early intervention. Tools that incorporate the HITS (Hurt, Insult, Threaten, Scream) instrument is best, this tool has been recently modified, to “anyone, including family” instead of only “your partner.” This change broadens the scope beyond intimate partner violence” (Savoy et al., 2019 p. 4).

It’s necessary to understand these SDoH conditions to get the full picture of a client’s health and potential future risks. These questions should occur at admission, discharge, and as many times as necessary to get the answers needed to prevent a readmission, exacerbation, unintentional injury or death of a client.

Heather Swift, MSN, RN
Expert Insights Contributor for Wolters Kluwer, Nursing Education
  1. Savoy, MD, M., Wilder, MD, V., & O’Gurek, MD, D. (2019). Social determinants of health guide to social needs screening. American Academy of Family Physicians, 1–6. https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/hops19-physician-guide-sdoh.pdf
Lippincott Nursing Education
Preparing today’s students to become tomorrow’s nurses.