Appreciating and understanding education as a social determinant of health has illustrated the privileges I’ve had in accessing education while deepening my awareness of the systemic barriers of those who have not had equal access. Growing up, my parents emphasized the importance of education due to their culturally diverse up-bringing's and experiences. My mother of predominantly Northern European descent was raised in a small town in Wisconsin, while my father, of Mexican and Spanish heritage, was raised in Gallup, New Mexico – a town marked by poverty and racial disparities.  In our household, education was never an option, rather an expectation. I believe the discipline and emphasis on education led me to be obedient, and ultimately gain respect for my elders, parents, educators, and the learning process itself. 

Despite my parents growing up in culturally diverse, rural and underserved communities, both received bachelor’s degrees and chose to leave their small towns behind for greater opportunities in Denver, Colorado. My dad explained to me, “If I didn’t leave to pursue an education, I may have never gotten out,”. With my dad growing up in Gallup, New Mexico, he watched friends skip school to care for siblings and other family members as parents held two to three jobs. He noticed these friends and family members skipping school more often, falling victim to drugs and crime. Today, we still have family members who have suffered the burden of oppression and inequity from growing up in Gallup. It is hard to see them struggle to maintain a consistent job and fall victim to political propaganda and misinformation.  

On my mom’s side of the story, she attended small country school programs with small class sizes. She remembers many of her friends and peers skipping school to help on the family farm and eventually dropping out of school to run farms and family businesses. While many of her peers remain in the same small town running those businesses or holding various jobs, they obtain drastically different perspectives on social issues, especially pertaining to race and politics compared to my mom and her peers now with broader exposures to education. Even though my parents grew up in very different parts of the country, they both were surrounded by loved ones and friends who lacked an education and now endure narrow views and the continued social constraints.  

My father and I both have brown skin and have felt the societal effects of stereotypes, racism, and discrimination. We have been approached on several occasions by white individuals attempting to communicate with us in Spanish and assumed our ethnicity to only see the surprised look on their faces when my father and I respond in fluent English. It is clear the world views us differently and there are persistent societal biases, which is why my dad has stressed the importance of receiving an education. Mexican-Americans have historically suffered systemic racism, and my dad always reminds me, “No one can ever take away your education.”. As I continue to grow and reflect, I become more appreciative of this statement and thankful for the opportunity to receive an education. I have seen how no matter my skin color, having the knowledge and education I do allows me to appreciate the complexity of individuals who make up communities who suffer continued discrimination and systemic limitations. 

A social determinant of health I have had experience navigating across my life is social and community context. I grew up in Colorado until I was 11, then moved to Southern California before returning to the Denver area at 18. As a result of my large move across the country, and smaller more frequent moves in the Los Angeles area, I found it difficult to maintain community and a strong social background. I relied heavily on the support of my mother and little brother who moved with me, but it was still difficult to keep connections and grow consistently with the environment around me constantly shifting, and for a long time it felt like I didn’t have a community to call my own. 

I identify as a gay man, and have had a difficult path to acceptance and confidence in myself because of outside influence and engagement with communities. I have been called slurs in public because of the ways I dress, speak, and present myself to the world. This was especially difficult to handle during my teenage years, and I can say for a fact that it impacted my mental health. I have had issues with anxiety for a lot of my life, but it was exacerbated when I didn’t have community and a place where I felt free to be myself. Although it took some time, I am so grateful to say that I have found my community now. I am friends with other incredible queer people, which has broadened my understanding of what it means to be free and open in the expression of my identity regardless about what a select few may have to say about it. An important part of this experience for me was the perspective I gained, and how I can bring my experience with me into my nursing practice to help those who feel isolated or unsupported in their broader community or social context.

I am very appreciative that I grew up in a middle class family. We had good healthcare coverage through my father’s work, but money was tight and I knew how much of a burden emergency department visits and expensive dental care were for my family when they popped up unexpectedly. I know it took hard work, but I am eternally grateful that they were able to manage that aspect to assure that me and my brother received quality, timely medical care when needed. I lived in a lot of communities where this was not the norm.

As I have grown into adulthood and entered the medical field as a career, I am lucky enough to be able to access parts of healthcare that many do not have the privilege too. It interesting to see how my identity affects my health, whether related to physical aspects like concerns over sexual health and exploration into my community’s history with HIV/AIDS, or regarding mental health and my increased risk for depression, eating disorders, and anxiety. I have realized that the more I openly explore these avenues and ways in which my health can be affected by community and social context, the more information I am armed with to prevent complications and potential pitfalls. I hope to bring this skillset into my practice, doing everything I can to acknowledge this social determinant of health and equipping my patients to do the same as well. Education is power, and so too is strong community and social context. 

Growing up in California in a middle-class neighborhood, I had the privilege of living less than a mile from the nearest hospital. Access to healthcare was never a challenge for me, it was something I could access easily. I walked to the hospital to receive care, and throughout my childhood I never missed a physical, vaccination, or dental appointment. My parents ensured I was always up to date with my medical care. For me, the availability of health services was almost exceptional. 

My dad was a probation officer, and his career provided my family with some of the best health insurance that covered him, my mom, and myself. We always had the best coverage with low co-pays and minimal financial stress. My mom worked in retail, and together they created a stable home where healthcare was never something I had to worry about. I’m an only child, which I believe also contributed to the ease of managing my healthcare needs. My household only spoke English, meaning language was never a barrier when interacting with healthcare providers. We were never treated differently because of how we looked, talked, or where we were from, and that itself is a huge privilege I have come to recognize more deeply. Beyond that, my health literacy has also been strong, mainly due to my education. I have a Bachelor's degree in community health sciences, which has deepened my understanding to navigate healthcare systems. 

Looking back now, I understand how great this constant access to quality care has shaped me. It has given me a deep appreciation for the healthcare system. More importantly, it has instilled in me a belief that healthcare is not just a privilege, but it should be a right. I believe that everyone deserves the same easy access to healthcare that I had, and I know this belief has influenced my values, goals, and choices to pursue a career in nursing. 

I consider one of my biggest strengths to be the strong foundation my parents built for me. Because my dad had a good career and we never struggled to make ends meet, I was able to grow up with stability and support. My parent’s never let me struggle, academically, emotionally, or with my health. My aunt is also a major influence in my life. She is successful, intelligent, and someone I have always looked up to. Watching her thrive inspired me to pursue a life that it successful and meaningful. 

In this course, I have learned about people who haven’t had the same experiences that I have. One being Henrietta Lacks, the character in my book. I have read stories about individuals who were denied care, who’ve struggled to afford it, and who’ve had to choose between paying for food or going to receive medical care. These are things I’ve never personally faced, and it makes me realize how lucky I am. It also makes me determined to be a nurse who recognizes those disparities and works to reduce them for others. 

Today, the only minor barrier I face is getting a specific migraine treatment approved, but that feels small compared to what someone like Henrietta Lack’s endured. I still feel heard and helped when I go to the doctor, and I want to carry that forward. As a future nurse, I want to be someone who advocates for equitable care, especially for those whose social determinants make that access difficult. I know I have been fortunate, and now I want to be part of the reason someone else gets the care they need.