Analyzing social determinants of health: Wald and IOM

Read the brief's opening line before anything else: *answer one of the following questions*. Two bulleted options follow — the Lillian Wald and Figure 1-6 question, and the IOM state action coalition question — and the first of them contains a further nested choice, *answer any one of the following*, between competencies you already use and competencies you do not. So the intended shape is one main question, and within it one sub-option. That said, the second bullet carries its own APA and references demand, which reads as though it might be a separate deliverable, and the two bullets are formatted inconsistently. If your rubric implies both, answer both; if it does not, answer one properly rather than two thinly. Say at the top which you selected, so a marker is never guessing. A single opening sentence naming your choice costs nothing and removes the ambiguity from the marker's side.

The Wald question is evaluative, and the operative word is *what*. Figure 1-6 breaks nursing's policy influence into who, what, where, when and why, and you are asked to look specifically at the *what* — the strategies and competencies — then judge which of them Wald used effectively. That is a judgement with a defence, not a biography. It is also unusually easy to evidence, because her methods are documented and distinct: direct service, with home nursing offered free or for whatever residents could pay; institution-building, including public health nursing in schools, the National Organization for Public Health Nursing and Columbia's School of Nursing; and coalition-building, through the NAACP, the US Children's Bureau and the National Child Labor Committee. Each of those three is a different row of the strategy column, which is what makes the mapping exercise worth doing.

The strongest answer to *which did she use effectively* is not a single strategy but the observation that she ran them concurrently, and that each fed the others. Home visiting generated the case knowledge that made the policy arguments credible; the institutions turned individual advocacy into something that outlived her; the coalitions gave a nurse access to legislative change she could not have reached alone. By 1913 the settlement had grown to seven buildings and 92 nurses making 200,000 visits a year — a figure worth citing, because it shows scale rather than asserting impact. If you argue one strategy was most effective, tie the claim to an outcome that survived, which is the test the *what* row of Figure 1-6 is implicitly applying. Reputation is not evidence here; the institutions she left behind are.

If you take the second option, note that it is a research task, not a recall task. *Based on your analysis of the website* means the state action coalition's own pages are your data, so the answer requires you to open your state's page and read what that coalition actually does — its projects, partners, published progress — rather than describing the IOM report and asserting that your state is working on it. Coalitions vary enormously; they are multi-sector by design, drawing in schools, libraries, emergency services, businesses and foundations, so the evidence you need may sit under partnerships rather than under nursing. Address each of the four recommendations in turn and say plainly where you found nothing, because an honest gap is a finding. Screenshot or quote what you find, so the analysis is anchored to something a marker could check.

One analytical point will lift this answer above most: the IOM report dates from 2011 and several of its targets carried deadlines that have now passed — most conspicuously eighty per cent of nurses holding a bachelor's degree by 2020, and a doubling of doctorally prepared nurses. Assessing your state's progress against a target whose date has expired is a sharper exercise than assessing progress in the abstract, and it lets you say something specific about whether the recommendation was met, missed, or quietly superseded by later work. Be careful to attribute correctly, too: the coalitions were created to advance these recommendations, so their activity is evidence of effort, and outcome data is what tells you about achievement. Naming a target, its deadline and what happened is three sentences that most answers to this question never manage.