Social Determinants and Access Practice Questions

40 multiple-choice questions on Social determinants and access for paramedic and EMT students, from Chapter 3 (Public Health). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

40 practice questions

1. Social determinants of health are:

   1. A. Inherited genetic factors that set disease risk
   2. B. Hospital policies that determine who gets care
   3. C. Conditions where people live, work, and age
   4. D. Personal lifestyle choices made by individuals
   Show answer

   Answer: C. Conditions where people live, work, and age

   Income, education, housing, and neighborhood matter as much as clinical care. This includes the conditions people are born into.

2. Poverty affects health largely by:

   1. A. Passing on genes that cause chronic disease
   2. B. Increasing physical activity from manual labor
   3. C. Limiting access to care, food, and housing
   4. D. Reducing personal motivation to stay healthy
   Show answer

   Answer: C. Limiting access to care, food, and housing

   Cost is only one of several barriers. Transportation is another common gap.

3. Food insecurity means:

   1. A. Living far from the nearest hospital or clinic
   2. B. Having a diagnosed food allergy or intolerance
   3. C. Limited or uncertain access to adequate food
   4. D. Following a restricted diet prescribed by a physician
   Show answer

   Answer: C. Limited or uncertain access to adequate food

   It is associated with worse control of chronic disease. Adequate here means enough nutritious food.

4. Lack of transportation affects health by:

   1. A. Lowering ED use since trips are hard
   2. B. Affecting only rural residents, not city dwellers
   3. C. Causing missed appointments and delayed care
   4. D. Affecting routine visits but not ED use
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   Answer: C. Causing missed appointments and delayed care

   Some 911 calls are transportation problems in disguise. Delayed care leads to more emergency calls. Without transportation, patients miss routine care and end up using the ED and 911 more, not less.

5. Health disparities are:

   1. A. Outcome gaps linked to social or economic disadvantage
   2. B. Random variation in health between individuals
   3. C. Measurement errors in how health data are collected
   4. D. Differences in outcome explained by genetics alone
   Show answer

   Answer: A. Outcome gaps linked to social or economic disadvantage

   Recognizing them is the first step toward addressing them. Environmental disadvantage also contributes.

6. A patient with limited English proficiency should be provided:

   1. A. Care using gestures, without verbal communication
   2. B. A family member as translator whenever convenient
   3. C. Written English instructions to take home and review
   4. D. A qualified interpreter, with family as a last resort
   Show answer

   Answer: D. A qualified interpreter, with family as a last resort

   Family members may filter, misunderstand, or have their own interests.

7. Cultural competence in EMS means:

   1. A. Treating everyone identically regardless of context
   2. B. Asking rather than assuming, and adapting to values
   3. C. Memorizing the beliefs of each cultural group
   4. D. Avoiding sensitive topics to prevent offense
   Show answer

   Answer: B. Asking rather than assuming, and adapting to values

   Asking a simple question avoids most mistakes. It starts with respecting differences.

8. Rural communities often face:

   1. A. Shorter transport times due to less traffic
   2. B. More specialty centers per capita than cities
   3. C. Longer distances to care and fewer providers
   4. D. Higher insurance rates as the only real difference
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   Answer: C. Longer distances to care and fewer providers

   System design must account for time and distance. Volunteer staffing challenges are also common.

9. Homeless patients commonly have:

   1. A. Higher rates of chronic disease and untreated illness
   2. B. No need for referrals since shelters provide care
   3. C. Full access to care through emergency departments
   4. D. Lower rates of chronic disease due to younger age
   Show answer

   Answer: A. Higher rates of chronic disease and untreated illness

   Connecting them to community resources is part of good care. Injury rates are high and follow-up is difficult.

10. Insurance status affects prehospital care mainly by:

    1. A. Determining the response priority assigned by dispatch
    2. B. Changing the treatment a paramedic provides
    3. C. Influencing when patients seek care and follow-up
    4. D. Deciding which treatment protocols the crew follows
    Show answer

    Answer: C. Influencing when patients seek care and follow-up

    Field treatment should never depend on the ability to pay.

11. Education level affects health because:

    1. A. It shapes income, health literacy, and behaviors
    2. B. Only advanced degrees produce a measurable effect
    3. C. It affects health only during childhood years
    4. D. It is unrelated once income is accounted for
    Show answer

    Answer: A. It shapes income, health literacy, and behaviors

    Each additional year of education correlates with better outcomes. It also shapes employment.

12. Employment affects health through:

    1. A. Income, insurance, stress, and workplace exposures
    2. B. No measurable pathway once age is controlled for
    3. C. Employer benefits alone, such as retirement plans
    4. D. Income alone, with no other measurable pathway
    Show answer

    Answer: A. Income, insurance, stress, and workplace exposures

    Unemployment harms both physical and mental health.

13. Housing quality affects health because:

    1. A. Mold, lead, pests, and crowding cause illness
    2. B. It affects children's health but not adults'
    3. C. Only a home's location matters, not its condition
    4. D. Its effects are cosmetic rather than medical
    Show answer

    Answer: A. Mold, lead, pests, and crowding cause illness

    Asthma is strongly linked to housing. Housing instability also contributes to illness and injury.

14. Neighborhood conditions affect health through:

    1. A. Safety, food and park access, and pollution
    2. B. School quality alone, through education levels
    3. C. Crime rates alone, independent of other factors
    4. D. Nothing measurable beyond individual income
    Show answer

    Answer: A. Safety, food and park access, and pollution

    Zip code predicts health outcomes. Social connection matters too.

15. A food desert is:

    1. A. A rural farming region with poor crop yields
    2. B. A home with little food on hand
    3. C. A fast-food restaurant with no healthy options
    4. D. An area lacking affordable, nutritious food
    Show answer

    Answer: D. An area lacking affordable, nutritious food

    Convenience stores often fill the gap poorly. A home short of food describes food insecurity, not a food desert.

16. A patient calls 911 for the third time this month asking to go to the ED for a medication refill. She has no car and the nearest pharmacy is two bus transfers away. Which response best addresses the underlying problem?

    1. A. Transport her every time, since she called 911 for help
    2. B. Tell her that 911 is not for refills and leave the scene
    3. C. Document the barrier and refer her to community paramedicine
    4. D. Report her to dispatch as a frequent caller to be flagged
    Show answer

    Answer: C. Document the barrier and refer her to community paramedicine

    Repeat 911 calls are often a symptom of a social need, here transportation and pharmacy access. Documenting the barrier and referring her to services that can arrange delivery, transport, or a medication plan fixes the cause. Transporting her each time treats the symptom. Refusing her or labeling her as a frequent caller leaves the need unmet.

17. Social isolation is associated with:

    1. A. Mental health effects only, without added mortality
    2. B. Mortality risk comparable to major risk factors
    3. C. Effects that fade once a person adjusts
    4. D. No measurable effect on physical health outcomes
    Show answer

    Answer: B. Mortality risk comparable to major risk factors

    Older adults living alone are at particular risk. The harm from isolation lasts; people do not simply adjust to it.

18. Discrimination affects health through:

    1. A. Chronic stress, reduced access, poorer treatment
    2. B. Employment barriers alone, through lower wages
    3. C. Mental health effects only, not physical illness
    4. D. Nothing measurable once income is controlled
    Show answer

    Answer: A. Chronic stress, reduced access, poorer treatment

    It is a recognized determinant.

19. Health disparities are considered avoidable because they:

    1. A. They are caused by genetic differences between groups
    2. B. They arise randomly and resolve on their own
    3. C. They cannot be measured and so can't be proven
    4. D. They stem from changeable differences in opportunity
    Show answer

    Answer: D. They stem from changeable differences in opportunity

    This is why equity efforts exist. Differences in resources can also be changed.

20. Which population typically experiences the highest rates of chronic disease?

    1. A. High-income groups with sedentary office jobs
    2. B. Suburban residents with long daily commutes
    3. C. Young adults with high rates of risky behavior
    4. D. Low-income groups with limited access to care
    Show answer

    Answer: D. Low-income groups with limited access to care

    Poverty concentrates risk. Healthy environments are also less available to them.

21. Uninsured patients are more likely to:

    1. A. Avoid EMS entirely, even in true emergencies
    2. B. Have an established primary care provider
    3. C. Seek early care at free community clinics
    4. D. Delay care until problems become emergencies
    Show answer

    Answer: D. Delay care until problems become emergencies

    EMS becomes a safety net.

22. Medicaid is:

    1. A. A federal health program for military veterans
    2. B. Private insurance subsidized through employers
    3. C. A federal insurance program for adults 65 and older
    4. D. A joint federal-state program for low-income people
    Show answer

    Answer: D. A joint federal-state program for low-income people

    Eligibility and coverage vary by state. It covers low-income individuals and families.

23. Medicare primarily covers:

    1. A. All uninsured residents regardless of age
    2. B. Low-income families through a state-run program
    3. C. Children in families above the poverty line
    4. D. Adults 65 and older and certain disabled people
    Show answer

    Answer: D. Adults 65 and older and certain disabled people

    It is a federal program.

24. Primary care access matters because:

    1. A. It prevents complications and reduces ED visits
    2. B. It is required for all insurance coverage
    3. C. It replaces the need for EMS in emergencies
    4. D. It removes the need for medication reviews on calls
    Show answer

    Answer: A. It prevents complications and reduces ED visits

    Shortages exist in many areas. Even well-managed patients still need a medication review on every EMS call.

25. A medical home refers to:

    1. A. A skilled nursing facility for long-term care
    2. B. A home health agency providing in-home visits
    3. C. A primary care practice that coordinates care
    4. D. The hospital where a patient was last admitted
    Show answer

    Answer: C. A primary care practice that coordinates care

    Patients without one rely on emergency services. It coordinates a patient's care over time.

26. Health literacy problems affect what portion of adults?

    1. A. Mostly recent immigrants only
    2. B. Mostly adults over age 75
    3. C. Almost none in developed countries
    4. D. A large proportion of adults
    Show answer

    Answer: D. A large proportion of adults

    Plain language helps everyone. Many adults struggle to understand health instructions.

27. Teach-back is a technique that:

    1. A. Replaces written instructions with verbal ones
    2. B. Has the patient explain instructions in their own words
    3. C. Quizzes the patient on terminology before discharge
    4. D. Is reserved for use by hospital nursing staff
    Show answer

    Answer: B. Has the patient explain instructions in their own words

    It catches misunderstanding before it causes harm.

28. Which practice improves communication with low health literacy patients?

    1. A. Precise medical terminology to avoid ambiguity
    2. B. Plain language and confirming understanding
    3. C. Speaking quickly to cover everything on scene
    4. D. Written handouts in place of verbal discussion
    Show answer

    Answer: B. Plain language and confirming understanding

    Avoid assuming understanding from nodding. Cover one topic at a time.

29. Limited English proficiency affects care because:

    1. A. Interpreters are never available in the field
    2. B. Misunderstanding causes errors and missed history
    3. C. It affects billing paperwork but not clinical care
    4. D. Patients with limited English usually refuse care
    Show answer

    Answer: B. Misunderstanding causes errors and missed history

    Interpreter services are a legal requirement in many settings. Poor adherence is another consequence.

30. Using a child as an interpreter for a parent is:

    1. A. Legally required when no adult speaks English
    2. B. Standard practice for most EMS systems today
    3. C. Inappropriate except in a true emergency
    4. D. Efficient, since the child is already on scene
    Show answer

    Answer: C. Inappropriate except in a true emergency

    Professional interpreters are preferred. It burdens the child and risks error.

31. Cultural humility differs from cultural competence by emphasizing:

    1. A. Identical standard treatment for every patient
    2. B. Self-reflection and learning from each patient
    3. C. Memorizing facts about each cultural group
    4. D. Avoiding cultural discussion to stay neutral
    Show answer

    Answer: B. Self-reflection and learning from each patient

    It acknowledges you cannot know everything. The reflection is ongoing.

32. Religious beliefs may affect:

    1. A. Nothing relevant to prehospital clinical care
    2. B. Treatment acceptance, modesty, and end-of-life choices
    3. C. Hospital choice only, not treatment decisions
    4. D. Billing and insurance decisions, not care itself
    Show answer

    Answer: B. Treatment acceptance, modesty, and end-of-life choices

    Ask respectfully. Dietary needs may also be affected.

33. Gender and sexual minority patients may avoid care because of:

    1. A. Past discrimination and fear of mistreatment
    2. B. Lower rates of illness than other populations
    3. C. Distance to specialized clinics, not bias
    4. D. Insurance barriers alone, unrelated to bias
    Show answer

    Answer: A. Past discrimination and fear of mistreatment

    Respectful, nonjudgmental care builds trust.

34. Patients with disabilities face barriers including:

    1. A. Equipment availability as the only barrier
    2. B. Cost of care as the only significant barrier
    3. C. No barriers beyond those of the general public
    4. D. Physical access, communication, and attitudes
    Show answer

    Answer: D. Physical access, communication, and attitudes

    Ask the patient how they prefer to communicate and move. Transportation is another barrier.

35. Veterans may have specific health needs related to:

    1. A. Nothing different from the general population
    2. B. Age-related conditions only, not service history
    3. C. Insurance gaps only, since VA covers the rest
    4. D. Service injuries, exposures, and mental health
    Show answer

    Answer: D. Service injuries, exposures, and mental health

    VA resources may be available.

36. Addressing social determinants in EMS most often means:

    1. A. Providing money or supplies directly
    2. B. Solving the underlying problem on scene
    3. C. Ignoring them as outside the EMS scope
    4. D. Recognizing, documenting, and referring
    Show answer

    Answer: D. Recognizing, documenting, and referring

    EMS is a connector.

37. Which is an example of a structural barrier to care?

    1. A. Inherited genetic risk for certain chronic conditions
    2. B. A patient's lack of interest in medical follow-up
    3. C. A patient's personal choice to skip scheduled visits
    4. D. Clinic hours that conflict with work schedules
    Show answer

    Answer: D. Clinic hours that conflict with work schedules

    Structural barriers require system solutions.

38. Rural health challenges include:

    1. A. Overcrowded emergency departments and long waits
    2. B. Distance, provider shortages, hospital closures
    3. C. Short transport times that limit field treatment
    4. D. Too many competing hospitals in small markets
    Show answer

    Answer: B. Distance, provider shortages, hospital closures

    Rural hospital closures have accelerated. Specialty care is also limited.

39. Telehealth can address access barriers by:

    1. A. Connecting patients with providers remotely
    2. B. Serving only urban areas with fast internet
    3. C. Eliminating any need for in-person care
    4. D. Replacing EMS response for most 911 calls
    Show answer

    Answer: A. Connecting patients with providers remotely

    EMS telehealth consultation is growing. Some systems use it from the field.

40. Which best describes the EMS provider's responsibility regarding social determinants?

    1. A. Document them but take no further action
    2. B. Recognize their impact and connect to resources
    3. C. Focus on transport and leave them to hospitals
    4. D. Treat them as outside the scope of EMS practice
    Show answer

    Answer: B. Recognize their impact and connect to resources

    The call is often a symptom of a larger problem.