M1.2 - Population Health & its Determinants

what is a “population”?

• group of people that share the same environment

• the whole number of people of inhabitants in a country or region

• the total of individuals occupying an area or making up a whole

• a group of people or animals of a particular kind that live in a place

public refers to

• environment, control of communicable diseases, assurance of health services, vital records

• the establishment is to improve population well-being/ mortality rate

medicine & healthcare

• people use medicine when they don’t have optimal health

• medicine is from diagnosis and treatment, we want to change it by focusing on what’s missing

determinants(factors) of health

• policymaking

• biology & genetic factors

  • gener, race, preborn genes

• individual behavior

• social factors

  • transportation, lifestyle

  • ex: the election made people nervous

• environmental factors

  • pollution, water quality

• individual lifestyle factors

• social and community networks

• other general macro-environmental conditions

social determinants of health

• gender, age, etc, things that we cannot change impacts everyone differently

• general socio-economic, cultural and environmental conditions

  • ex: immigration

• living and working conditions

  • agriculture and food production

  • education

  • work environment

  • unemployment

  • water & sanitation

  • healthcare services

  • housing

individual lifestyle factors

• exercise, sexual activity, and diet and constitutional factors within a person are direct determinants of a persons health

social and community networks

• within immediate environment of an individual

  • people around you

  • ex: moving to cstat from our hometown (small or big)

other general macro-environmental conditions

• education

• work environment

• living and working conditions

• healthcare services

• food production

• water & sanitation

• housing

• crime

physical environment

• connection between health and environment

  • water, food, milk sanitation

  • improve nutrition

• could deteriorate without adequate support of the governmental public health infrastructure

  • ex: living in area with high traffic and need to commute to work, traffic can impact mental well-being (physical environment can impact overall health)

environmental health problems

• global warming

  • climate change

• population growth

  • always growing

• habitat destruction & loss of green spaces

  • cutting down forests, which takes YEARS to regrow

• not amenable to quick technical fixes!!! resolution requires community and societal engagement

• places in which people work and live

  • tobacco smoke & drinking

  • pesticides

  • toxic housing: lead based paint, asbestos-containing insulation

• urban vs. rural

  • exercise

    • cities have side walk, small towns don’t

  • diet

    • supermarket

  • air populations

    • southeast houston

examples of environmental health problems

• hurricane disasters

  • flooding

  • power outages

  • water supplies

  • food and water supply

  • shelter

  • clean up

• all listed are examples of environmental factors that if untreated, can impact our health

types of social determinants of health: health & health care

• because of access to healthcare, insurance, transportation, or quality of care

• access barriers of not receiving healthcare:

  • rural area

  • language barrier

  • insurance

  • transportation

  • no appointment

socioeconomic status vs health

• socioeconomic status (SES)

  • social standing or class of an individual or group

    • education, income and occupation (blue collar vs white collar)

  • in general, socioeconomically advantaged people have lower mortality, morbidity, and disability rates

• studies examined association between SES and health

  • mortality or morbidity

• SES is strongly related to access to and the quality of preventive care, ambulatory care (private care services), and high technology procedure

  • people who have better SES have a better health outcome

examples of social determinants***

• availability of resources to meet daily needs (e.g. safe housing and local food markets)

• access to educational, economic, and job opportunities

• access to health care services

• quality of education and job training

• availability of community-based resources in support of community living opportunities for recreational and leisure-time activities

• transportation opinions

• public safety

• social support

• culture

• social norms & attitudes (e.g. discrimination, racism, and distrust of government)

• exposure to crime, violence, and social disorder (e.g. the presence of trash and lack of cooperation in a community)

• socioeconomic conditions (e.g. concentrated poverty and the stressful conditions that accompany it)

• residential segregation

• language/literacy

• access to mass media and emerging technologies (e.g. cell phones, the internet, and social media)

racial & ethnic disparities in health

• racial and ethnic (genetics & culture) is an important issue in the US

• minority (other than americans) populations may experience burdens of disease and health risk at disproportionate rate

  • asian americans are likely to have certain cancer based off statistics

social connectedness (important factors)

• complex relationships between individuals and among groups

• strong social ties can have a direct and positive impact on health

  • higher level of perceived social connectedness

    • prevention of chronic diseases

prevention of chronic diseases

• lower blood pressure rate

• better immune responses

• lower levels of stress hormones

the importance of place

• characteristics of places carry health risks for residents

  • neighborhood, school, work sites, countries…

  • rural vs. urban

• U.S: one of the richest countries in the world, but also one of the most unequal in the distribution of wealth

  • the annual household incomes in the United States range from under $10,000 to $7.8 billion

  • the middle 50% of the annual household incomes in the United States range from $25,000 to $90,000

income inequality

• what caused income inequality in the US? political education, etc

  • lack of investment in education, development, and social services?

  • weak civic and social bonds; lack of trust between people

    • get better from changing our individual behavior, we have done a lot to make changes population wise

population-level preventive interventions

• health risk is related to a complex of social, economic, and political factors that both surpass and powerfully interact with “downstream” elements such as individual behaviors, biological traits, and access to health care services

• encourage vaccines, hand washing, etc at population level

classification of population-level preventive measures

• universal preventive measure

• selective preventive measure

• indicated preventive measure

universal preventive measure

• recommend for everyone in an eligible population

  • ex: hand washing (meant for everybody

selective preventive measure

• recommended only when an individual is a member of a subgroup of the population whose risk of becoming ill is above average

  • ex: genetic disorders, mammograms

indicated preventive measure

• applicable to a person who, on examination, manifests a risk factor, condition, or abnormality that identifies them individually as being at high risk for the future development of a disease

  • ex: already has a condition, high cholesterol

effectiveness of preventive measures

• in some cases, universal measure may be more optimal and cost-effective than interventions targeted further downstream

  • tobacco use prevention

  • automobile-related injury prevention population-based strategies (e.g., laws)

• upstream policy interventions may refer to modifying the broader, social determinants of health

what can we do towards effectiveness of preventive measures

• chronic disease has often been less of a priority for public health and health organization

• its not a one agency job

public health: not a one agency job

• its partnership with all entities in public health system

• make program and policy decisions based on the evidence

• communicate effectively

• accountability