Class 2 - social determinants of health

Universal Human rights and health care in America ← among the rights in the declaration are:

• All human beings are born ____ and ____ in dignity and

  rights.

• Everyone has the right to ____, ____ and _____ of person.

• No one shall be subjected to ____ or to ____, _____ or _______ treatment or punishment.

• All are ____ before the law and are entitled without any

___________ to equal _________ of the law.

Universal Human rights and health care in America ← among the rights in the declaration are:

• All human beings are born free and equal in dignity and

  rights.

• Everyone has the right to life, liberty and security of person.

• No one shall be subjected to torture or to cruel, inhuman or

  degrading treatment or punishment.

• All are equal before the law and are entitled without any

discrimination to equal protection of the law.

Drivers of health

• _______ behavior contributes to one’s health, but health is an outcome shaped by a ________ of factors.

• Health/illness is influenced by the ____ experience and the ____ and ____________ surroundings in which the individual exists.

• Health-____________ behaviors can be ___________ by factors that are ______ an individual’s control (e.g., social, environmental)

Drivers of health

• Individual behavior contributes to one’s health, but health is an outcome shaped by a multiplicity of factors.

• Health/illness is influenced by the lived experience and the social and environmental surroundings in which the individual exists.

• Health-compromising behaviors can be reinforced by factors that are outside an individual’s control (e.g., social, environmental)

socio-ecological model of health behavior

• sustains that individual ______ and ________ occur in a ____ context

socio-ecological model of health behavior

• sustains that individual beliefs and behaviors occur in a social context

key drivers of health outcomes

1. societal/policy: ____ and ______ norms and ____________ policies that affect health behaviors and healthcare

key drivers of health outcomes

1. societal/policy: social and cultural norms and governmental policies that affect health behaviors and healthcare

2. community/organizational/institutional: _______/______ systems, _____, ____, _________ organizations, _______, ____ communities

2. community/organizational/institutional: hospitals/health systems, schools, media, community organizations, employers, faith communities

3. interpersonal: ____, ______, co-workers, personal physicians, teachers, neighbors, close associates

3. interpersonal: family, friends, co-workers, personal physicians, teachers, neighbors, close associates

4. individual/intrapersonal: _______ attributes, ____________, _______, attitudes, and ________

4. individual/intrapersonal: personal attributes, characteristics, beliefs, attitudes, and behaviors

changes in these (4 ^^) layers will produce changes in _______ behavior and _____ outcomes

changes in these (4 ^^) layers will produce changes in individual behavior and health outcomes

Health disparities (inequities) = _________ in health between groups that arise from broader _____ _______.

• The term has been widely used to refer to _________ in health ________ based on a variety of ______, such as race, ethnicity, socioeconomic status, geographic location, gender, and sexual orientation.

Health disparities (inequities) = differences in health between groups that arise from broader social inequities.

• The term has been widely used to refer to differences in health outcomes based on a variety of factors, such as race, ethnicity, socioeconomic status, geographic location, gender, and sexual orientation.

Health disparities are ________ and are

directly related to the historical and current unequal

distribution of _____, _______, _______, and

_____________ resources.

Health disparities are inequitable and are

directly related to the historical and current unequal

distribution of social, political, economic, and

environmental resources.

These disparities are often driven by ____,

_______, and ________________ factors that are beyond

the control of ________, such as ______,

___________, and inadequate access to _____

___.

These disparities are often driven by social,

economic, and environmental factors that are beyond

the control of individuals, such as poverty,

discrimination, and inadequate access to health

care.

The U.S. spends more ______ on health care than any other

developed country, yet its healthcare system ____________

on important health metrics (2022):

• the _______ life expectancy at birth

• highest ____ rates for _______ conditions

• the highest _______ and ______ mortality rates

The United States is known for its wealth and technological

advancements, but it is also known for its persistent health

disparities.

The U.S. spends more $$$ on health care than any other

developed country, yet its healthcare system underperforms

on important health metrics (2022):

• the lowest life expectancy at birth

• highest death rates for treatable conditions

• the highest maternal and infant mortality rates

The United States is known for its wealth and technological

advancements, but it is also known for its persistent health

disparities.

Socioeconomic disparities: People who live in _____ or have ____ incomes may have ____ access to quality _______, healthy ____ options, safe __________, and other resources that contribute to good health.

Socioeconomic disparities: People who live in poverty or have lower incomes may have less access to quality healthcare, healthy food options, safe neighborhoods, and other resources that contribute to good health.

geographic disparities: _____ communities may have fewer

_________ facilities and _______, leading to disparities in

access to ____ and ______ outcomes

geographic disparities: Rural communities may have fewer

healthcare facilities and providers, leading to disparities in

access to care and health outcomes

sex disparities: Women may experience health disparities,

including ______ rates of certain conditions such as _________

_______, _________, and worse _____ prognoses as the result

of __________ screening for _____ and _______ cancer

sex disparities: Women may experience health disparities,

including higher rates of certain conditions such as autoimmune

diseases, depression, and worse cancer prognoses as the result

of inadequate screening for breast and cervical cancer

gender disparities: ___________ and gender ______________

Individuals face unique challenges and disparities in _________

health care and experiencing ___________ in healthcare settings

gender disparities: Transgender and gender nonconforming

Individuals face unique challenges and disparities in accessing

health care and experiencing discrimination in healthcare settings

Americans living in rural areas (46 million

people/15% of total population) are more likely to die from:

•____ disease

•_____

•____________ injuries

•Chronic lower _______ disease (CLRD)

•____

Americans living in rural areas (46 million

people/15% of total population) are more likely to die from:

•Heart disease

•Cancer

•Unintentional injuries

•Chronic lower respiratory disease (CLRD)

•Stroke

^^

• more of these deaths are potentially _________

• reasons for the health gap between rural and urban residents include ____, _______, and ______________ factors

• more of these deaths are potentially preventable

• reasons for the health gap between rural and urban residents include social, structural, and environmental factors

_____ factors that might put ______ residents at higher risk of death from

public health conditions:

• Older age and more _____ than their urban

  counterparts

• Higher rates of ______ _____, high

  _____ _____, and _____

• Less _____-time, ______ activity and lower

  _______ use

• higher rates of _______

• less access to ________ and _____ ________

Social factors that might put rural residents at higher risk of death from

public health conditions:

• Older age and more illness than their urban

  counterparts

• Higher rates of cigarette smoking, high

  blood pressure, and obesity

• Less leisure-time physical activity and lower

  seatbelt use

• higher rates of poverty

• less access to healthcare and health insurance

racial/ethnic disparities: People of _____, including Black, Latino,

and Native American populations, are more likely to experience a

range of ______ ________, including higher rates of ______ disease,

infant _______, and maternal _______

racial/ethnic disparities: People of color, including Black, Latino,

and Native American populations, are more likely to experience a

range of health disparities, including higher rates of chronic disease,

infant mortality, and maternal mortality

social determinants of health (SDOH)

• If a health outcome is seen to a ______ or _____ extent

  between _________, there is a disparity

• _____ factors ______ to an individual that may not

  seem directly relevant to health, but that ultimately

  shape the conditions in which people ___, ____, and

  ____ in ways that can both _______ well-being and

  cause ______ risk.

*SDOH are ____ factors that drive ____ health outcomes

social determinants of health (SDOH)

• If a health outcome is seen to a greater or lesser extent

  between populations, there is a disparity

• Social factors external to an individual that may not

  seem directly relevant to health, but that ultimately

  shape the conditions in which people live, work, and

  grow in ways that can both promote well-being and

  confer disease risk.

*SDOH are social factors that DRIVE poor health outcomes

*refer to knowt on definitions of all these social determinants of health

racism

• system of structuring ________ and assigning ____ based

  on the ____ interpretation of how one ____ (which is what we

  call ”race”)

  • Unfairly __________ some individuals and

    communities

  • Unfairly __________ other individuals and

    communities

  • Saps the strength of the whole society through the

    waste of human resources

racism

• system of structuring opportunity and assigning value based

  on the social interpretation of how one looks (which is what we

  call ”race”)

  • Unfairly disadvantages some individuals and

    communities

  • Unfairly advantages other individuals and

    communities

  • Saps the strength of the whole society through the

    waste of human resources

structural racism refers to the ways in which society is

set up in such a way that _________ and __________

are preferentially given to those of ____ race rather than to

______

• Processes, attitudes and behavior(s) which amount to __________ through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which ____________ minority ethnic people

structural racism refers to the ways in which society is

set up in such a way that advantages and opportunities

are preferentially given to those of one race rather than to

another

• Processes, attitudes and behavior(s) which amount to

  discrimination through unwitting prejudice, ignorance,

  thoughtlessness and racist stereotyping which

  disadvantage minority ethnic people.

levels of racism

• institutionalized

  • differential ______ to the goods, services, and opportunities of ______, by “race”

ex: housing, education, employment, income

medical facilities

levels of racism

• institutionalized

  • differential access to the goods, services, and opportunities of society, by “race”

ex: housing, education, employment, income

medical facilities

levels of racism pt. 2

• personally-mediated racism

  • differential _________ about the ______, ______, and ______ of others, by “race”

  • differential _____ based on those assumptions

  • _______ and __________

• personally-mediated racism

  • differential assumptions about the abilities, motives, and intents of others, by “race”

  • differential actions based on those assumptions

  • prejudice and discrimination

levels of racism pt.3

• internalized racism

  • _________ by the stigmatized “races” of _______ messages

    about their own _______ and intrinsic _____

ex: self devaluation

levels of racism pt.3

• internalized racism

  • Acceptance by the stigmatized “races” of negative messages

    about their own abilities and intrinsic worth

ex: self devaluation

Health inequities: _______ in health that stem from unjust, systemic ______

and _______ which ____ opportunities for good health

Health inequities: Disparities in health that stem from unjust, systemic policies

and practices which limit opportunities for good health

Health Equity: everyone has _____ to the conditions and resources they need to achieve _____ health

• _____ health care, including _____, _____, and

  advanced care for _____ and _____ conditions

• affordable ______

• _____ and _____ dwellings and neighborhoods

• consistent _____ to _____ food

• _____ support

Health Equity: everyone has access to the conditions and resources they need to achieve good health

• Quality health care, including dental, vision, and

  advanced care for injuries and chronic conditions

• affordable housing

• safe and secure dwellings and neighborhoods

• consistent access to healthy food

• social support

“environmental characteristics” affect us

______ conditions can affect an individual’s health and

well-being by putting their _____ at risk

• Inadequate ______ causes or contributes to many

  preventable _______ and ______:

  • ________ conditions

  • ______ system, ____________ diseases and ______

  • poor ______ or _________ of homes is the cause of most home _______

living; health

housing; diseases; injuries

respiratory

nervous system, cardiovascular diseases and cancer

design; construction; accidents

• Poor housing conditions can lead to _________ and ______ among

  residents.

  • Perceived overcrowding increases feelings of _______ and

    _________.

  • Neighborhood _______ — _____ lots and buildings, _________, trash, etc.

• how can a healthy community and environment affect the health of the people?

  • Clean air and water, sanitation and green spaces, safe workplaces

    can enhance people’s quality of life:

    • reduce _______ and _______

    • ______ healthier lifestyles

    • improve _________ of workers and their families

    • improve lives of ______, ______ and ______

    • improve _____ ______

depression; hostility

hostility; depression

disarray; vacant; vandalism

mortality; morbidity

promote

productivity

women; children; elderly

mental health

Adequate _______ or the _________ of precarious

_______ must be considered a key component of health

_________ or _______ prevention

housing; prevention; housing; promotion; disease

anthropology of garbage

• how the ___ from a household can be helpful in analyzing its ____ ____________ habits

  • A small-scale study was done by Jill Baguchinsky on a

    household on Marco Island, Florida to study the _____

    habits of a household by analyzing its _______ ____

    for three days.

trash; food consumption

eating; domestic trash

If health disparities are driven by social and economic inequities, what do we do?

_______ those factors contributing to poor health outcomes

• _______ access

• _______ barriers

• _______ health systems

address;

expanding

removing

creating

How does public health address these inequities?

• research: Public health leaders are conducting _______ to

  better understand the _____ of _____ on health outcomes and

  to identify effective __________. This includes _______ the

  relationship between ______ and _____ _______, ______

  _____, and other health issues

research; impact; poverty; interventions; studying; poverty; chronic diseases; mental health

• education: Public health leaders _______ the public about the

  link between _______ and ______ outcomes. This includes

  providing _________ on how ______ affects access to

  _____ ____, healthy ____, safe ______, and other essential

  resources

educate; poverty; health; information; poverty; health care; food; housing

How does public health address these inequities?

• collaborations: Public health leaders are collaborating with

  _________ organizations and other stakeholders to address the

  ____ causes of poverty. This includes partnering with

  organizations that provide ___ _______, _______ ______

  education, and other ______ services to ___-income

  individuals

community; root; job training; financial literacy; support; low

• policy development: Public health leaders are working with

  policymakers to develop _______ that address ______ and

  improve _____ outcomes. This includes _________ for

  policies that increase _______ to affordable health care,

  increase the _______ ____, improve _______ to _____

  _________, and expand _____ _____ ___ programs

policies; poverty; health; advocating; access; minimum wage; health insurance; social safety net

the factor most important in determining the health of a community is its ____-_______ _____ (SES)

• people with higher _______ tend to be _______ for a variety of reasons

socio-economic status

incomes; healthier

Government

Responsibility

• To make organized, _________-driven

efforts to ensure public health

Role

• Determined by ____:

______, ____, ____

Branches involved

• _______, _______, _______

Government

Responsibility

• To make organized, community-driven

efforts to ensure public health

Role

• Determined by laws:

federal, state, local

Branches involved

Judicial, Executive, Legislative

Government

Public health seems to be a series of _______ and __________ related to the

law

• How much ______ can/should the ______________

  have to regulate our health, vs. How much

  freedom/liberty should we _______?

• How much ______ can/should _______ ___________ have to regulate health vs. How much

• power can/should the ______/_______ GOVERNMENT

  have to address matters of health?

Government

Public health seems to be a series of struggles and controversies related to the

law

• How much power can/should the GOVERNMENT

  have to regulate our health, vs. How much

  freedom/liberty should we maintain?

• How much power can/should FEDERAL

  GOVERNMENT have to regulate health vs. How much

  power can/should the STATE/LOCAL GOVERNMENT

  have to address matters of health?

structures of the government

Federal power (enumerated)

• Allowed to ____ us, to take that money from _____ and _____ it

• to get involved in _______ _______

• to get involved in _______

structures of the government

Federal power (enumerated)

• Allowed to tax us, to take that money from taxes and spend it

• to get involved in homeland security

• to get involved in interstate

structures of the govt.

State power (plenary)

• involved in most things that affect our _____ life and _______

• most things in public health falls to the _____ level

structures of the govt.

State power (plenary)

• involved in most things that affect our daily life and behaviors

• most things in public health falls to the state level

Federal Government…

Exerts influence by:

-_____ and ________ instruments

-Legal structures

-Political structures

-Financial structures

- Institutional structures

- Global treaties

Federal Government…

Exerts influence by:

-Policy and regulatory instruments

-Legal structures

-Political structures

-Financial structures

- Institutional structures

- Global treaties

The Judicial branch creates _____ ____

• This happen when there is a court case, and the judge

  realizes that there isn’t a ___ that tells us what to do in

  this situation. Then, the judge makes a decision, and

  that decision _________ the ___.

So, when a law is passed it is usually very vague on _______. We pass laws that are vague because it is ____ to pass them that way. But then once the law is passed it goes to the appropriate ______ for the _____ to be set, and this is where the details get filled in.

The Judicial branch creates case laws

• This happen when there is a court case, and the judge

  realizes that there isn’t a law that tells us what to do in

  this situation. Then, the judge makes a decision, and

  that decision BECOMES the law.

• So, when a law is passed it is usually very vague on

  purpose. We pass laws that are vague because it is

  easy to pass them that way. But then once the law is

  passed it goes to the appropriate agency for the rules to

  be set, and this is where the details get filled in.

purpose of govt.

• to promote _______ _______

• Governments have broad powers to act in

  ways that curtail the _____ of individuals (i.e.,

  restrictions, enforcements, taxes, punishments)

*ex: it’s against the law to smoke in bars/restaurants in Boston

purpose of govt.

• to promote general welfare

• Governments have broad powers to act in

  ways that curtail the rights of individuals (i.e.,

  restrictions, enforcements, taxes, punishments)

*ex: it’s against the law to smoke in bars/restaurants in Boston

purpose & powers of the govt.

These powers are invoked for 3 reasons:

 To prevent a person from _______ others

 To defend the interests of __________ persons such as

• _______ or the _______ _______

 To protect a person from harming _______/_______

purpose & powers of the govt.

These powers are invoked for 3 reasons:

 To prevent a person from harming others

 To defend the interests of incompetent persons such as

children or the mentally impaired

 To protect a person from harming himself/herself

Public health law

any statute, rule, or ordinance that has the purpose of

_______ or ________ the public health. Public health

laws and policies aim to fulfill society's interest in

assuring _________ for people to be healthy.

Public health law

any statute, rule, or ordinance that has the purpose of

promoting or protecting the public health. Public health

laws and policies aim to fulfill society's interest in

assuring conditions for people to be healthy.

Public _____ and _______ intend to prevent health problems

and promote health across the population.

Public laws and policies intend to prevent health problems

and promote health across the population.

• Speed _____ on roads and highways have increased motor

  vehicle safety.

• Smoking _____ in workplaces and other public spaces have

  protected people from the dangerous effects of second-hand

  smoke.

• And laws requiring ___________ for public school students

have dramatically reduced the spread of many _________

_________.

• Speed limits on roads and highways have increased motor

  vehicle safety.

• Smoking bans in workplaces and other public spaces have

  protected people from the dangerous effects of second-hand

  smoke.

• And laws requiring vaccinations for public school students

have dramatically reduced the spread of many infectious

diseases.

the prevention orientation

There are several characteristics that distinguish public

health law from other areas of health law (e.g., medical

law and healthcare law)

Many areas of health law tend to focus on issues related to

_______ treatment

Public health law, however, has a distinct emphasis on _______ and _______ _______

the prevention orientation

There are several characteristics that distinguish public

health law from other areas of health law (e.g., medical

law and healthcare law)

Many areas of health law tend to focus on issues related to

disease treatment

Public health law, however, has a distinct emphasis on disease and injury prevention

Smoking bans aim to prevent exposure to second-hand smoke.

But why? These laws are based on decades of research showing

that second-hand smoke is associated with:

• An increased risk of ____ disease,

• ______,

• emphysema (lung disease)

• Other diseases

The primary goal of smoking bans and other public health laws is

to prevent _________ cases of disease and injury

Smoking bans aim to prevent exposure to second-hand smoke.

But why? These laws are based on decades of research showing

that second-hand smoke is associated with:

• An increased risk of heart disease,

• Cancer,

• Emphysema

• Other diseases

The primary goal of smoking bans and other public health laws is

to prevent avoidable cases of disease and injury

the population perspective

Another distinguishing characteristic of public health law is its focus

on _________ health

• Aims to improve the health of entire _______ __________.

• Public health laws and policies are often intended to promote the _______

_____, which refers to _______ benefits for all or most members of a given

community

Another distinguishing characteristic of public health law is its focus

on population health

• Aims to improve the health of entire human populations.

• Public health laws and policies are often intended to promote the common

good, which refers to shared benefits for all or most members of a given

community

vaccination laws aim to promote the common good through a phenomenon known as herd immunity.

• Herd immunity is a form of _______ protection from _______ _______ for individuals who are not _______ to an infection

• Herd immunity occurs when a _____ ________

  of the population is _________ against a

  disease, which disrupts ______ of infection

  and thereby provides _______ ________ for

  individuals who are not vaccinated

vaccination laws aim to promote the common good through a phenomenon known as herd immunity.

• Herd immunity is a form of indirect protection from

  infectious disease for individuals who are not

  immune to an infection

• Herd immunity occurs when a large proportion

  of the population is vaccinated against a

  disease, which disrupts chains of infection

  and thereby provides indirect protection for

  individuals who are not vaccinated

federal agencies ← why are they important?

• law makers are not always experts in the types of issues that arise

• so, they set up _______ and appoint ______ to handle complicated matters

ex: department of education, department of agriculture

federal agencies ← why are they important?

• law makers are not always experts in the types of issues that arise

• so, they set up agencies and appoint experts to handle complicated matters

states and local responsibilities

• collect _____ data about the population

• _______ children before they enter school

• regulate __________ hazards and _______

• promote _____ (gun and traffic laws)

• _______ licensure (license to practice medicine)

• inspect _________ and _____ vendors

states and local responsibilities

• collect health data about the population

• immunize children before they enter school

• regulate environmental hazards and sanitation

• promote safety (gun and traffic laws)

• medical licensure (license to practice medicine)

• inspect restaurants and food vendors

state health departments

• Protection of _____, _____ and ______

 May rely on other ____ agencies

 Social services

 Aging

 Mental health

 Environment

 Set _______ for ____ health departments

 Determine _______ of state ____

 Data coordination

 Licensing and certification

 Medical personnel

 Healthcare facilities

 Medicaid services

state health departments

• Protection of health, safety and welfare

 May rely on other state agencies

 Social services

 Aging

 Mental health

 Environment

 Set policies for local health departments

 Determine allocation of state funds

 Data coordination

 Licensing and certification

 Medical personnel

 Healthcare facilities

 Medicaid services

local public health departments

• responsibilities

  • Communicable _______ _______ programs

  • _______ and _______

  • health ________ services

  • _______ _______ control programs

  • _______ / _______ programs

  • public health _______ programs

  • care to the _________

local public health departments

• responsbilities

  • Communicable disease control programs

  • screening and immunization

  • health education services

  • chronic disease control programs

  • sanitation / inspection programs

  • public health nursing programs

  • care to the underserved

local public health departments

• funding

  • taxes

  • state funds

  • federal funds

  • grants

  • city or county legislature

local public health departments

• funding

  • taxes

  • state funds

  • federal funds

  • grants

  • city or county legislature

non-governmental organizations (NGO’s)

• they have a special role in _______, _______ & _______

• often focused on specific _______ (ex: american heart association)

• professional ___________ organizations

• philanthropic foundations provide _______ for _______

non-governmental organizations (NGO’s)

• they have a special role in lobbying,

  education & research

• often focused on specific diseases (ex: american heart association)

• professional membership organizations

• philanthropic foundations provide funding for research