HOSA Health Disparities in the US Chapter 2 Notes What is Health?

According to the WHO, what is the definition of health?

"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." It is complete well-being and is fairly strict in definition.

Why is the WHO's definition of health faulty?

Has limited value from a policy context, and is difficult to achieve (unrealistic).

Creates a health dichotomy, either you're healthy or you're not (not accurate).

What are the three axes of health in the WHO's definition of health?

Physical health, mental health, social well-being

According to Andrew Twaddle, what is the definition of health?

"Health must be understood first as a biophysical state" and that "illness is any state that has been diagnosed as such by a competent professional." It also involves the absence of symptoms and signs.

What are the two dimensions of health according to Andrew Twaddle's model?

Absence of symptoms, absence of signs

What are symptoms?

sensations noticed by the patient, interpreted as abnormal

What are signs?

objective characteristics noted by a health professional, patient may not be aware

What are the problems with Twaddle's definition of health?

It tells what health isn't, but not what health is. The patient and doctor might also disagree, and it is difficult to interpret abnormal signs of illnesses

Abnormal signs of illnesses are called what?

Area variations (CAT scans, EKGs, lab tests etc)

What was Talcott Parsons' definition of health?

health was the reflection of the extent to which "an individual is able to maintain a normal level of functioning within their social context," and "Health may be defined as the state of optimum capacity of an individual for the performance of roles and tasks for which he has been socialized."

tldr: the ability to function normally

What is the difference between Parsons' definition of health vs the WHO's definition?

focuses more on what a person can do with their body than based on the physiological (functional) state of that person's body

What are the drawbacks of Parsons' definition of health?

The same level of physical functioning for two individuals could imply different states of health depending on their social roles and tasks.

ex. Violinists with arthritis may be seen as unhealthy due to arthritis impacting their ability to perform their society duty as a violinist.

House cleaners with the same degree of arthritis may be seen as healthy because they can still perform their house cleaning duties.

This model can maintain inequalities for race, ethnicity, and gender due to different social roles

What are the five activities of daily living (ADLs)? (STATE)

Feeding one's self

Bathing one's self

Dressing one's self

Being able to use the toilet without assistance

Being able to transfer one's self without assistance (ex. from a bed to a chair)

A person's eligibility for welfare or extra benefits is determined through what?

Ability to perform the five activities of daily living

What is the psychological model of health?

A model of health based on a person's own perception of their health only; often time specific

What is the AHRQ?

US Agency for Healthcare Research and Quality

What is the MEPS?

Medical Expenditure Panel Survey

What was the number of healthy older US adults (65+) in 2000?

14 million (42.4%)

What was the number of healthy older US adults (65+) in 2014?

22.4 million (48.2%)

Which groups reported lower rates of health in the AHRQ MEPS survey? (STATE)

African Americans, Hispanics, Lower incomes, lower education levels

How is the alcoholic CEO judged according to the three models?

The Alcoholic CEO is doing poorly in the medical model, quite well in the sociocultural model, and difficult to regard in the psychological model. He is generally regarded as unhealthy nonetheless.

How is the Stanford student judged according to the three models?

The Stanford University student studying for final exams would have a high level of stress psychologically, but the stress is short term. The student is doing well medically and socioculturally, so this student should not be of concern health-wise.

How is the teenager born underweight judged according to the three models?

A teenager born weighing two pounds with cognition and coordination problems has signs of significant health impairment medically, and these difficulties may cause them to have less opportunities to participate, making them feel discouraged or depressed.

How is the paraplegic athlete judged according to the three models?

A paraplegic yet athletic person who works high tech only has impairment based on the use of his legs. Otherwise, he is doing very well socioculturally and likely psychologically, so he is generally regarded as very healthy.

How is the overweight, sad teenager judged according to the three models?

A teenager who is overweight and sad because she has few friends should be concerned on all fronts, because obesity leads to serious medical issues. She also has poor social functioning and low perception of her own health. She is super unhealthy.

How is the terminal diseased 94 year old judged according to the three models?

A 94 year old who lives in the same house and is starting to get terminal diseases could actually be doing quite well. Their perception could be positive since they might want to die and may feel as if their life is already fulfilled.

Who are the healthiest individuals?

the 94 year old and the disabled high tech engineer

Who are the least healthy individuals?

the alcoholic CEO and the overweight teenager

What did Wolinsky say about health? (STATE)

Health should be considered a three dimensional concept

What are the three dimensions of health according to Wolinsky?

Health as the absence of disease, health as social role functioning, and psychological health

What is SF-36?

36 Item Short Form Health Survey (helps compare health outcomes of different patients using different healthcare systems)

What are the physical health scales in SF-36?

Physical Functioning

Role Limitations Due to Physical Problems

Bodily Pain

General Health Perceptions

What are the mental health scales in SF-36?

Vitality

Social Functioning

Role Limitations Due to Emotional Problems

General Mental Health

What is the relationship between the SF-36 score and healthcare costs?

Worse SF-36 health score requires more healthcare, increasing costs

What is the relationship between the three dimensions of health?

changes in physical health changes emotional health, which changes psychological health

What are the main causes of poor health in Wilson and Cleary's 3 dimensional model? (STATE)

biological and physical abnormalities

What is ELBW?

Extremely low birthweight (under 1000 grams)

What is NBW?

Normal birth weight (at least 2500 grams)

What was interesting regarding ELBW and NBW teens towards the SF-36 scale?

Despite higher frequencies of problems, ELBW and NBW teens had the same quality of life

What did Faith Fitzgerald suggest in regards to approaching health as a moral issue? (STATE)

it can be problematic to approach behaviors associated with poor health as an issue of individual moral worth.

To compare the health of different communities, what general categories are used?

Rates of illness and rates of death

Which state had the highest rate of hypertension? (Mississippi, New York, California, Iowa)

Mississippi

Which state had the lowest rate of hypertension? (Mississippi, New York, California, Iowa)

California

Which state had the highest rate of diabetes? (Mississippi, New York, California, Iowa)

Mississippi

Which state had the lowest rate of diabetes? (Mississippi, New York, California, Iowa)

Iowa

Which state had the highest rate of obesity? (Mississippi, New York, California, Iowa)

Mississippi

Which state had the lowest rate of obesity? (Mississippi, New York, California, Iowa)

California

Which state had the highest rate of asthma? (Mississippi, New York, California, Iowa)

New York

Which state had the lowest rate of asthma? (Mississippi, New York, California, Iowa)

Iowa

Why might the rate of disability among older adults vary?

Differences in educational attainment, social / economic circumstances

What is the relationship between disability and education?

Disability is more prevalent in populations of older adults with low levels of education (no high school)

The highest levels of disability are in what states?

Mississippi, Kentucky, West Virginia

A baby born in the USA in 2016 could expect to live how long?

78.6 years

A male baby born in the USA in 2016 could expect to live how long?

76.1 years

A female baby born in the USA in 2016 could expect to live how long?

81.1 years

Life expectancy varies as much as how long between countries at the lowest and highest levels? (STATE)

Up to 20 years

Which two states have the highest rates of infant mortality?

Alabama (1st) and Mississippi (2nd)

How low was the rate of infant mortality in California and Vermont?

California: 5th lowest

Vermont: 1st lowest

Which state has the highest rate of death from heart disease?

Mississippi

Which state has the lowest rate of death from heart disease?

Minnesota

Which state has the lowest level of family income between Mississippi, New York, California, and Iowa?

Mississippi (also has higher rates of economic inequality)

Infant Mortality Rate

of a thousand babies born alive, the number who will die before their first birthday

Maternal mortality rate

of one hundred thousand women giving birth, the number who will die as the result of complications during the birthing process

Why is it difficult to use rates of illnesses to compare the health of different countries?

different illnesses are unique to different areas and different economic levels

Which countries have the lowest infant mortality rates?

Singapore and Norway (2 / 1000 births)

Which country has the highest infant mortality rate?

Democratic Republic of the Congo (72 / 1000 births)

Which country has the lowest life expectancy?

Nigeria (F: 56 years, M: 55 years)

Which countries have the highest life expectancy for women?

Canada and Singapore (85 years)

Which countries have the highest life expectancy for men?

Canada, Norway, and Singapore (81 years)

Which country has the lowest per capita income of the ones listed?

Democratic Republic of the Congo ($870)

Which country has the highest per capita income of the ones listed?

Singapore ($90,570)

What is the relationship between income, mortality, and life expectancy?

As we go up the income ladder, infant and maternal mortality declines and life expectancy increases.

Why is Russia a discrepancy in the income-mortality-life expectancy relationship?

While Russia has low infant and maternal mortality, there are relatively low life expectancies

Why is the USA a discrepancy in the income-mortality-life expectancy relationship?

Despite having one of the highest per capita income of the countries, the USA performs the worst of all the high income countries

Why might infant mortality statistics be inaccurate between countries?

There are different ways that infant mortality is counted:

- In Western countries this means with a spontaneous heartbeat and other signs of vital organ functioning

- For less developed countries, the baby has to survive the first 24 hours of life before counting as a live birth

How much will life expectancy increase by the year 2030 across industrialized countries?

Life expectancy will increase for all countries with a probability of at least 65% for women and 85% for men

What is DALY?

Disability-adjusted life year; It estimates the magnitude of the burden created by a disease or condition. Based on the concept of potential years of life lost due to certain causes, while also estimating the level of disability attributed to the disease for those who don't die from it.

Living one year with a disease that reduces one's level of functioning by 50% would mean the loss of how much DALY? This is equivalent to dying five years prematurely.

0.50 DALY

Living 10 years with a 50% disability and dying 5 years prematurely would mean the loss of...

10 DALYs (five for the disability when alive, and five for the premature death)

What is the GBD?

the Global Burden of Disease (comprehensive picture of what disables and kills people across countries, time, age, and sex)

Among children, what disease is the biggest health burden? (Diarrhea, Worm Infection, Tuberculosis, and Ischemic Heart Disease)

Diarrhea

Among seniors (over 60), what disease is the biggest health burden? (Diarrhea, Worm Infection, Tuberculosis, and Ischemic Heart Disease)

Ischemic Heart Disease

More than 2/3rds of deaths globally that were associated with a high body mass index (BMI) were due to what?

Cardiovascular disease

Which country had the highest rate of death associated with BMI among the 20 largest countries?

Russia

The USA is experiencing a stagnation of the rate of obesity / diabetes because of what?

growing emphasis on reducing caloric intake (especially in sugared beverages) and increasing physical activity.

Which disease caused the most deaths in the USA?

Heart Disease

What are the three leading causes of loss in DALYs in the US? (STATE)

ischemic heart disease, lung cancer, and chronic obstructive pulmonary disease.

What six individual risk factors accounted for most of the DALY loss?

moking, high BMI, poor diet, alcohol and drug use, high fasting plasma glucose (diabetes), and high blood pressure.

How much did opioid use disorder rise in leading causes of death?

74.5% increase

What is QALY?

Quality Adjusted Life Year (Evaluates effectiveness of a specific treatment in prolonging the lives of those with certain diseases.)

What is HRQL?

Health related quality of life (Living an additional year with a 50% HRQL constitutes 0.50 QALY. living an additional year with 100% HRQL is 1.0 QALY.)