Lecture 1: Health Equity, Social Determinants of Health, and Vulnerable Populations

public health nursing

the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences

equity

what is the underlying concept behind optimum health as a basic human right?

health disparity

differences in health and healthcare that occur between groups of people; exists when “… a health outcome is seen to a greater or lesser extent between populations"

health inequity

**ex: people w/ type 2 diabetes who cannot afford cost of medication and therefore are unable to take it as ordered will experience higher A1C levels and experience more adverse outcomes

systematic differences in health outcomes; avoidable gaps in health outcomes

begin with advocacy

while nurses address health inequity in a variety of ways, what do they often begin with?

vulnerability

the degree to which an individual, population, or organization is unable to anticipate, cope with, resist, and recover from the impact of disease and disaster

vulnerable populations

collection of individuals who are more likely to develop health problems as a result of excess risks, limits in access to health care services, or being dependent on others for care

health gradient

health disparities among populations within a country wherein there is a series of progressively increasing or decreasing differences

social gradient

a gradient in health that runs from top to bottom of the socioeconomic spectrum; means that health inequities affect everyone

socioeconomic factors

much of the health disparity between groups is driven by what?

social determinants of health

the social and environmental conditions in which people live and work

-neighborhood and built environment

-economic stability

-education

-social and community context

-health and health care

what are the social determinants of health?

-medical care

-health behaviors

-genes & biology

-social/societal characteristics

what are the determinants of health?

1. assessment

2. policy development

3. assurance

what are the 3 core function of public health?

assessment

core function of public health that focuses on the systematic collection, analysis, and monitoring of health problems and needs

policy development

core function of public health that refers to using scientific knowledge to develop comprehensive public health policies

assurance

core function of public health that relates to assuring constituents that public health agencies provide services necessary to achieve agreed-upon goals

equity = center of core functions of PH

what is at the center of all core functions of public health?

race

categorizes groups of people based on superficial criteria such as skin color, physical characteristics, and parentage; a social construct with no biological foundation

culture

the beliefs, values, and norms shared across a group of people

cultural competency

a core aspect of care for healthcare providers; the attitudes, knowledge, and skills the health-care provider uses to provide quality care to culturally diverse populations

cultural humility

an understanding that self-awareness about one’s own culture is an ongoing process; acknowledgment that we must approach others as equals, with respect for prevailing beliefs and cultural norms

Healthy People 2030

evidence-based National Health objectives for improving the health of all Americans; covers a 10-year time frame

all people achieve full potential for health & well-being across lifespan

what is the vision of HP2030?

social capital

resources available to individuals and communities based on membership in social networks; usually refers to a person’s or a community’s capacity to obtain support from the social connections available to the person or community

social justice

a doctrine that is related to health and to strive to promote equal opportunities to maximize the health of individuals and communities

socioeconomic status (SES)

a composite measure of the interrelated concepts of income, education, and occupation

↓ SES = ↑ vulnerability to poor health

**d/t lack of economic resources

what is the relationship between socioeconomic status (SES) and vulnerability?

poverty threshold

a yearly determination of a standard of living below which a family has the lack of goods and services commonly taken for granted by mainstream society

poverty

occurs when household income falls below the economic threshold considered to be adequate to support the number of persons in the household

poverty guidelines

a federal measure that includes guidelines are used for administrative purposes, such as determining who is eligible for federal programs aimed at aiding those living in poverty

the benefits that occur through social networks

what is the central point of social capital?

quantity and quality of interpersonal ties among people and communities

social capital is highly dependent on what?

root causes

to reduce vulnerability, it is necessary to examine what?

marginalization

a social process through which a person or group is on the periphery of society based on identity, associations, experiences, or environment

individuals in those groups do not matter or are of little concern to rest of society

the marginalization of certain groups conveys what idea?

↓ opportunities for establishing relationships to access healthcare

how does marginalization impact health care?

racism

a belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race

discrimination

occurs when one group gives unjust or prejudicial treatment to another group based on his or her race, ethnicity, gender, SES, or other group membership

1. individual

2. institutional

3. structural

what are the 3 levels of discrimination?

individual discrimination

type of discrimination that refers to the behavior of individual members of one race/ethnic/gender group intended to have a differential, harmful effect on the members of another race/ethnic/gender group

institutional discrimination

type of discrimination that refers to the policies of the dominant race/ethnic/gender institutions and the behavior of individuals who control these institutions and implement policies intended to have a differential, harmful effect on minority race/ethnic/gender groups

structural discrimination

type of discrimination that refers to the the policies of dominant institutions and the behavior of the individuals who implement these policies and control these institutions, which are race/ethnic/gender neutral in intent but which have a differential, harmful effect on minority race/ethnic/gender groups

stigma

a mark of shame or discredit; individuals possess, or are believed to possess, some attribute that is not valued in a particular social context

1. lacks a fixed, regular, & adequate nighttime residence

2. lives somewhere designed for temporary residence

3. lives in a place not normally used as accommodation

what are the qualifying characteristics of homelessness?

food security

occurs when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life

1. health is more than health care

2. health is tied to distribution of resources

3. racism imposes health burdens

4. choices we make are shaped by choices we have

5. high demand + low control = chronic stress

6. chronic stress is toxic

7. inequality is bad for health

8. social policy is health policy

9. health inequalities = not natural

10. we all pay the price for poor health

according to the film "Unnatural Causes", what are 10 things to know about health?

life expectancy is 29th in the world

what is the United States' standing in life expectancy rates worldwide?