Social Determinants of Health in the Population

What is population health research concerned with?

Investigation of differences in health status (e.g. demographic groups - age, race/ethnicity, gender; geographically defined populations - HIV/AIDS not in Africa)

What does population health research examine?

Interrelationships between the distribution of social, economic, demographic, cultural, political, and other valued societal resources and health at the community level

What is population health research aimed at improving?

Health of the entire population rather than individuals

What term can be defined as the absence of disparities or avoidable differences among socioeconomic and demographic groups or geographic areas in health status and health outcomes such as disease, disability, or mortality?

Healthy equity

Health Equity

The absence of disparities or avoidable differences among socioeconomic and demographic groups or geographic areas in health status and health outcomes such as disease, disability, or mortality (e.g. leveling the playing the field)

What term can be defined as the inequalities that are deemed to be unfair, unjust, avoidable, or unnecessary?

Health inequities

Health Inequities

The inequalities that are deemed to be unfair, unjust, avoidable, or unnecessary

What can health inequities be reduced or remedied through?

Policy action

What do health inequities lead to?

Health disparities

4 Types of Health Disparities

1. Racial/ethnic disparities (e.g. osteoporosis in white women)

2. Socioeconomic status

3. Lack of access to healthcare

4. Decreased quality of healthcare

Examples of Health Disparities

Diabetes among Latinos

Stroke among African Americans

Cancer in minority groups

HIV among African Americans and Latinos

Environmental inequities among low-income communities

Are health inequities avoidable; yes or no?

Yes

What model describes well documented, chronically high levels of stress faced by members of stigmatized minority groups?

Minority stress model

Minority Stress Model

Describes well documented, chronically high levels of stress faced by members of stigmatized minority groups

According to the Minority Stress Model, what may the chronically high levels of stress faced by members of stigmatized minority groups be caused by?

Poor social support

Low socioeconomic status

Interpersonal prejudice and discrimination

6 Social Determinants of Health

1. Economic stability (e.g. socioeconomic status - housing)

2. Neighborhood and physical environment

3. Education

4. Food

5. Community and social context

6. Health care system

Which social determinant of health includes the following: employment, incomes, expenses, debt, medical bills, support; economic stability, neighborhood and physical environment, education, food, community and social context, or health care system?

Economic stability

2 Types of Employment

1. Stable (e.g. healthcare workers)

2. Unstable (e.g. service workers)

Is consumerism economy-driven or recession proof?

Economy-driven

Is healthcare economy-drive or recession proof?

Recession proof

What is the type of employment an individual has linked to?

Education level

Age

Race/ethnicity

Gender

What can the type of employment affect?

Health outcomes

What does the U.S. Census Bureau use to determine who is in poverty?

Set of dollar value thresholds that vary by family size and composition

Although defined in several ways, what is poverty particularly determined by?

Socioeconomic status

What can poverty lead to?

Increase in chronic diseases and early death

Which social determinant of health includes the following: housing, transportation, safety, parks, playgrounds, walkability, zip code/geography; economic stability, neighborhood and physical environment, education, food, community and social context, or health care system?

Neighborhood and physical environment

Quality of Housing

The physical condition of a person's home as well as the quality of the social and physical environment in which the home is located (e.g. air quality, home safety, space per individual, presence of mold, asbestos, or lead)

What 3 environment conditions affect health and contribute to health disparities in the quality of housing?

1. Water quality

2. Air quality

3. Air temperature

What challenges does housing instability cause?

Paying rent

Overcrowding

Moving frequently

Staying with relatives

Spending the bulk of income on housing

What can housing instability negatively affect?

Physical health (making it harder to access healthcare)

True or False: Housing instability can impact some populations more than others including members of marginalized communities.

True

How may people with housing instability be victimized?

Witness violence or property crimes in their community

Hear about crime and violence from other residents

What can violence lead to?

Premature death

Non-fatal injuries

Which social determinant of health includes the following: literacy, language, early childhood education, vocational training, higher education; economic stability, neighborhood and physical environment, education, food, community and social context, or health care system?

Education

Components of Literacy

Oral literacy (e.g. listening and speaking skills)

Print literacy (e.g. writing and reading skills)

Numeracy (e.g. ability to understand and work with numbers)

Cultural and conceptual knowledge

Language

Method of human communication, either spoken or written, consisting of the use of words in a structured and conventional way

What does early childhood, particularly the first 5 years of life, impact?

Long-term social, cognitive, emotional, and physical development

What does a healthy development in early childhood help prepare children for?

Educational experiences of kindergarten and beyond

What environmental and social factors can early childhood development and education opportunities be affected by?

Early life stress

Socioeconomic status

Relationships with parents and caregivers

Access to early education programs

What is a standard requirement for most jobs and for higher education opportunities?

A high school diploma

What is the dropping out of high school linked to?

Negative health impacts (e.g. limited employment prospects, low wages, poverty)

What factors may a student’s ability to graduate from high school be affected by?

Personal (e.g. family)

Institutional (e.g. school, community)

Higher Education

Any type of education after high school (e.g. 12th grade) including 2-year college (e.g. community college), certificate programs, 4-year college (e.g. bachelor programs), graduate programs, and professional programs

What are 3 barriers to accessing a higher education?

1. Gender

2. Age

3. Race/ethnicity

Which social determinant of health includes the following: hunger, access to healthy options; economic stability, neighborhood and physical environment, education, food, community and social context, or health care system?

Food

What factors is food security based on?

Income

Employment

Race/ethnicity

Disability

What does access to healthy foods support?

Healthy eating habits (e.g. caloric intake, availability of fresh and healthy foods)

What can the disruption of food intake or eating patterns occur as a result of?

Lack of money and other resources

What does the disruption of food intake or eating patterns not equal?

Hunger (but hunger is an outcome)

Which social determinant of health includes the following: social integration, support systems, community engagement, discrimination, stress; economic stability, neighborhood and physical environment, education, food, community and social context, or health care system?

Community and social context

Social Cohesion

The strength of relationships and the sense of solidarity among members of a community

What is one indicator of social cohesion?

Amount of social capital a community has (e.g. shared group resources such as a friend-of-a-friend's knowledge of a job opening)

Civic Participation

A wide range of formal and informal activities (e.g. voting, volunteering, participating in group activities, community gardening)

What does one-way civic participation improve? How?

Health by building social capital

Social Capital

Features of social organization such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit

Discrimination

A socially structured action that is unfair or unjustified and harms individuals and groups

What can discrimination be attributed to?

Social interactions that occur to protect more powerful and privileged groups at the detriment of other groups

Do all stressful experiences negatively affect health and occur because of discrimination; yes or no?

No

Incarcerated Population

Number of inmates under the jurisdiction of state or federal prisons or held in local jails

State and federal prisons house inmates sentenced to more than how many years of incarceration?

One

Who are higher rates of incarceration often seen among?

Racial/ethnic minorities

People with lower levels of education

Which social determinant of health includes the following: health coverage, provider availability, provider linguistic and cultural competency, quality of care; economic stability, neighborhood and physical environment, education, food, community and social context, or health care system?

Health care system

Health Care Access

The timely use of personal health services to achieve the best possible health outcomes

True or False: Many people face barriers that prevent or limit access to needed health care services which may increase the risk of poor health outcomes and health disparities.

True

Primary Care Access

The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community

What services do primary care providers offer?

Source of care

Early detection and treatment of disease

Chronic disease management

Preventive care

What are patients with a usual source of care more likely to receive?

Recommended preventive services (e.g. flu shots, blood pressure screenings, cancer screenings)

Health Literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions

What does health literacy encompass?

Being able to read and comprehend essential health-related materials (e.g. prescription bottles, appointment slips)

What may health literacy increase?

A person's capacity to take responsibility for their health and their family's health

Health Outcomes of the Social Determinants of Health

Mortality

Morbidity

Life expectancy

Health care expenditures

Health status

Functional limitations

What 5 social factors do the social determinants of health involve that strongly influence people’s ability to avoid risks and to minimize the consequences of disease once it occurs?

1. Knowledge

2. Money

3. Power

4. Prestige

5. Social connections

Through what intervening mechanisms are the inequities in health closely linked to the social inequities?

Health behaviors

Medical care

Working conditions

Environmental exposure

Personality

Early life conditions

What are ways to neutralize the social determinants of health?

Cultural humility

Lifestyle (e.g. sedentary vs active)

Illness/disability (e.g. locus of control)

Cultural Humility vs. Cultural Competence

Cultural humility is the ability to recognize one's limitations to avoid making assumptions about other cultures while cultural competence is the ability to work respectfully with people from diverse cultures while recognizing one's own cultural biases

What can the application of cultural humility to patient charting have a direct impact on?

Readmissions

Pain management ("drug seeking")

Surgical procedures

General health outcomes

Internal vs. External Locus of Control

Internal control is the belief that one's effort and decisions determine outcomes ("I am in control") whereas external control is the belief that luck, fate, and other people determine outcomes ("outcomes are beyond my control")

What did the initiative introduced by the Department of Health and Human Services in 1980 present?

A national strategy for increasing the span of healthy lives by reducing health disparities through the provision of access to preventive health services for all Americans

What type of impact did the initiative introduced by the Department of Health and Human Services have on the nation?

Geographic areas have become increasingly interested in population health monitoring and in providing background data needed to understand a population's health equity issues

What were the 2 main results of the Department of Health and Human Services initiative?

1. Improvements in access to healthcare (e.g. medications)

2. Higher life expectancies

What does trauma-informed care shift the focus from?

"What's wrong with you?" to "What happened to you?"

What does trauma-informed care seek to do?

Realize the impact of trauma and understand recovery paths

Recognize the signs and symptoms of trauma

Integrate knowledge about trauma into practices

Actively avoid re-traumatization