CH7: Structural and Social Drivers of Health and the Role of Law in Optimizing Health

Drivers of Health

factors that contribute to a person's current state of health

drivers contribute to

health and healthcare disparities

What are some types of disparities

financial disparity and education disparity

What determines SES

income, occupations, and education

what is health disparity?

the outcome of our health

what is healthcare disparity?

it is about access to services

what is health equity?

it is giving people what they need

Explain health and healthcare in the US

systemic and a deeply challenging problem

equality does NOT mean

equity

factors that contribute to health and healthcare disparities

race, SES, geographical location, individual behaviors, healthcare provider bias, cultural expectations

different lenses of disparities

race, ethnicity, SES, age, geography, language, gender, disability status, citizenship status, and sexual identity, and orientations

structure of a country is

the government

Structural Drivers of Health

the "root" causes of population level health inequities

examples of structural drivers of health

nations system of governance, laws, public policies

what are a few examples of public policies

housing, education, wage

In the US who has control?

congress

amendment

changes of a law

How society operates-

Shape the distribution of power, resources, and opportunities across the population

structural drivers of health are-

outside the direct control of individuals

Some of the policies , institutions , systems , norms , and practices are ________ .

outdated

laws can be eliminated if they -

don't follow norms of population

social drivers of health

social conditions into which people are born and that affect their daily lives and overall well-being as they move through life

WHO Social drivers of health definition

the conditions in which people are born, grow, live, work and age

(CDC)Social drivers of health are shaped by-

the distribution of money, power, and resources at both local and national levels

Types of Social Drivers of Health

- access to high quality educational opportunities

- access to medical care services

- access to social media and other technologies

- availability of community- based resources and opportunities for recreational activities

- availability of resources to meet daily needs

- culture

- language / literacy

- public safety

- residential segregation

- social norms and attitudes

- socioeconomic conditions

- transportation options

link between social drivers and health outcomes

The overwhelming weight of evidence demonstrates the powerful effects of socioeconomic and related social factors on health.

Is law a social determinant of health?

yes because laws can promote individuals to improve peoples wellbeing

The law can be used to design and perpetuate social conditions that can have-

terrible physical, mental, and emotional effects on individuals and populations

examples when laws were used to design and perpetuate social conditions:

-jim crow laws

-the age discrimination in employment act

-the pregnancy discrimination act

The law can be utilized as a mechanism through which:

behaviors and prejudices are transformed into distributions of well-being among populations

examples of when law was used as a mechanism

-incarceration rate

-healthcare discrimination

story behind incarceration rate

government racial profiling

story behind healthcate discrimination

healthcare providers not providing same patient care

who implements laws

administrative agencies

where are laws passed

congress

law can be determinative of-

health through their under-enforcement

what is an example of when law determined health through under enforcement

residential lead-based paint hazard reduction act

law can be determinative of health through-

their interpretation

what is an example of law determining health through interpretations

Medicaid expansion in the ACA

During the Medicaid expansion in the ACA what happened?

court ruled that ACA can recommend states to expand Medicaid

the law can be used to structure direct responses to health harming social needs that result from-

things like impoverishment, illness, market failure, and individual behavior that harms others

examples of when law was used to structure direct responses to health harming social needs:

-EMTALA

-Indian health services

Texting and driving policies

-Bicycle and motorcycle helmet laws

What is EMTALA?

antidumping law enacted to prohibit the refusal of care for indigent and uninsured pts, and to prohibit the transfer of unstable patients

Health in All Policy strategy

collaborative governmental approach to health improvement by incorporating health consideration into an array of policy decisions, and by engaging governments and other stakeholder in a multisector approach to shaping the economic, physical, and social environments in which people live, work, and play.

Right to Criminal Legal Representation is which amendment

6th

Right to Criminal Legal Representation

The government is required to provide legal counsel to criminal defendants who are unable to afford their own attorneys

example of the 6th amendment

Gideon v Wainwright (1963)

civil legal assistance

There is NO right to the assistance of a lawyer in civil matters, even when the most basic human needs are at stake

examples of civil matters

immigration status, domestic violence, disability law, family law, housing needs, public benefits

Civil matters vary by

state laws

Civil legal aid or Civil legal services:

Promote strategies to address the severe gap in access to both criminal and civil justice for low-income and vulnerable population

what is medical legal partnership

legal services to patients

characteristics of MLP

- many life circumstances issues are unfixable by healthcare providers alone

-improve social conditions via civil legal assistance

- Create an interconnected care system focusing on the whole patient

MLP includes both:

medical and legal professionals

MLP helps connect

people and their legal understanding

benefits of MLPs from small-scale studies

- impact on patient health and well being

-financial impact on partners and patients

impact on knowledge and training of health providers