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“Downstream”
Providing Clinical Care- Standard PT Practice
“Midstream”
Addressing individual social needs
Screening for social factors
“Upstream”
Improving Community Conditions-
Laws, policies, regulations that create community conditions
Food desert
Residents have few to no convenient options for healthy affordable foods
Food swamp
Areas with high density establishments selling high calorie fast food relative to healthy options
ICF Model Looking Upstream
Environmental Factors
Personal Factors
Socioecological Model
Individual- Patient factors (Knowledge, attitudes, beliefs)
Interpersonal (Social relationships & support)
Organizational (Organizations/ social institutions)
Community (Relationships between organizations)
Public Policy (State local laws & regulations)
Structural Racism
A major contributor to poor health outcomes for ethnic minorities including:
Slavery
Black Code
Jim Crow Laws
Redlining
Redlining
Broadly means racial discrimination (of any kind) in housing
The term originated in 1930’s era home ownership programs related to the New Deal
Redlining Color Coded Maps
U.S. Government used color coded maps of areas to rank “worthiness” of homes. Ranked from least risky to most risky. Was not ever shown publicly.
Property values that were likely to go down were mapped in red. These were ranked D- areas. These areas were where black residents lived. These homeowners could not get home loans backed by the U.S. Government because of this.
Is redlining still present today?
The cumulative effect of this type of legislation, policies, discrimination, & exclusionary practices endures through present day.
Redlining Effects Today-
Worse mental health & worse self-rated health
Increased rates of gunshot- related ED visits & injuries
Increased odds of perterm birth
Higher rates of diabetes specific mortality & years of life lost
Worse Covid-19 outcomes than residents within non-redlined areas
