Health Disparities and Public Health

Health Disparities

Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.

Numerical Data on Life Expectancy Disparities

  • Montgomery County: 81.3 years

  • Arlington County: 80.1 years (10 miles = 8-year life span disparity)

  • Fairfax County: 80.9 years (17 miles = 3-year life span disparity)

  • Prince George's County: 75 years (30 miles = 9-year life span disparity)

Source: Robert Wood Johnson Foundation, Commission to Build a Healthier America, CDC 2023.

Social Systems Influence on Behavior

Social systems influence behavior by:

  • Shaping norms: Creating shared expectations about behaviors in a society.

  • Enforcing social control patterns: Implementing rules that govern behavior.

  • Providing opportunities: Facilitating or hindering engagement in behaviors (both positive and negative).

  • Stress management: Reducing or producing stress that could lead to maladaptive coping strategies, particularly in short-term situations.

Jellybean Diagram

Jellybean Diagram: A visual representation of the various contributors to public health in Delaware County, showcasing the interconnectedness of different health determinants such as providers, employers, community organizations, and various health services.

Socioeconomic Status (SES) in the U.S. Context

Socioeconomic Status (SES) is typically assessed based on:

  • Family income

  • Educational level or parents' educational level

  • Professional status or parents' professional status
    Health status, measured by life expectancy and healthy life expectancy, is strongly associated with SES.
    Greater life expectancy correlates with higher SES.

Examples of SES Impact on Health

Three examples of how SES affects health include:

  1. Living conditions: Improved sanitation, reduced crowding, better heating and cooking methods lead to better health outcomes.

  2. Educational opportunities: Education is linked to health awareness and better health behaviors; education for women impacts children's health.

  3. Occupational exposures: Lower socioeconomic jobs often come with health risks, influencing overall health status.

  4. Access to goods and services: Having access to high-quality foods, medical services, and protective devices can improve health outcomes.

  5. Environmental exposures: Lower SES is associated with higher exposure to pollution and health hazards.

Health Equity

Health Equity is defined as the achievement of conditions in which every individual has the opportunity to attain their full health potential without being disadvantaged by social position or other social determinants. Health inequities manifest as differences in:

  • Length of life

  • Quality of life

  • Rates of disease

  • Severity of diseases

Reference: Centers for Disease Control and Prevention, 2020

Social Determinants of Health (SDOH)

Social Determinants of Health (SDOH) are defined as the conditions in which people are born, live, learn, work, play, worship, and age. These conditions affect a range of health outcomes and risks.

Categories of Social Determinants of Health:

  1. Economic Stability

  2. Education

  3. Social and Community Context

  4. Health Care Access and Quality

  5. Neighborhood and Built Environment

Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) are stressful events occurring in a child’s life before age 18 that may adversely impact their health and well-being. Examples of ACEs include:

  • Living in foster care

  • Physical and emotional abuse

  • Racism

  • Bullying

  • Household dysfunction (e.g., parental mental illness, incarceration of a relative).

Expanded ACEs:

  • Emotional abuse

  • Physical neglect

Allostatic Load

Allostatic Load refers to the cumulative physiological wear and tear on the body resulting from chronic exposure to stress and adverse life events. This chronic stress is a significant factor in the development of diseases, particularly cardiovascular disease (CVD).

Upstream vs. Downstream Approaches to Health Improvement

Upstream Approaches include:

  • Policies and environments affecting health at a national, state, and local level.

  • Community impacts focusing on social networks and cultural norms.

Downstream Approaches deal with interpersonal and individual factors affecting health, such as personal beliefs and behavior.

Social Ecological Model Assumptions

  1. Health is influenced by personal factors and the physical and social environment.

  2. Environments are multidimensional.

  3. Interaction occurs at different levels/groups.

  4. Feedback exists between groups and environments.

Levels of the Social Ecological Model

  1. Policies & Environments: National, state, and local laws governing living and working conditions.

  2. Community: Social networks and cultural norms among individuals and groups.

  3. Organizational: Institutional rules and regulations (e.g., schools).

  4. Interpersonal: Influence of family and friends on social identity.

  5. Individual: Personal characteristics including demographic and genetic factors.

Health Impacts of Urban Sprawl

Urban sprawl results in increased driving and decreased walking, leading to higher risks of chronic diseases such as obesity, diabetes, and cardiovascular disease.

  • Evidence:

    • Driving for >10 hours/week increases CVD mortality risk by 82% compared to <4 hours/week (Warren et al. 2010).

    • Sitting >10 hours/day increases risk for CVD irrespective of other activity levels (Pandey et al, 2016).

Other impacts include environmental health hazards (e.g., air pollution, water contamination) and social factors (e.g., decreased social capital).

Infectious Diseases

Historically significant infectious diseases include:

  • Tuberculosis

  • Cholera

  • Typhoid

  • Smallpox

  • Other respiratory and gastrointestinal diseases.

Developments Addressing Infectious Diseases

  • Water purification

  • Proper sewage disposal

  • Milk pasteurization

  • Vaccinations

  • Improved food safety and nutrition

  • Personal hygiene

  • Use of antibiotics

Types of Infectious Disease Agents

  1. Bacteria: Single-celled organisms; treated effectively with antibiotics.

  2. Viruses: Not complete cells; do not respond to antibiotics.

  3. Parasites: Larger than bacteria, feed off hosts; antibiotics may or may not work depending on the type.

Koch's Postulates

Koch's Postulates help establish a causal relationship between a microorganism and a disease, comprising these criteria:

  1. Organism must be present in every diseased case.

  2. Must be isolated and grown in a lab.

  3. Injection into healthy subjects must elicit disease.

  4. Must be re-isolated from test subjects and repeated.

Chain of Infection

The chain of infection consists of four links:

  1. Pathogen: The infectious agent.

  2. Reservoir: Where the pathogen lives.

  3. Mode of Transmission: How the pathogen spreads.

  4. Susceptible Host: Individuals who can be infected.

Public Health Actions for Each Link

  • Infectious Agent: Prompt treatment, antibiotics, and antivirals.

  • Reservoir: Isolation, safe waste management.

  • Mode of Transmission: Hygiene and vector control.

  • Susceptible Host: Vaccination and overall health promotion.

Measles and Contagiousness

Measles is extremely contagious, potentially infecting non-immune individuals for up to two hours after an infected person leaves the area.

  • Infection Rates:

    • Each measles patient infects 12 to 18 people.

    • Compare to influenza (1-4), mumps (4-7), and Ebola (1-2).

R-naught (R0)

R-naught (R0) measures the infectiousness of a disease, indicating how many people one infected person will infect in a fully susceptible population.

Herd Immunity

Herd Immunity occurs when a significant portion of a population becomes immune, indirectly protecting individuals who aren't immune. This can be achieved through vaccination or previous infection.

Crowd-Epidemic Diseases

Crowd-Epidemic Diseases are diseases that require close proximity for spread, often resulting in rapid mortality or recovery leading to immunity.

  • Examples include yellow fever, malaria, and tuberculosis.

Contact Tracing

Contact Tracing is a public health strategy for identifying and monitoring individuals who have come in contact with an infected person to curb the disease spread.

COVID-19 vs. Influenza

COVID-19 has a far higher fatality rate than influenza, with estimates indicating COVID-19 to have an Infection Fatality Rate (IFR) of 0.5 to 1% compared to 0.02% to 0.05% for influenza, making COVID-19 15 to 30 times more lethal.

Comorbidities and Risk Factors for Mental Health

Comorbidities exist when an individual has more than one health issue simultaneously. Risk factors for mental illness include:

  • Family history of mental illness.

  • Stressful life events.

  • Chronic medical conditions (e.g., diabetes).

Chronic Diseases

Chronic Diseases are conditions lasting one year or more that require ongoing medical attention or limit daily living activities. Unlike many infectious diseases, chronic diseases typically have multiple causes.

Risk Factors for Health Conditions

Five types of risk factors include:

  1. Behavioral: Smoking, physical inactivity, poor diet.

  2. Physiological: High blood pressure, cholesterol.

  3. Demographic: Age, gender, SES.

  4. Environmental: Air pollution, lack of healthy food access.

  5. Genetic: Family history, genetic predispositions.

Metabolic Syndrome

Metabolic Syndrome is a combination of risk factors that increase the likelihood of type 2 diabetes, stroke, and heart disease. It is generally asymptomatic and diagnosed using at least three of the following five criteria:

  1. Elevated triglycerides (≥150 mg/dL).

  2. Low HDL cholesterol (<40 mg/dL for men, <50 mg/dL for women).

  3. Abdominal obesity (≥40" for men, ≥35" for women).

  4. Elevated blood pressure (≥130/85 mmHg).

  5. Elevated fasting glucose (≥100 mg/dL).

Environmental Health and One Health Initiative

Environmental Health Services deal with multiple health aspects, like air quality, water safety, food inspection, housing regulations, waste management, and radiation safety.

One Health is a collaborative approach that connects human, animal, and environmental health, recognizing their interdependence. Common issues include Antimicrobial Resistance (AMR) which illustrates how health across these domains is intertwined.

Medical Care System Contributions

The medical care system plays crucial roles including maintaining a healthy workforce, promoting public health through disease prevention, and providing care for the sick and injured while addressing broader health determinants.

Health Insurance Terms

  • Premium: The regular payment for health insurance, required monthly.

  • Deductible: The yearly amount paid out of pocket for healthcare before insurance coverage begins, e.g., $1,000 before benefits kick in.

  • Copayment: A set dollar amount paid at the time of service, e.g., $25 for a doctor’s visit.