HAHS 1511 – Issues of Health & Quality of Life: SDOH, Health Policy, and Health Literacy Notes

Course Context and Key Concepts

  • HAHS 1511: Issues of Health & Quality of Life, University of North Carolina Charlotte (UNCC)
  • Focus areas include: Social Determinants of Health (SDOH), health disparities, health policy, health literacy, and intercultural competence
  • Course organizing concepts include: Health Disparities, SDOH, Health Care System, Intercultural Competence

What is a Determinant?

  • Determinants are factors that influence health
  • Types of determinants of health:
    • Individual Biology/Genetics
    • Individual Behaviors
    • Physical Environment
    • Socio-cultural Factors

Social Determinants of Health (SDOH)

  • Definition: the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks
    • Source: U.S. Department of Health and Human Services, Healthy People 2030; health.gov
  • SDOH are mostly responsible for health inequities – unfair and avoidable differences in health status seen within and between countries
    • Source: WHO

Significance of SDOH

  • Health is very sensitive to the social environment
  • Social environments are created and can be changed
  • Improve daily living conditions
  • Tackle inequitable distribution of power, money, and resources
  • Think of the “cause of the causes” – root causes of health disparities
  • Implications: shifts how we talk about health and health inequities

Social Positionality

  • Social identities are constructed from multiple factors (examples): class, citizenship, ability, age, race, sexual orientation, cis/trans status, gender
  • These identities position individuals in society
  • Positions influence how we see/experience the world and how others see/experience us
  • Impacts interactions with social determinants of health

Intersectionality (Crenshaw)

  • A framework for understanding how multiple identities relate to systems of disadvantage and privilege
  • People’s lives and experiences cannot be explained by just one factor
  • Factors influence each other
  • Analytic tool to understand and address issues of health disparities

Inequality, Equity, and Justice (Visual Concept)

  • Equality: everyone benefits from the same distribution
  • Equity: systemic barriers may persist even with targeted aids to improve access
  • Justice: systemic barriers are removed to ensure equitable access

The Five HP2030 Domains (SDOH)

  • Domain count: 55 domains
    • Economic Stability
    • Education Access and Quality
    • Health Care Access and Quality
    • Neighborhood & Built Environment
    • Social & Community Context

Economic Stability

  • Goal: Help people earn steady incomes that allow them to meet their health needs
  • Key components:
    • Employment Status
    • Level of Food Security
    • Level of Housing Stability
    • Income Status

Education Access & Quality

  • Goal: Increase educational opportunities and help children and adolescents do well in school
  • Key components:
    • Early Childhood Education and Development
    • Enrollment in Higher Education
    • High School Graduation
    • Language and Literacy

Social & Community Context

  • Goal: Increase social and community support
  • Key components:
    • Civic Participation
    • Experience of Discrimination
    • History of Incarceration
    • Social Cohesion

Health Care Access & Quality

  • Goal: Increase access to comprehensive, high-quality health care services
  • Key components:
    • Access to Health Care
    • Access to Primary Care
    • Health Literacy Level

Neighborhood & Built Environment

  • Goal: Create neighborhoods and environments that promote health and safety
  • Key components:
    • Access to Foods that Support Healthy Eating Patterns
    • Crime and Violence Levels
    • Environmental Conditions
    • Quality of Housing

SDOH Frameworks and Determinants (WHO)

  • Major determinants in the WHO framework include:
    • Social Gradient
    • Stress
    • Early Life
    • Social Exclusion
    • Work
    • Unemployment
    • Social Support
    • Addiction
    • Food
    • Transport

Social Gradient and Early Life (SDOH Details)

  • Social Gradient: The “social ladder” that shapes health outcomes
  • Early Life: Includes pregnancy and early childhood experiences
  • Stress: Cumulative impact of physical and social environments on health

Social Exclusion and Work (SDOH Details)

  • Social Exclusion: Being excluded from or treated as less than equal
  • Work: Impact of stress in the workplace
  • Unemployment: Lack of job security and its health effects

Social Support, Addiction, Food, and Transport (SDOH Details)

  • Social Support: Mutual support contributes to better health
  • Addiction: Coping strategies, social norms, and influences on health behaviors
  • Food: Healthy food access and political dimensions
  • Transport: Access to reliable transportation

GUSAF (Social Determinants Mnemonic)

  • Meet my friend, GUSAF: Gradient, Unemployment, Stress, Addiction, Food, Social Support, Work
  • Purpose: A mnemonic to recall key SDOH factors

Reflection & Application

  • Prompt: How have the Social Determinants of Health influenced your own health and quality of life?
  • Encourages personal reflection and application to real-life contexts

Health Policy and Government Structure (SDOH & Policy Lens)

  • Health policy involves decisions, plans, and actions to achieve health care goals in a society
  • A health policy is intended to define a vision, set targets, outline priorities, build consensus, and inform the public
  • Source: WHO topic on health policy
  • Health policy is influenced by multiple actors and institutions (communications, courts, Congress, private sector, health agencies, etc.)

The U.S. Government Structure and Checks & Balances

  • Three branches: 33 branches of government
    • Executive Branch
    • Legislative Branch
    • Judicial Branch
  • System of checks and balances

Executive Branch

  • Leader: President/Governor
  • Responsibilities: Implement and enforce laws created by Congress
  • Power: Veto laws

Legislative Branch

  • Structure: Congress (House of Representatives and Senate)
  • Responsibilities: Make laws
  • Power: Can overturn a presidential veto

Judicial Branch

  • Structure: U.S. court system including the U.S. Supreme Court and federal appeals courts
  • Responsibilities: Decide constitutionality of laws; issue opinions

Health Policy: What is Health Policy?

  • Definition: Decisions, plans, and actions undertaken to achieve specific health care goals within a society
  • An explicit health policy:
    • Defines a vision for the future and establishes targets
    • Outlines priorities and the roles of different groups
    • Builds consensus and informs people

Health Policy Examples: Public Health Achievements (1900–1999)

  • 10 Greatest Public Health Achievements (as listed):
    1) Immunizations
    2) Motor-vehicle safety
    3) Workplace safety
    4) Control of infectious disease (clean water)
    5) Declines in Heart Disease and Stroke deaths
    6) Safer and healthier foods
    7) Healthy mothers and babies
    8) Family planning
    9) Fluoridation of drinking water
  • Note: The slide lists 9 items; a 10th item is not shown here

Health Policy Example: HIPAA (Health Insurance Portability and Accountability Act, 1996)

  • Protects personal health information in written and electronic form
  • Exceptions for public health emergencies
  • Violations incur fines and are enforced through the Office for Civil Rights (OCR)

Health Policy Example: Affordable Care Act (ACA)

  • Expanded eligibility to include young people up to age 2626
  • Mental health coverage parity with physical health (parity)
  • Eliminated pre-existing condition clause
  • Eliminated annual caps on coverage
  • Required electronic health records
  • Source: Healthcare.gov timeline

How to Maintain a Care Plan: SDOH and Health Literacy Lens

  • SDOH illustrated within health literacy: everyday questions people face (e.g., choices about diet, preventive services, treatment options, etc.)
  • Emphasizes integrating social context into decision-making for care plans

What Does It Mean to Be an Informed Consumer? Health Literacy

  • Key component of consumer-driven health care
  • Definition (Healthy People 2010):
    • Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
  • Includes understanding directions, appointments, personal health behaviors, and how to access care

Assessing Information Sources and Questioning Information Sources

  • Use reliable sources
  • How to assess reliability:
    • Who is making claims and contact information
    • Disclosure of financial interests
    • Evidence claims are true (references)
    • Is the information dated (too old/too new)?
  • Wikipedia is discouraged in schools for reliability reasons

AHRQ Campaign and Asking Questions

  • AHRQ campaigns promote health care quality and safety via PSAs
  • Encourages patients to ask questions to their health care providers
  • Resources include AHRQ-10 Questions

AHRQ-10 Questions to Ask Your Health Care Providers

1) What is the test for?
2) How many times have you done this procedure?
3) When will I get the results?
4) Why do I need this treatment?
5) Are there any alternatives?
6) What are the possible complications?
7) Which hospital is best for my needs?
8) How do you spell the name of that drug?
9) Are there any side effects?
10) Will this medicine interact with medicines that I'm already taking?

The Healthcare System and Information Literacy

  • The U.S. health care system is market-based with multiple players
  • Information literacy is essential for consumers to achieve the best health outcomes

Looking Ahead and Questions?

  • The next focus: The Healthcare System and ongoing health policy discussions
  • End with opportunity for questions and discussion