Health 3 – Determinants of health

The conditions in which people are born, grow, work, live, and age and the wider set of forces and systems that shape those conditions

Mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries

The unfair and avoidable differences in health status seen within and between countries

- Employment

- Income

- Expenses

- Debt

- Housing

- Transportation

- Safety

- Parks

- Literacy

- Language

- Early childhood education

- Higher education

- Hunger

- Access to healthy options

- Social intergration

- Support systems

- Community engadgement

- Discrimmination

- Health coverage

- Provider avalibility

- Provider linguistic and cultural competency

- Quality of care

Socio-economic status

- House size/income

Any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury

Indirect contributing factor - affect the level of direct factor

- Social determinants of health = income, education, transportation, social mores/attitudes

Direct contributing factor - affects the level of risk factor

- More closely linked to risk factors, desires, needs, genetics, obligations, access

Risk factor - directly affect health issue

- Directly associated with a health issue, maybe behavioral or biological

Health issue

- The issue, of obesity, diabetes, hypertension

1. Study of British civil service

- CS = very herarchial

Grade = status

Begun in 1967

Studied cardiovascular disease prevalence and mortality rates > 18,000 male civil servants

Studied > 10,000 male and female civil servants

Study still ongoing

Identified a strong association between different grade levels o civil servants and mortality rates from a range of causes

- Those in the lowest grade had a mortality rate 3X higher than that of those in the highest grade

- Differences observed in male and female

- Gradient observed in a single band

All had access to basic healthcare so stress caused it

- Work organization and atmosphere

- Social influences outside workplace

- Lifestyle and healthy behaviors

Adverse childhood events

One of the largest studies of childhood maltreatment and later health events

- There were >17,000 memebers 1995-1997

- Initial physicals and on-going health monotoring

- Details interviews regarding childhood events

- There were >50 research articles published and 100 scientific presentations

1. Abuse

2. Neglect

3. Household dysfunction

- Physical

- Emotional

- Sexual

- Physical

- Emotional

- Mental illness

- Mother treated violently

- Divorce

- Incarcerated relative

- Substance abuse

Risk for these behavioral and health outcomes rises in a strong and graded linear fashion the more ACEs an individual has

- There are people with ACE experience who do NOT develop these outcomes

- This study is NOT saying someone with one of the diseases or behaviors was abused

- It IS saying there is an association

- Things true at a population level are not always true at an individual level

1. Causes the liver to produce more glucose

2. Causes adipose tissue to lock down and hold on stored fat

3. Increases huger

Damages telomeres

Protective cap at end of chromosome

The sum of the total of the learned behavior of a group of people that are generally considered to be the tradition of people and are transmitted from generation to generation

Learned, shared behaviors and what we think/believe about the behaviors

- What we think and believe about health

- Backdrop of our lives

- Loaded with behavioral cues, triggers, enablers, and impediments that impact behavior

- We are often totally unconscious of the impact the environment plays in our choices

- Noice, population, density, air/water quality

Has structures and context that are:

- Health inducing

- Health decreasing

- Provide cues and opportunities that trigger behavior

Land use, accessibility, design, noise, population, transportation, protection from climate, lighting, safety, protection/access for walking, biking

If you want to radically change behavior, you must radically change the environment

Differences in health status and outcomes between different population subgroups

Social determinants of health

- Gender, race and ethnicity, income, geography, medical access

People of different social status lead lives that are fundamentally different from one another

- Childhood experiences and education

- Occupational

- Family and social circumstances

- Physical environment

- Healthcare access and quality

Socioeconomically disadvantaged

- Hispanics have better-than-expected health