Untitled spreadsheet - Sheet1 (1) Flashcards
1
Q
What are the five historic racial categories, as defined by the US Census Bureau?
A
- White 2. Black or African American
- American Indian and Alaska Native
- Asian
- Native Hawaiian and Other Pacific Islander
2
Q
What are two second division categories, independent of race and based on ethnicity, as defined by the US Census Bureau?
A
- Hispanic Origin 2. Not of Hispanic Origin
3
Q
In comparison to white Americans, African Americans have…
A
Higher infant mortality rates and shorter life expectancy
4
Q
In 2016, the portion of the United States economy that is spent on providing healthcare rose from ___% to ____%
A
11% to 17.9%
5
Q
What are some of the main causes for the increase in healthcare costs (2)?
A
- The expansion of access to health insurance due to the Affordable Care Act - Investments in new medications, facilities, and technology
6
Q
In 2017, what five categories did the National Center for Health Statistics divide the population into (based on race and ethnicity) when reporting birth/death rates in the U.S.?
A
- White (non-Hispanic) 2. Black (non-Hispanic)
- American Indian or Alaskan Native
- Asian or Pacific Islander
- Hispanic
7
Q
What is life expectancy?
A
The average a number of years a newborn can expect to live at current mortality levels (commonly broken down between male and female)
8
Q
What is infant mortality?
A
How many children, out of 1000, are expected to die before they turn 1.
9
Q
In 2015, the United States had a higher infant mortality rate than ____ out of ____ of the most developed countries in the world
A
31 out of 35
10
Q
What are the top three causes of death?
A
heart disease, cancer, and unintentional injuries (accidents and poisonings)
11
Q
What is the main reason for the increase in unintentional injuries in the United States, according to the US Department of Health and Human Services?
A
The Opioid Epidemic, which has increased deaths from opioid overdoses
12
Q
Between diastolic and systolic pressure, elevation of which of the two is most often associated with more severe diseases?
A
diastolic pressure
13
Q
Babies in the United States in 2015 were expected live about how many years less than babies born in other developed countries?
A
2-6 years less
14
Q
Japan Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 10.7% - Infant Mortality: 2.0
- Male life expectancy: 81.0
- Female life expectancy: 87.1
15
Q
Sweden Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 10.9% - Infant Mortality: 2.5
- Male life expectancy: 80.6
- Female life expectancy: 84.1
16
Q
France Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 11.5% - Infant Mortality: 3.7
- Male life expectancy: 79.2
- Female life expectancy: 85.5
17
Q
Germany Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 11.3% - Infant Mortality: 3.4
- Male life expectancy: 78.6
- Female life expectancy: 83.5
18
Q
Switzerland Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP: 12.3% - Infant Mortality: 3.6
- Male life expectancy: 81.7
- Female life expectancy: 85.6
19
Q
Greece Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 8.4 - Infant Mortality: 4.2
- Male life expectancy: 78.9
- Female life expectancy: 84.0
20
Q
Canada Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 10.4% - Infant Mortality: 4.7
- Male life expectancy: 79.8
- Female life expectancy: 83.9
21
Q
United Kingdom Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 9.7% - Infant Mortality: 3.8
- Male life expectancy: 79.4
- Female life expectancy: 83.0
22
Q
United States Health Index (% of GDP spent on health care, infant mortality rate, male life expectancy at birth, and female life expectancy at birth)
A
- GDP %: 17.1% - Infant Mortality: 5.9
- Male life expectancy: 76.1
- Female life expectancy: 81.1
23
Q
What two causes of death are the most responsible for the reduced life expectancy for Americans?
A
Opioid overdoses and suicide rates (“deaths of despair”)
24
Q
What group most greatly contributes to deaths caused by opioid overdoses and suicides?
A
non-Hispanic whites who lived outside of large, urban areas
25
In the 1983 book, "A Tale of Two States", economist Victor Fuchs discovered that though Utah and Nevada were two similar states, people in Nevada suffered from extremely worse health than those in Utah. Why was this?
The influence of the Mormon church in Utah decreased the smoking and alcohol abuse of the population
26
What factors, other than healthcare are responsible for altering a person's health status (3)?
- lifestyle factors (jobs, family-composition, etc.) - living standard/quality of life (sanitation, housing, public health measures)
- social hierarchy (income, social standing, etc.)
27
The rising standard of living in the United States from 1900 to 1970, was most associated with a decline in...
death rates from infectious diseases such as measles, tuberculosis, pneumonia, diphtheria, typhoid, and polio
28
What two important medical discoveries were made in the 20th century?
antibiotics and vaccines
29
What is allostatic load?
wear and tear on the body associated with chronically elevated levels of stress
30
A society's hierarchy of health care is closely associated with ______ status and _______ inequality.
social status and economic inequality
31
What is the Gini coefficient?
the decimal fraction of a society's collective income that would need to be redistributed to reach full economic equality (high Gini coefficient = high mortality rate)
32
On a graph displaying economics within a society, what does the 'Lorenz curve' measure?
the actual distribution of income or wealth in a society (the further the curve from the baseline, or 'line of full equality', the higher the level of economic inequality)
33
What does 'decile ratio' measure?
the ratio of the income earned by the top 10% of households to the income earned by the bottom 10%
34
What does 'income ratio' measure?
the ratio of the income of the highest-paid executive in a firm to the lowest-paid employee in that firm
35
What does the 'Robin Hood index' represent on a graph?
the maximum vertical distance between the line of full equality and the Lorenz curve
36
What does 'poverty income ratio' measure?
the proportion of collective income in a society earned by the bottom (50%, 70%, etc.) of households
37
In a 2018 study, researchers concluded that people living in areas classified as 'less cohesive' engage in thoughts and behaviors that are related to greater physiological wear and tear, which in turn increases ___________ risk.
cardiovascular risk
38
Poor quality of a built environment (man-made surroundings) is associated with rapid cognitive decline, especially among what racial demographic?
African Americans
39
People in disadvantaged positions are more likely to experience what 3 negative forces in their communities in relation to social capital?
- high levels of violence - high levels of social anxiety
- increased perceptions of discrimination
40
Constant stress due to inadequate living conditions results in chronically elevated levels of stressor hormones. Over time, this leads to what 3 health concerns?
- cellular damage - illness
- premature death
41
Living in a disadvantaged neighborhood has been linked to higher rates of which 2 diseases?
diabetes and cardiovascular disease
42
A 2002 study found that elderly people who have regular social engagement tend to have lower _______ rates.
mortality rates
43
Why do people with stronger social networks have higher levels of antibodies against colds?
the more people we interact with, the more colds we get-- thus the more antibodies we develop against future colds
44
Life expectancy in the U.S. decreased from ____ years in 2014 to ____ years in 2017.
78.9 to 76.6
45
The CDC reports that suicide rates nationally increased by ___% from 1999 to 2016.
30%
46
Determine the age group, level of urbanization, and racial groups (2) where suicide rates were highest.
- 35-64 years - rural areas
- White and American Indian/Alaskan Native
47
The CDC reported that use of what drug was primarily responsible for the recent increase in deaths due to illicit drug use?
fentanyl
48
Researchers suggest the U.S. currently has 2 opioid epidemics. What are they?
1) prescription drugs (such as painkillers) 2) illegally manufactured drugs (such as heroin)
49
Between 2000 and 2015, the rate of opioid use increased among all racial groups, the highest being among ____.
Whites
50
Which state has had the highest opioid overdose death rate in the U.S. since 2010?
West Virginia
51
The HEAL initiative focuses on improving what 2 means to address the opioid crisis?
1) treatments available for opioid misuse and addiction ) strategies for pain management without the chronic use of opioids
52
_________ is an opioid derivative that can be can be used to prevent withdrawal symptoms from opioid addiction.
buprenorphine
53
What are prescription drug monitoring programs (PDMPs) and what is the purpose of them?
require physicians and other professionals who prescribe opioids to register with a state database, allowing staff members to check if a patient has already been prescribed opioids from another provider
54
What is the Whitehall study?
The Whitehall study was conducted over several decades in England. It followed employees in the British Civil Service, and monitored different aspects of their health status.
55
What did the results of the Whitehall study show?
that people who have higher paying jobs usually have better health and lower death rates than those with lower paying jobs
56
What does SES stand for? What does it mean?
Socioeconomic status: a measure of status within the social hierarchy according to measures such as income
57
What happens to health and mortality rates at lower levels of the socioeconomic hierarchy?
health decreases and mortality increases
58
People of lower socioeconomic status are at higher risk for what diseases?
arthritis, hypertension, and other chronic diseases
59
In 2012, two years after the Affordable Care Act (ACA) was signed, how many people had no health insurance and little access to health care?
48 million people (most of them in low-to moderate-income working families)
60
In 2014, the changes enacted by the ACA reduced the number of uninsured people by _____. However, _____ people were still without health insurance.
- the number of uninsured people was reduced by nearly 18 million - 27 million were still without health insurance
61
When and where was the constitution of the World Health Organization adopted?
At the International Health Conference in New York (1946)
62
The preamble to the WHO's constitution defines health as...
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
63
Health involves not only the absence of disease, but also_____ (3)?
1. The health of the body 2. The health of the mind and emotions
3. Health of the social context in which one lives
64
Andrew Twaddle, a 20th-century sociologist, stated what about health?
...health must be understood first as a biophysical state and that "illness is any state that has been diagnosed by a competent professional"
65
What are two fundamental dimensions of health, according to the medical model?
1. an absence of symptoms (sensations noticed by the patient and interpreted as abnormal) 2. An absence of signs (objective characteristics noted by a health professional, of which a patient may often be unaware)
66
What is an "area variation"
a phenomena in which the same laboratory tests, are interpreted differently by different individuals
67
What are the 5 ADLs (Activities of Daily Living)?
1. Feeding one's self 2. Bathing one's self
3. Dressing one's self
4. Being able to use the toilet without assistance
5. Being able to transfer one's self without assistance (EX: from a bed into a chair)
68
What is MEPS?
- The Medical Expenditure Panel Survey - A survey conducted by the US Agency for Healthcare Research and Quality (AHRQ) since 1996. The purpose of the survey is to measure the health status of the US population
69
According to MEPS, the number of healthy adults in the US between 2000 and 2014 increased from___ to ____.
From 14 million (42.4%) to 22.4 million (48.2%)
70
When age and gender was controlled for MEPS, what groups reported lower rates of health (4)?
1. African Americans 2. Hispanics
3. Those with lower incomes
4. Those with lower levels of education
71
One method of measuring health, as suggested by Wolinsky, is to dichotomize each dimension of health into ____ and ____ and compare the ratio of the two dimensions.
- "well" and "ill" - if someone is well psychologically and socially, but ill physically, they should still be considered well
72
What does SF-36 stand for? Who created it and what study was it used in?
- A 36-Item Short Form Health Survey created by John Ware for use in the Medical Outcomes Study
73
The purpose of the SF-36 is to...
compare the health outcomes overtime of patients enrolled in alternative health care delivery systems
74
How does the SF-36 differ from Wolinksy's idea of health?
While Wolinsky's model views health as dichotomous, SF-36 views health as continuous
75
What are the 4 subscales used to measure overall physical health in the SF-36?
1. Physical functioning 2. Role limitations due to physical problems
3. Bodily Pain
4. General health perceptions
76
What are the 4 subscales used to measure overall mental health in the SF-36?
1. Vitality 2. Social Functioning
3. Role Limitations Due to Emotional Problems
4. General Mental Health
77
How does the Wilson and Cleary model suggest that different aspects of health are associated with each other (2)?
- The three dimensions of health are linked, with a change in physical health triggering an emotional and functional change - The three dimensions of health should not be the only thing we focus on/ instead, we should focus on overall quality of life
78
In the Wilson and Cleary model of health, what are the two fundamental models of poor health? What reduces a person's quality of life?
- Biological and physical abnormalities are the fundamental causes - A person's perception of their poor health, reduces their quality of life
79
A person's sex can be defined as...
a biologic quality based on chromosomes and sex hormones
80
A person's gender can be defined as...
a person's self-perception and self-representation in a broader social and cultural context
81
What does ELBW stand for? What are the qualifications to be considered ELBW?
- ELBW: extremely low birth weight - A premature infant weighing less than 1,000 grams
82
When comparing teenagers born as ELBW with teenagers born at NBW (normal birth weight), what was discovered (2)? What was the difference in the quality of life for the two groups/
The teenagers who were ELBW had lower: - physiological health (cognition and sensation)
- functional health (mobility and self care) However, there was essentially no difference in the two group's quality of life
83
What behaviors are commonly seen as causes of illness (7)
- obesity - smoking
- lack of exercise
- high cholesterol
- poor diet
- alcohol abuse
- drug abuse
84
Rates of asthma, as of 2015, in California, Iowa, Mississippi, and New York
- California: 7.7%- Iowa: 7.6%
- Mississippi: 7.8%
- New York: 9.9%
85
Rates of diabetes, as of 2015, in California, Iowa, Mississippi, and New York
- California: 9.6% - Iowa: 7.7%
- Mississippi: 13.6%
- New York: 8.9%
86
Rates of hypertension, as of 2015, in California, Iowa, Mississippi, and New York
- California: 25.7% - Iowa: 30.6%
- Mississippi: 42.4%
- New York: 29.3%
87
Rates of obesity, as of 2016, in California, Iowa, Mississippi, and New York
- California: 25.0% - Iowa: 32%
- Mississippi: 37.3%
- New York: 25.5%
88
Rates of breast cancer deaths, as of 2015, in California, Iowa, Mississippi, and New York
- California: 19.6 - Iowa: 18.5
- Mississippi: 21.8
- New York: 19.2
89
Rates of heart disease deaths, between 2014-2016, in California, Iowa, Mississippi, and New York
- California: 279 - Iowa: 312
- Mississippi: 453
- New York: 348
90
Infant mortality rate, as of 2016, in California, Iowa, Mississippi, and New York
- California: 4.2 - Iowa: 6.1
- Mississippi: 8.6
- New York: 4.5
91
Median family income, as of 2015, in California, Iowa, Mississippi, and New York
- California: $64,500 - Iowa: $54,736
- Mississippi: $40,593
- New York: $60,850
92
According to a study by professor and doctor JK Montez and her colleagues, the highest rates of disability in most states is concentrated in what population?
Older adults (45+) who did not complete high school
93
What states had the highest rates of disability?
Mississippi, Kentucky, and West Virginia
94
According to the federal government, a baby born in the United states in 2016 could expect to live, on average, for how many years? How long could a male expect to live? A female?
- On average: 78.6 years - Male: 76.1 years
- Female: 81.1 years
95
What is a principal contributor to reduced life expectancy?
the rate of infant mortality
96
In 2016, which state had the highest infant mortality rate? Which state had the second highest? The fifth lowest? The absolute lowest?
- Alabama had the highest - Mississippi had the second highest
- California had the fifth lowest - Vermont had the lowest
97
Which state has the lowest rate of death from heart disease, and what is the rate? Which state has the highest rate?
- Minnesota has the lowest (225 deaths/100,000 for those over age 35) - Mississippi has the highest
98
In 2015, which state had the lowest median income for a family of four?
Mississippi
99
According to the WHO, what are the 4 standard indicators to compare health among countries globally?
1. Male life expectancy at birth 2. Female life expectancy at birth
3. Infant mortality rate: # of babies, out of one thousand, who will die before their first birthday
4. Maternal mortality rate: of one hundred thousand women giving birth,the number who will die as the result of complications during birth
100
Argentina (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 74 - Female expectancy: 80
- IMR: 10
- MMR: 52
- Per capita: $20,270
101
Bangladesh (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 71 - Female expectancy: 74
- IMR: 28
- MMR: 176
- Per capita: $4,040
102
Brazil (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 71 - Female expectancy: 79
- IMR: 14
- MMR: 44
- Per capita: $15,160
103
Canada (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 81 - Female expectancy: 85
- IMR: 4
- MMR: 7
- Per capita: $45,750
104
Colombia (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 71 - Female expectancy: 78
- IMR: 13
- MMR: 64
- Per capita: $14,170
105
Democratic Republic of Congo (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 59 - Female expectancy: 62
- IMR: 72
- MMR: 693
- Per capita: $870
106
Greece (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 79 - Female expectancy: 84
- IMR: 3
- MMR: 3
- Per capita: $27,820
107
Haiti (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 61 - Female expectancy: 66
- IMR: 51
- MMR: 359
- Per capita: $1830
108
India (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 67 - Female expectancy: 70
- IMR: 35
- MMR: 174
- Per capita: $7,060
109
Mexico (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 74 - Female expectancy: 79
- IMR: 13
- MMR: 38
- Per capita: $17,740
110
Nigeria (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 55 - Female expectancy: 56
- IMR: 67
- MMR: 814
- Per capita: $5,680
111
Norway (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 81 - Female expectancy: 84
- IMR: 2
- MMR: 5
- Per capita: $63,530
112
Russian Federation (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 66 - Female expectancy: 77
- IMR: 7
- MMR: 25
- Per capita: $24,893
113
Singapore (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 81 - Female expectancy: 85
- IMR: 2
- MMR: 10
- Per capita: $90,570
114
United States (Male and female life expectancy at birth, IMR, MMR, and Per Capita Income)
- Male expectancy: 76 - Female expectancy: 81
- IMR: 6
- MMR: 14
- Per capita: $60,200
115
In Western countries, when determining IMR, an infant born alive is defined as an infant who has....
a spontaneous heartbeat and other signs of vital organ functioning
116
In a country that does not have resources to provide intensive care to a premature infant, an infant that is born alive is defined as an infant who has...
survived the first 24 hours of life
117
According to an analysis published Dimitris Kontis and his colleagues, which predicts the life expectancies across 35 industrialized countries through the year 2030, what is the probability of a change in life expectancy for men and women?
- 85% chance of an increase for men - 65% chance of an increase for women
118
Projected life expectancy (through the year 2023) is lower in countries that have...(4)
- higher young adult mortality - higher major chronic disease risk factors
- higher social inequalities
- less effective health systems
119
By 2030, according to Dimitris Kontis and his analysis, how will the life expectancy in the United States compare to other industrialized countries?
The life expectancy will be even lower
120
What does DALY stand for? What is it?
- DALY: disability-adjusted life year - a measurement instrument used to estimate the magnitude of the burden created by a disease or condition
121
What is an example of a DALY measurement?
living one year with a disease that reduces one's level of functioning by 50 percent would mean the loss of 0.50 DALY
122
How many DALY's would be lost if a person lived with a disease for 10 years, with a loss of 50% functional ability, and died five years prematurely?
10 DALYs would be lost (five) DALYs for the effect of the disability when alive, and an additional five DALYs for the premature death.
123
What does GBD stand for? What is it for?
- GBD: The Global Burden of Disease - a metric intended to provide a comprehensive picture of what disables and
kills people across countries, time, age, and sex
124
Among children, what illness inflicts the largest health burden globally?
diarrheal illness, affecting primarily young children
125
What disease heavily affects those over 60 years old? How does this disease's global impact compare to diarrheal illness?
- ischemic heart disease affects those over 60 - its global impact is half of diarrheal illness
126
According to the GBD international research group, how has the prevelance of obesity grown since 1980?
it has double in more than 70 countries
127
More than ____ of deaths globally that were associated with a high body mass index (BMI) were due to what disease?
cardiovascular disease
128
Out of the 20 largest countries, what country has the highest rate of death associated with increased BMI?
Russia
129
Why has the United States seen a flattening rate of obesity (2)?
1. Growing national emphasis on reducing caloric intake (especially sugared beverages(
130
What caused the most deaths in America in 2015?
Heart disease
131
Though heart disease caused the most deaths in America in 2015, ______ caused ___% more years of life lost than heart disease?
Cancer caused 23% more years of life lost
132
In 2016, what were the three leading causes of loss of DALYs in the U.S.?
1. Ischemic heart disease 2. Lung cancer
3. Chronic obstructive pulmonary disease
133
In 2016, what were the six behavioral risk factors that led to the three leading causes of loss of DALYs in the U.S.?
1. Smoking 2. High BMI
3. Poor diet 4. Alcohol and drug use
5. High fasting plasma glucose (diabetes)
6. High blood pressure
134
Opioid use disorders moved from the ____th leading cause of DALYs in 1990 to the ____th leading cause in 2016. What percent change did this represent?
- Opioid use disorders moved from the 11th leading cause to the 7th leading cause - This was a 74.5% change
135
What does QALY stand for? What is it commonly used for?
- QALY: Quality-adjusted life year - It is used in developed countries to evaluate the effectiveness of a specific treatment in
prolonging the lives of those with specific diseases
136
How is QALY calculated?
It first estimates the number of years a person's life is extended by the treatment, then estimates the health-related
quality of life (HRQL) experienced by that person during those additional years
137
What is an example of QALY?
Living an additional year with a 50 percent HRQL constitutes 0.50 QALY; living an additional year with no impairment in HRQL constitutes 1.0 QALY
138
Cardiovascular disease (CVD) includes what two diseases?
Heart disease and stroke
139
What are the known risk factors for developing CVD (4)?
- Hypertension - High cholesterol
- Diabetes
- Smoking
140
How are SES and CVD connected?
A low SES is strongly linked to the development of CVD as a result of biological, behavioral, and psychosocial risk factors
141
After Hurricane Katrina, what type of people were primarily found in Red Cross shelters (5)?
Those that were: - unemployed or underemployed
- low-income
- unmarried
- suffering from chronic medical problems
- lacking health insurance
142
Of those who died in Hurricane Katrina, what age were half of the victims?
75+ years old
143
During Hurricane Katrina, what racial group had the highest death rate?
Black people over the age of 18
144
What was the range of the black/white ratio for the deaths of the different racial age groups after Hurricane Katrina?
From 1.7:1 to 4:1
145
During the Chicago heat wave, what were the 8 factors that increased the likelihood of dying?
1. people with known medical problems who were confined to bed 2. people who did not leave home each day
3. people who lived alone
4. people who lived on the top floor of a building
5. people with few regular social contacts
6. people with no working air conditioner
7. people with no access to transportation
8. people who had nailed their windows shut for safety
146
What is the difference between socioeconomic status and socioeconomic position?
- Socioeconomic status: deals with a social or professional rank, position, or standing; a person's relative importance - Socioeconomic position: deals with a person's circumstances, condition, or situation, especially as affecting his/her influence, role, or power to act
147
How did mortality rate change among white women between the ages of 45-84, with differing levels of education (college educated, high school graduates, and women who did not graduate high school)
- Mortality rates decreased for college educated women, remained fairly constant for high school graduates
without a bachelor's degree, and increased for women who did not graduate from high school
148
People who did not finish high school had a mean annual earning of $_______ in 2017
$31,121
149
People who only graduated high school had a mean annual earning of $_______ in 2017
$39,005
150
People who got an Associate's degree had a mean annual earning of $_______ in 2017
$46,629
151
People who got a Bachelor's degree had a mean annual earning of $_______ in 2017
$62,100
152
People who got a Master's degree had a mean annual earning of $_______ in 2017
$77,685
153
People who got a Professional degree had a mean annual earning of $_______ in 2017
$110,656
154
How is the level of pain experienced by people in the United states associated with SES?
As income decreases, pain increases
155
How many years of expected life remain (at age 25) for men and women with no high school diploma?
- Men: 47.1 - Women: 51.7
156
How many years of expected life remain (at age 25) for men and women with a high school diploma/GED?
- Men: 51.4 - Women: 57.0
157
How many years of expected life remain (at age 25) for men and women with some college education?
- Men: 52.3 - Women: 58.1
158
How many years of expected life remain (at age 25) for men and women with a Bachelor's Degree or higher?
- Men: 56.4 - Women: 60.3
159
The IMR in Appalachia compared to the rest of the united States in 2009-2013, was ____% higher
16%
160
Life expectancy in Appalachia compared to the United states in 2009-2013 was ___ years shorter
2.4 years
161
What states had the highest rates of smoking and secondhand smoke exposure in the country during 2009-2013
Kentucky and West Virginia
162
What are two reasons why wealthier/richer people healthier than poorer people?
1. Richer people are less susceptible to long term stressors (low health, unstable housing, exposure to trauma) 2. Richer/wealthier people are less susceptible to drug and alcohol addiction
163
A study done in England, followed individuals that were 65+ years old that had no signs of dementia at the beginning of the story. 12 years later, the rate at which signs of dementia began to appear was measured. The risk of developing dementia was ______ times greater for poorer people than richer people.
1.68 times greater
164
The death rate of black men is _____% higher than that of white men.
21%
165
The death rate of black women is _____% higher than that of white women.
13%
166
What is the main possible explanation for the higher death rates in Black Americans
the level of educational attainment for black and white Americans
167
What was the death rate of 45+ year old black men in 2015?
1,040
168
What was the death rate of 45+ year old black women in 2015?
711
169
What was the death rate of 45+ year old white men in 2015?
862
170
What was the death rate of 45+ year old white women in 2015?
627
171
Blacks in the United States are, educationally, more likely than whites to...(2)
1. Never graduate high school 2. Graduate high school, but not go to college
172
Whites in the United States are, educationally, more likely than blacks to...(3)
1. Finish college 2. Get a master's degree
3. Obtain a doctorate or professional degree
173
Black men and women earn _____ incomes than white men and women, even with the same level of education
lower, even for those who do not graduate high school/do not go to college
174
According to data gathered in 1980, what is the ratio in the death rate of lowest income to highest income?
the ratio ranges from 2.4 - 2.9
175
According to data gathered in 1980, what is the ratio in the death rate of black vs white people for higher income men and lower/middle income women?
the ratio ranges from 1.04 for higher-income men to 1.65-1.67 in lower- and middle-income women (blacks died at higher rates than whites)
176
What was the median household income in the United States in 1980?
$17,710
177
What was the median household income in the United States in 2017?
$61,372
178
What three factors can one's position in the hierarchy of a social system, depend on?
1. Time preference: some are willing to start college sooner or later than others. Additionally, some are more willing to stop smoking sooner than others 2. Self-efficiency: how a person views their ability to direct their own life
3. Social anomie: a difficutly to adhere to behaviors identified by the norms of society
179
What are the three forms an individual's time perspective might take/
1. Future: planning for and achievement of future goals, considering the consequences and preferring consistency 2. Present (fatalistic): the belief that the future is predestined and cannot be changed because of fate
3. Present (hedonistic): being focused on enjoy the present without worrying about the consequences
180
Students who demonstrated a "Future" perspective experienced what (4)?
- Higher grades - More time spent studying
- Decreased likeliness to exhibit aggressive behavior
- Heightened impulse control
181
Students who demonstrated a "Present-Fatalistic" perspective experienced what (3)?
- More aggressive tendencies - Lower grades
- Impulsive behavior
182
List the 5 layers in the casual cascade of the social determinants of health
1. Social structure of the society into which one is born 2. One's position in the social hierarchy
3. Social and material environment in which a person grows up and lives as an adult
4. Individual behavior and the physiological factors that result
5. Illness or injury and One's resulting health status
183
Men from England and Wales were considered for the following characteristics: Did they own a car? Did they own their house or rent it? Did their job involve manual or nonmanual labor? Based on the characteristics, which group of men had the highest mortality rate? Which group had the lowest?
- Highest mortality rate: Men who did not own a car, rented their home, and worked in manual labor
- Lowest mortality rate: men who owned a car, owned their home, and worked in nonmanual labor
184
For people who reported multiple episodes of economic hardship, the odds of experiencing poor health is ____ to ____ times greater than those who did not experience hardship
3 to 5 times
185
What are some major causes of death in the US (9)?
- lung cancer - other cancers
- coronary heart disease
- strokes
- other cardiovascular disease
- chronic bronchitis/ other respiratory disease
- gastrointestinal disease
- genitourinary disease
- accidents and violence
186
Out of the 2.3 million deaths that occured in the United States during 2000, what percent were due to social inequality, low levels of education, residential racial segregation, poverty, and low levels of social support?
873,000 (38%)
187
Scientists Pensola and Martikainen performed a study on 110,000 men born in Finland between 1956 and 1960. They recorded each subject's SES at birth, and then in adulthood. What was the difference in mortality rate for each SES status (low SES throughout life vs. high SES throughout life) (change in SES throughout life vs. no change in SES)?
- the mortality rate was nearly three times as high for the men born into lower SES and remaining in lower SES, when compared to men who
were born into and remained in higher SES
- the mortality rate for those
men who transitioned from one SES category to another between childhood and
adulthood had a mortality rate that was midway between the rates for the constant SES categories
188
What three factors can weaken the body and lead to illness, while also indicating a person's SES?
1. Crowding 2. Inadequate sanitation
3. Nutritional shortages
189
Define "the status syndrome"
The higher the social position, the better the health
190
What effects can chronic stress have on the body (4)?
Chronic stress can: - weaken the immune system
- strain the heart - damage memory cells in the brain
- deposit fat at the waist rather than the hips and buttocks (risk factor for heart disease, cancer, etc)
191
A low social status can lead to prolonged chronic stress, which weakens their stress response system. What two effects does this have/
1. They are less effective at responding to stress 2. They are less able to respond to the stress of illness or injury, due to weakened
immune systems
192
What are the two basic parts of the body's stress control mechanism?
1. the brain as the body's monitoring and control mechanism 2. the adrenal gland as the source of stress response hormones
193
Define thermostasis
the mechanisms within the human body that are deployed to maintain an internal temperature of 98.6 degrees Fahrenheit
194
What is the hypothalamus?
A built-in thermostat in the unconscious part of the brain that relays messages to the thalamus, and helps maintain thermostasis
195
Apart from maintaining thermostasis, what does the hypothalamus do? This is also known as....
- monitors and responds to stress - AKA allostasis
196
After the hypothalamus senses stress, it sends a message over nerve pathways to...
the brain's relay center: the pituitary gland
197
Where is the pituitary gland located? What does it do?
- located at the base of the brain - accepts messages from the brain, converts them into hormones, and secretes them into the bloodstream, where they target a specific part of the body and tell it to turn on or off
198
In the case of stress response hormones, what part of the body is targeted?
the adrenal galnd
199
Where is the adrenal gland? What does it do after receiving a message from the pituitary gland?
- the adrenal gland is adjacent to the kidney on each side of the body - after receiving the message to "turn on" it pumps hormones into the bloodstream
200
What three hormones are released by the adrenal gland during the body's stress response?
- Epinephrine (adrenalin) - Norepinephrine (noradrenalin)
- Cortisol (cortisone)
201
Describe the speed at which cortisol kicks in and wears off. Also, list the other function of cortisol within our body's.
- Cortisol is slow to kick in and slow to wear off - It is important in our circadian rhythm
202
What is the name of the combined control mechanism involving the hypothalamus, the pituitary gland, and the adrenal gland?
Hypothalamic-pituitary-adrenal axis (HPA).
203
Define allostatic load
The level at which the HPA response is functioning. The higher the level of stress response hormones in the blood, the higher the allostatic load.
204
How does a chronically elevated allostatic load occur?
When a person experiences constant stressors, and their allostatic response cannot recharge, causing it to stay dangerously high
205
A chronic elevation of cortisol and other stress hormones has been shown to trigger...
inflammation in cells through the release of chemicals called inflammatory cytokines
206
What cells are most adversely affected by chronic inflammation?
the cells that line the arteries and arterioles that distribute blood throughout the body
207
Inflammation of the arteries and arterioles can lead to injury to what type of cells? This can then lead to what?
- the inflammation can cause injury to vascular cells - this can lead to scarring within the cell and the formation of calcium deposits
208
As vascular cells become scarred and covered in calcium, the vessel itself can experience...(2)
- thickening/stiffness - narrowing
209
What is a biomarker, in relation to the damage caused by chronic inflammation?
- a biomarker is a biochemical compound that can provide a measure of the cellular injury caused by chronic inflammation
210
What are four major biomarkers for chronic inflammation?
- C-Reactive protein (CRP) which leads to fibrinogen - Interleukin-6 (IL-6) - Coronary artery calcium (CAC)
211
Describe the role of CRP in cardiovascular disease (CVD).
elevated levels of CRP are highly predictive of future CVD such as heart attacks and strokes
212
What is fibrinogen?
clotting protein in blood that also helps form scar tissue
213
Increased levels of fibrinogen can lead to...
- thickened/stiff arterial walls (intima-medi thickness or IMT)
214
What is interleukin-6 (IL-6)?
a group of molecules called inflammatory cytokines, that increase cellular inflammation throughout the body (especially cells lining blood vessels)
215
What device can be used to measure the amount of calcium deposited in the coronary arteries?
Computed tomographic (CT) scans
216
A study was done on nearly 3,000 patients over a period of 15 years. Using repeated CT scans of the heart, each patient was measured for the amount of CAC in their arteries. How did the levels of CAC in patients with higher education, compare with those who had less education?
Those with lower education had higher levels of CAC than those with higher education
217
Hypertension is strongly associated with what three health issues?
1. Heart attacks 2. Stroke
3. Kidney disease
218
What is systolic pressure?
a measure of how hard the heart is beating
219
What is diastolic pressure?
a measure of the stiffness of the blood vessels (less stiff is better)
220
Chronic elevation in which reading of blood pressure (systolic or diastolic) is most strongly associated with more diseases?
diastolic pressure
221
Instead of relying on court to address the issue of health care disparities, who does the author of the textbook suggest people work with (2)?
- Organizations like the Joint Commission - Congress or other governmental agencies
222
What is the Joint Commission?
the organization that monitors the quality of care provided by hospitals and health plans nationally
223
What percentage of hospitals, nationally, collected data on race and ethnicity of the patients they served?
80%
224
What percentage of hospitals, nationally, collected data on the language spoken by the patients they served?
60%
225
Section 4302 of the Affordable Care Act did what?
initiated a process of establishing national standards for the collection of patient data on race, ethnicity, sex, language, and disability status
226
What two factors primarily contribute to patients who need a type of care, but do not get the care?
1. The physician recommends the care, but the patient chooses not to undergo the care
227
Why might a patient who is recommending a certain type of care, choose to not undergo the care?
reason—racial/ethnic differences in patients' under- standing of and preference for alternative treatment approaches.
228
What is central to the quality of the physician-patient interaction and is a major determinant of the treatment decisions that come out of it?
trust
229
The 1972 Tuskegee Syphilis Study on Negro Males caused a decrease of ____ for African Americans
trust in the medical care system
230
List the three things that, when perceived by a minority patient, can decrease their satisfaction with their physician
The patient's perception of: - the physician's thoroughness
- how well the physician listened
- how well the physician explained things
231
What greatly affects the physician-patient interaction for black patients being treated for cancer by a nonblack oncologist?
mistrust of one's physician due to past experience of racial discrimination
232
A study was conducted in which 113 black cancer patients, were assessed for their perceptions of of past discrimination in a healthcare context and their general level of trust or mistrust in physicians, before their visit with their oncologist. Based on videotapes of the subsequent visits, what was observed in the patients who expressed greater levels of mistrust?
they talked more during the visit, and used a more negative tone in the words they used
233
breasts with increased tissue density. What does this indicate?
that the woman is at in-
234
211 white and 241 black women underwent screening mammograms and were found to have increased breast density. Each woman was informed of her increased breast density and each was given information about the increased cancer risk. After the appointment, the women were surveyed. In comparison to the white women, what did black women report regarding the information they received (2)?
The black women reported: - greater levels of anxiety
and suspicion - a stronger intent to discuss the information with a physician to gain a better understanding
235
Compared to white patients, how did black patients with chronic heart conditions feel about the care they recevied? How did the patient's trust affect their satisfaction?
- blacks were much less satisfied with their care than whites - the more the patient trusted the physician, the more satisfied they were
236
The greater the perceived racial bias, the lower the...
satisfaction
237
List the 4 determinants of patient satisfaction with care.
1. Age 2. Perceived racial bias
3. Trust
4. Black
238
Those who report higher levels of trust in the healthcare system are more likely to end up with a.... from their physician.
a referral
239
Which racial group (black or white) typically undergoes cardiac catheterization less frequently, due to lack of trust and greater perceptions of bias?
Black people
240
List the 3 factors that predict receiving cardiac catheterization.
1. Perceived racial bias 2. Trust
3. Satisfaction with care
241
When a patient feels like their physician listens to them, they are less likely to avoid....
treatment
242
Based on interviews with 135 white, black, and Hispanic, low-income patients, what 4 factors characterize a high-quality and culturally sensitive interaction between physician and patient?
1. good people skills 2. effective communication
3. a sense of individualized care
4. evidence of technical competence
243
What racial + gender group faces one of the highest risk profiles for cardiovascular disease of any group in the United States?
black men
244
How did (mostly black) medical students at the University of Pennsylvania, use barber shops to address the disproportionate amount of black men affected by CVD?
- many black men go to the barbershop every 2-3 weeks for a haircut. They trust and are familiar with their barbers and the other patrons. - the students went to the barbershop every week, and talked to the people there about high blood pressure
- they took the men's blood pressure, described the risks of untreated hypertension, and advised them on how to get help
245
Based on previous studies, what do many black men believe about treating hypertension (2)?
- changes in diet and exercise are sufficient - medication is not necessary
246
Was the barbershop intervention successful?
Very! Many men saw reduced blood pressure and increased health
247
What 2 roles does communication play in lessening racial/ethnic trust gaps in healthcare?
1. Communication helps in decision making about interventions and health behaviors 2. Doctors have poorer communication with minorities, which has received little attention as a
potential, but solvable, cause of health disparities
248
Based on previous studies, how does a doctor's communication style differ between white and black patients?
Physicians tend to have more: - "patient-centered" communication with white patients
- verbally dominant communication with black patients
249
What is racial/ethnic concordance in healthcare?
the situation in which the patient and the physician are of the same race or ethnicity
250
What is racial/ethnic discordance in healthcare?
a difference in race/ethnicity of the dyad (two-person communication)
251
What can greater racial and ethnic diversity among health professionals, lead to (4)?
- Improved access to care for minority patients
- Greater patient choice and satisfaction
- Better patient-provider communication
- Better educational experiences
for all students while in training
252
What 2 racial groups make up the largest share of practicing physicians in the United States?
White and Asian people
253
Asian people make up a percentage of medical school graduates that is more than ____ times their percentage of the population.
4x
254
Whites make up approximately _____ percentage of medical school graduates as their percentage of the population.
the same
255
White people make up what percentage of physicians?
75%
256
White people make up what percentage of medical school graduates?
62.70%
257
White people make up what percentage of the population?
64.20%
258
Asians/Pacific Islanders make up what percentage of physicians?
12.80%
259
Asians/Pacific Islanders make up what percentage of medical school graduates?
22.20%
260
Asians/Pacific Islanders make up what percentage of the population?
5.20%
261
Hispanic people make up what percentage of physicians?
5.50%
262
Hispanic people make up what percentage of medical school graduates?
7.80%
263
Hispanic people make up what percentage of the population?
17.20%
264
Black people make up what percentage of physicians?
6.30%
265
Black people make up what percentage of medical school graduates?
6.60%
266
Black people make up what percentage of the population?
12.60%
267
Native Americans make up what percentage of physicians?
0.50%
268
Native Americans make up what percentage of medical school graduates?
0.80%
269
Native Americans make up what percentage of the population?
0.70%
270
What does URM stand for? What three racial/ethnic groups are URM?
- URM: Underrepresented in Medicine - Blacks, Hispanics, and Native Americans are URM
271
Regents of the University of California v. Bakke (1978)
A 1978 Supreme Court decision holding that a state university could not admit less qualified individuals solely because of their race
272
Grutter v. Bollinger (2003)
Allowed the use of race as a general factor in law school admissions at University of Michigan
273
What is the "Holistic Review" process in regards to college admissions?
A process in which students are evaluated on their academics ability as well as factors like service, cultural sensitivity, empathy, capacity for growth, emotional resilience, strength of character, interpersonal skills, and the life choices they have made
274
Throughout most of the twentieth century, the United State's government took a hands-off approach to the provision of medical, and supported the views of Sade, which was published in the New England Journal of Medicine (1971). What views did Sade express?
Sade wrote that "Medical care is neither a right nor a privilege: it is a service that is provided by doctors and others to people who wish to purchase it"
275
Medicare (1965)
A federal program of health insurance for persons 65 years of age and older
276
Medicaid (1965)
A federal and state assistance program that pays for health care services for people who cannot afford them
277
CHIP
- Children's Health Insurance Program - health insurance for children under 18 whose parents earn too much to qualify for Medicaid, but not enough to afford private insurance
278
According to the federal government's National Health Disparities Report, people without health insurance are more likely to...
- die early - have poor health
- report more problems getting care
- be diagnosed at later disease stages
- get less therapeutic care
- be sicker when hospitalized
- die during their stay in the hospital
279
Between 1987 and 2010, the proportion of the population who were uninsured grew from just under ____% to about _____ %
12% to about 16%
280
What percent of uninsured families had at least one adult who worked on a regular basis throughout the year? Of those working, what percent worked full time?
- 79% had one adult regularly working - 80% had an adult working full time
281
What percent of uninsured adults and children lived in families with incomes greater than the federal poverty level?
62%
282
White people make up ___% of the uninsured population in America.
44%
283
Hispanic people make up ___% of the uninsured population in America.
34%
284
Black people make up ___% of the uninsured population in America.
16%
285
Asian people make up ___% of the uninsured population in America.
5%
286
List the 5 times universal healthcare was considered in the US.
1. 1930s: the original creators of the Social Security program wanted to include universal health insurance in it, but the political implications stopped them 2. After WWII when the UK establish the National Health Service, and other European countries followed suit. However, many feared that this move was too socialist
3. 1960s: Medicare and Medicaid were created
4. 1970s: it was a part of the movement to health maintenance organizations
5. 1990s: it was a part of President Bill Clinton's national agenda
287
Who is Gail Wilensky (2)?
- the Director of Medicare and Medicaid from 1990 to 1992 under President George H. W. Bush - Chair of the Medicare Payment Advisory Commission from
288
The National Academy of Medicine created a collaborative, nationwide effort titled "Vital Directions for Health and Health Care". In this effort, what was a central priority to improve the health of Americans?
- removing barriers to integration of social services with medical services
289
How can a physician incorporate consideration of the social determinants of health into the existing medical care system (2) ?
1. Be knowledgeable about screening and identifying social determinants of health and approaches to treating patients whose health is affected by social deter-
minants
2. Increase interprofessional communication and collaboration that
encourage a team-based approach to treating patients at risk of being negatively affected by social determinants of health
290
What is a "help desk"?
In some healthcare facilities, when a patient is identified to have unmet social needs, they can be sent to a "help desk" where a staff member can recommend additional resources to the patient and advocate for them, following up with them and reporting their progress to the provider
291
Inspired by the "help desk" model, the federal Centers for Medicare and Medicaid Services (CMS) established the Accountable Health Communities Model of primary care delivery. What is the goal of this model?
to test if identifying and addressing the social needs of those seeking Medicaid and Medicare will impact health care costs and reduce health care utilization
292
In 2018, the federal Centers for Medicare and Medicaid Services (CMS) published a "Health-Related Social Needs Screening Tool". What six core issues does this screening tool include?
1. Housing instability 2. Food insecurity
3. Transportation problems
4. Utility help needs
5. Interpersonal safety,
6. Employment, education, substance use, and mental health.
293
What is an 1115 waiver?
As part of the Medicaid program, CMS allows state Medicaid programs to be granted this waiver to try new ways of enhancing the quality of the care provided to Medicaid beneficiaries
294
What is an example of a 1115 waiver program in Oregon?
A health program in Oregon was made, where community advisory councils were created to work with Medicaid providers to develop and administer a community health needs assessment offer supplemental support services for those with unmet social needs
295
What is an example of a 1115 waiver program in California?
California allows certain county Medicaid programs to use Medicaid funds to pay the costs of permanent supportive housing for homeless individuals
296
What does EHR stand for?
electronic health record
297
What does ICD stand for?
International Statistical Classification of Diseases and Related Health Problems
298
What is an ICD?
A code in which a patient's electronic health records are stored on
299
What is ICD-10
the most recent versions of ICD codes, AKA Z codes, that identify the social determinants of health of a specific patient
300
What are some examples of Z codes (3)?
Codes containing social determinants such as: - Education and literacy
- Problems related to housing
- Problems related to family
circumstances
