Week 3 (Social determinants) Flashcards
(23 cards)
Gaps in life expectancy at birth
-Inequalities in health between and within countries are avoidable
-Reducing these social injustices in health, and thus meeting human needs, is an issue of social justice
What accounts for gaps in life expectancy at birth
-social dynamics and physical environment (not only genetics)
-Combo of nature and nurture
Proximate cause
- immediate (or downstream) causes of poor health outcomes
-Disease, injury, mortality
Ultimate/Distal cause
-root (or upstream) factors contributing to risk of poor health outcomes
-Social inequities (race, class, gender), institutional power (gvt, business, school)
Social Determinants of health (SDOH)
-the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness
-Can influence health in both positive and negative ways
Thomas McKeown
-scottish physician in 1900s that studied death records in UK from 1800s-1960s and found life expectancy increased before certain medical breakthroughs (antibiotics)
-Proposed population health influenced not just by healthcare but by changes in living conditions (improved nutrition, sanitation, and clean water)
SDOH framework and public health
-Comprehensive understanding of health: health is influenced by more than biology or healthcare access
-Focus on prevention: addressing SCOH emphasizes prevention by tackling root causes of disease and poor health rather than treating symptoms
-Equity and justice: the framework recognizes that health inequities arise from systemic inequities, including discrimination and marginalization
-Systems thinking approach: health outcomes are interconnected with various sectors and systems, such as economic policies, social norms, and political stability
-Broader scope of interventions: expands the scope of public health interventions to include policies and programs in housing, education, transportation, and economic development
-Global relevance: accounts for how factors like poverty, conflict, climate change, and globalization affect health outcomes across populations
SDOH broad and narrow applications
-Broad: socioeconomic conditions (wealth, income, education) as key upstream determinants that can influence health-related behaviors and environments
-Narrow: health-related neighborhood characteristics (walkability, recreational areas, pollution, exposure, health food access, etc)
SDOH connections to health outcomes
-SDOH account for 30-55% of health outcomes (more than healthcare use or lifestyle patterns)
-SDOH shape individual access to healthcare and other resources while also influencing living conditions and behavioral patterns
-Many overlap between factors and how many interact to shape individual health
Epigenetics
-above genetics
-A newer subfield of genetic research
-Important because epigenetic modifications affect gene expression
-Its not only genes you inherit, but how your cells express them, that matters
-Sensitive to the environment (toxicants, nutrition, stress)
-Evidence suggests that epigenetic modifications may be transmitted across generations (but also occur in response to lived experiences in an individual’s lifetime)
How epigenetics works
-Modifications to DNA that do not change the actual structure of DNA but influence how the DNA is expressed, thereby shaping physical (phenotypical) outcomes
-One way in which gene-environment interactions play out
-Results in plasticity (variation) in gene expression
-Epigenetic changes can happen early in life (including in utero) and influence later biology, development, and health
What causes epigenetic changes
Diet, stress, sleep, trauma, disease, chemical exposure, migration, etc.
Telomere length
-Telomeres are caps on end of chromosomes (organized packages of DNA)
-Every time a cell replicates, telomeres get shorter
-If too short, cells no longer replicate effectively and enter a state called senescence. Senescent cells accumulate in tissues and contribute to aging by releasing inflammatory signals that damage neighboring cells
-Rate of telomere shortening is impacted by cardiovascular disease, diabetes, cancer, but also chronic stress, poor diet, lack of exercise, and environmental toxins can accelerate telomere shortening leading to premature aging even in otherwise healthy individuals
Health disparities in the US
-People in poverty have greater disease risk and shorter life expectancy (limited healthcare access, poor nutrition, exposure to harmful behaviors more likely, greater exposure to violence and neighborhood pollution)
-These factors can’t fully account for discrepancies in health outcomes, psychosocial stress also important
Allostatic load
-the wear and tear on the body that happens when someone experiences long-term stress
-Body has systems to help respond to short-term stress, “fight-or-flight”, but when stress doesn’t go away, your body stays in high alert for too long, which can hurt health (heart, brain, immune system, etc)
-High blood pressure, diabetes, depression, weakened immune system
-helps explain why some groups have worse health outcomes than others (stress from environment, neighborhood, racism, lack of resources)
Issues with addressing SODHs
-Lack of clarity on defining and measuring SODH (different definitions and what factors should be included)
-Whether to focus on upstream or midstream effects, on the social factors or the inequitable distribution of those factors
-Complex, multifaceted, intersecting causal mechanisms that can be difficult to test
-Time lags in the manifestation of downstream health effects requires longitudinal studies that are expensive and difficult to conduct
-Can be difficult to obtain data across multiple sectors (education, housing, health) or across multiple programs within a given sector to assess health impacts and intervention effectiveness
Cross-sectional study
data collected at one point in time
Longitudinal study
data collected repeatedly over time
Recommendations to address SODH
-Improve living conditions (more intentional designs)
-take steps to decrease inequitable distribution of resources (taxes)
-train healthcare workforce in SDOH and raise public awareness
-focus efforts on most vulnerable communities, refer individuals to community-based social services
-involve a range of stakeholders and perspectives to more comprehensively address SDOH
Social support
informational support, emotional support, instrumental support
Informational support
-provision of information used to guide or advise, enhance perception of control over managing illness and ameliorate confusion
-Explanations, opinions, personal experiences, advice, info resources
Emotional support
-communicating caring and concern to bolster self esteem and permit the expression of distress
-Listening, empathizing, reassuring, comforting, encouraging
Instrumental support
-provision of material goods or practical assistance to offset loss of control experienced during illness
-Transportation, money, or assistance with household chores
