Community - Exam 2 Social Determinants of Health Flashcards
Population and Population Health~
collection of peeps with one or more personal/environmental characteristics in common
aiming to improve health of whole population AND reduce inequities among population groups#
Key Components of Pop Health~
Health determinants: what determines if your healthy or not - causes
Health outcomes: generally refers to the length/quality of life
Policy Development: stuff that helps improve the other two#
Who drives pop health decisions~
Wide range of disciplines: health profs, community members, farmers, engineers, gov workers, etc.
seek out POV of those whos health is affected
Innovation#
Upstream approaches~
Systemic changes that will prevent health issues - big picture
large populations, gov. level
Example: smoking ban everywhere#
Midstream interventions~
Within organizations or populations - at community level
Example: policy of no smoking on campus#
Downstream interventions~
Individual level - behavioral modification
Example: smoking cessation programs, etc.#
SDOH~
non medical factors shaped by social, political forces
conditions in which peeps born/grow/live/work/age that shape health, functioning, and quality of life outcomes and risks
Social and economic environemnt
PHysical environment
Individual characteristics and behavior#
Economic Stability (1)~
Income, social status
employment
food insecurity
housing instability
poverty
ex: low income, afford unhealthy food - obesity/diabetes = disparity#
Education Access and Quality (2)~
Early childhood education and development
Enrollment in higher education
High school graduation
Language and literacy#
Healthcare Access and Quality (3)~
Access (transportation)
Access to primary care
Health literacy (be able to utilize health information)#
Neighborhood and Built Environment (4)~
Access to healthy food
Crime and violence
Environmental conditions
Quality of housing#
Social and Community Context (5)~
Civic participation
Discrimination
Incarceration
Social cohesion#
SDOH Nursing Clinical Practice Process~
Ascertain
Assess
Advocate
Address#
Ascertain~
Performed at population level
determine prevalence of a concern (is it a problem?)
Analyze if pop characteristics warrant special attention#
Assess~
At individual level
screen for concern - use evidence-based measures and supportive practices
ex: ask what protection methods using#
Address~
Individual level
Apply personalized interventions that address concern
- patient edu
- resource referrals
- consultation with social/case worker
- support/affirmation
ex: where to get condoms; where to get sti testing#
Advocate~
Population level
systematically encourage policy makers and funders to devote resources to concern
ex: fund for reduced cost of testing; establish sti clinic in a neighborhood#
Foundational aspects of economic stability~
Household income and financial stability that supports overall health and well-being
Most important social determinant of health for developing child and family
Influenced by
- poverty
- employment
- food insecurity
- housing instability#
Poverty~
equates material hardship
tend to have poorer health
not uncommon
12% of US
Half of families with infants and children live at or below 200% of federal poverty level
Federal poverty guidelines are used to determine financial eligibility for certain federal programs#
Health Effects related to Poverty~
Higher rates of chronic illness
higher infant morbidity/mortality
decreased life expectancy
higher complex health porbs
more complications and physical limitations
Hospitalization rates higher
For community:
More minority residents and single-parent families
higher rates of unemployment
lower wage rates
more likely to be victims of crime, substance abuse, and racial discrimination
lower access to healthcare#
Ascertain examples~
Determine prevalence of concern for population
analyze whether population characteristics warrant special attention#
Assess~
Screen for concern using measures (2-question hunger vital sign and supportive associated practices)
have you had diff making ends meet at end of month?
Have you filled out and and sent in your tax forms?#
Address~
Apply personalized interventions:
care coordination, individual/family education, resource and interprofessional referrals, consultation w/social worker or certified rehabilitation counselor and support affirmation
Referral to social worker
referral to community resources: pantry, rent/engery assistance, WIC, SNAP#
Advocate~
Systematic encouragement of policy makers and funder to devote resources to concern:
Lobbying for increased funding for resources used by those in poverty such as SNAP, WIC, financial assistance at state and federal level
Community involvement to ensure access to resources for those living in poverty#
Obesity trends~
2nd leading cause of preventable death
Overweight BMI 25-29.9
Obese BMI 30+#
Obesity in children~
overweight BMI: 85th to 95th percentile
obese BMI: 95th percentile
Contributors: genetics, family diet, environment, influence#
Adult trends~
Drastic increase since the 80’s#
Impact on SDOH~
Economic stability: cheap crap, expensive good stuff
Access to and quality education
Access to and quality health care
Neighborhood and built environment
Social and community context: community norms, exercise#
Primary prevention for obesity~
Food bank
Healthy foods
Dietary education
Farmers markets
Walking trails (context could be tertiary)#
Secondary prevention for obesity~
Screening BMI#
Tertiary prevention for obesity~
walking trails
encouraging exercise#
Community based obesity~
?#
Community oriented obesity~
Walking trails
?#
Upstream intervention obesity~
Legislation for food costs
Increase taxes on soda/fast food#
Midstream intervention obesity~
Accessibility of healthy food
Farmers market
prevent food deserts
advocate for grocery stores
food banks#
Downstream (individual) obesity~
individual referrals
education#
Environmental Health overview~
impact on major/chronic disease
poor envir quality correlated to preventable health
responsible for 25% of world’s preventable health conditions#
Envir health risks~
Lead
Climate
pesticides
water quality
air quality
food hazards
land and food quality#
Lead~
homes built before ‘78
Iowa: 70% of homes were built before ‘78
areas where a house was torn down#
Climate change risks~
Greenhouse
ice melt
> Rising temp>
More extreme weather>
Rising sea levels>
Increasing CO2>
disease risk grows
Air pollution
Point sources: immovable (smoke stacks, etc.)
Nonpoint sour: moveable (vehicles, runoff, etc.)
Indoor air quality: dust, CO, mold, mites, cleaning, smoke
Smoking: leading cause of preve death
kills one nonsmoker every 10 min
secondhand smoke = 3rd leading cause of preventable death
E-cigs#
Water quality~
2.5% of planet is freshwater
pollution: nonpoint sources, runoff, pharmaceuticals, treatment systems, stormwater runoff#
Food quality~
Pesticides
ABX
growth hormones
Organic: must say Certified Organic to be organic#
Land use risks~
use through zoning laws: laws prevent housing development from being on a landfill
Fracking: extraction#
Evaluation of client’s health problem~
understand envir risks within the community
windshield survey:
- urban: smokers, highways, old buildings, trash
- rural: pesticides, ag stuff#
I PREPARE~
Investigate potential exposures
Present work
Residence
Environmental concerns
Past work
Activities (extracurricular)
Referrals and Resources
Educate#
Environmental Health ‘RISK’ Assessment (not I PREPARE)~
- hazard identification (what health problems by pollutant)
- Dose-response (what are health probs of diff exposures)
- Exposure assessment (how much of it are exposed during specific time - how many people)
- Risk characterization (what is the extra risk of health problems in exposed population#
Reducing environmental health risks~
Reduce Reuse Recycle#
Risk Communication~
Right information
to the Right people
at the Right time
understandable, concise information sent to affected or concerned people timely to prevent risk
how to peeps get their info (news/paper/media)#
Roles of nurse in envir~
- Assessment
- Referral
- Community involvement and public participation
- Risk communication
- Epidemiological investigations
- Policy development#
