Exam 1 Short Answers Flashcards
Do you think the US has the best healthcare system in the world? Why do Bodenheimer and Grumbach talk about a paradox or a dilemma? Why do we spend so much on health care? Why is it a problem that we spend 18% of our GDP on health?
- The question of if the US has the best healthcare system is subjective, people base their opinions on experiences, values, and different evaluation criteria
- US spends $3.8 trillion on healthcare annually, 18.3% of GDP
Why do we spend so much?
- Advanced and cutting-edge medical technologies, administrative complexity (insurance providers, billing systems, regulatory framework), chronic disease management
Why is this a problem?
- Opportunity cost, the funds spent on healthcare could be better spent elsewhere like education. Sustainability, equity and access, global comparison
The paradox of the US Healthcare system: Excess and deprivation
- Challenges of achieving high-quality, accessible care while containing costs. Tension between achieving new goals while controlling escalating costs
- US healthcare is at the same time the best and the worse–spends the most out of all other developed countries, but is not the healthiest
- Best: above and beyond levels of care, facilities, innovation
- Worst: America statistically unhealthier than other nations
- Not the healthiest: highest percentage of people living with two or more chronic conditions, lower life expectancies, high maternal and infant mortality rates
- Problems with both over treatment (excess) and under treatment (deprivation)
- Limited access: physical, financial, social
- Disease disproportionately affecting certain populations
- Unequal availability/access to care leads to no balance between too much or too little
How do we define the social determinants of health? How do these factors determine our health? What are upstream/midstream/downstream social factors? Provide examples.
- The social determinants of health are the conditions in which people are born, grow, live, work, and age
- These circumstances of shaped by the distribution of money (economics), power and resources at the global, national, and local levels (social policies and politics)
Living conditions: communities, local government (government policies could be part of the problem or the solution, eg. public school tax allocation), local services, green spaces, air quality. Convenience of good health decisions
Occupation, employment opportunities, education
Income, leading to physical location, occupation, etc.
Peer behavior and influence
Available resource and their quality, social community
Health outcomes that SDOH affect:
Mortality, morbidity, life expectancy, health care expenditures, health status, functional limitations
SDOH are what is primarily responsible for the health inequities (unfair and avoidable differences in health status seem within and between countries)
Upstream: closer to the fundamental nature of the cause and often further from observed health outcome
- Laws, policies, underlying values that shape: income, accumulated wealth, income inequality, educational attainment, employment, household composition, experiences based on race or ethnic group, social mobility, stressful experiences related to any of the above
Midstream: factors that are strongly influenced by upstream factors and that are likely to affect health
- Neighborhood features, work environments, housing, transportation, conditions in homes schools work communities
Downstream: closest to ends of causal chains
- Unhealthy diet, lack of exercise, smoking
what are the leading causes of death for all age groups in the US
Why are there different leading causes of death? Due to other distinctions between age groups, living longer makes you more susceptible to chronic differences. Face different threats throughout lifespan
Examples include heart disease, cancer, unintentional injuries, COPD, stroke, Alzheimer’s, diabetes, influenza and pneumonia
15-19 age group: unintentional injuries/accidents, homicide, suicide, cancer, heart disease, congenital malformations, covid
What is public health? What do we mean by the “upstream approach”? What explains our dismal response to Covid-19 pandemic?
Public health: a field of study and practice that aims to improve the health and well-being of communities and populations as a whole. It involves the organized efforts of society to prevent illness, promote health, and prolong life through various strategies including health education, disease prevention, policy development, and community engagement
Upstream approach: addressing the root causes and fundamental determinants of health issues rather than just treating the symptoms or focusing on individual behaviors. It recognizes that many health problems have social, economic, and environmental determinants that need to be addressed at a systemic level
- Downstream level: individuals seek healthcare for specific illnesses
- Public health addresses upstream factors, aims to prevent illness or death by focusing on the risk factors and changing behaviors
Poor Covid response:
Weaknesses in global pandemic preparedness and response systems. Coordination between organizations and government is lacking. Healthcare infrastructure struggled under the weight of surges in cases, shortages of medical supplies, and strain on healthcare workers. Political divisions and misinformation contribute to complexity of response. Global health disparities, some groups facing more challenges in obtaining resources
According to Hemenway, why don’t we spend enough on public health? Do you see the impact of this underspending in the reading by Weber and colleagues, Hollowed-Out Public Health System?
- Invisibility of prevention: public health efforts are often preventative and focus on averting potential health threats, the impact of successful prevention may go unnoticed. Less visible and undervalued
- Short term political horizons: political cycles operate on short-term timelines, and the benefits of public health interventions may not be immediately evident, decision makes may prioritize issues with more immediate and visible outcomes to align with their electoral cycles
- Competing budget priorities: resources are finite, governments may face competing budget priorities, public health often loses to more pressing needs
- Lack of understanding: among both the public and policymakers about the essential role of public health in preventing diseases, promoting health, and addressing social determinants of health
Weber: “historically, even when money pours in following crises…it disappears after the emergency subsides…a lot of what we’re seeing right now could be traced back to the chronic funding shortages”
Impacts of underfunding:
- Limited capacity to detect, monitor, and respond to emerging health threats, potentially resulting in delayed or insufficient responses
- Workforce challenges, shortage of trained public health professionals, reducing the ability to carry out essential public health functions
- Reduced community engagement, public health agencies struggling to engage with communities and implement outreach programs due to resource constraints
- Vulnerability to emerging threats: hollowed-out public health system is less resilient in the face of new and emerging health threats, as it lacks necessary infrastructure and responses
Reading 11 by Hemenway, Why Don’t We Spend Enough on Public Health provides four reasons to answer the question in the title: Politicians put great effort into putting out today’s fires and little into preventing tomorrow’s, the beneficiaries of public health measures are generally unknown, the benefactors are often unknown, and some public health efforts encounter disinterest and opposition. How can we combat these four specific reasons that explain why America underspends on Public Health?
- Short-term focus: advocacy for prevention–emphasizing long term benefits of preventative measures, involves highlighting the cost-effectiveness and positive health outcomes associated with investing in public health initiatives. Education and awareness–public and political awareness campaigns can help educate policy makers and the public about the importance of prevention in reducing long-term health costs and improving overall community well-being
- Invisibility of prevention: data and research–demonstrate tangible benefits of public health measures. Success stories–humanizes the impact of public health efforts making it easier for the public and policymakers to connect with the positive outcomes
- Lack of recognition: public health campaigns, community engagement–build relationships to create sense of shared responsibility for public health
- Disinterest and opposition: public education–address misinformation and raise awareness about importance of specific measures, mitigate opposition by providing accurate information, stakeholder engagement–engage key stakeholders like community leaders, advocacy groups and policy makers
What do we mean by “race is socially constructed”? How does race in the US impact the health outcomes such as life expectancy, infant mortality, maternal mortality etc. Is it always through SES? (refer to Braveman et al. or KFF article)
- The idea of race assumes that simple external or superficial anatomical characteristics can be used to classify people into groups
Race as a social construct: an artificial distinction created by humans
- It is the culture of a particular society that constructs and attaches social significance to physical differences
Racial disparity: the increased presence and severity of certain diseases, poorer health outcomes, and greater difficulty in obtaining healthcare services for certain races and ethnicities
Racism: an ideology of interiority that is used to justify discrimination of certain groups defined as inferior
Braveman: “racism refers not only to overt, intentionally discriminatory actions and attitudes, but also to deep-seated societal structures that, even without the intent to discriminate, systematically constrain some individuals’ opportunities and resources on the abscess of their race or ethnic group”
- African Americans have an overall death rate that is higher than that of the white population at all ages
- Non-Hispanic blacks/African Americans have 2.3 times the infant mortality rate
- Infants are four more likely to die from complications relation to low birth weight
SES predicts variation in health within minority and white populations and accounts much of the racial differences in health
SES–the causal pathway by which race affects health. Race is a determinant of socioeconomic status in the US
Racism has restricted socioeconomic attainment for members of minority groups in various ways such as lower salaries or residential segregation (redlining)
What are some of the policies we can propose to address racial disparities in maternal health? Do you agree with any of the proposals in the Black Maternal Health Omnibus act mentioned in the article by Tina Suliman Black Maternal Mortality: ‘It is Racism, not Race?
- Allow black mothers to define maternal health, collaboratively design programming and initiatives driven by the people they were meant to benefit
- Embrace that communities being served are full of assets and not singularly defined by deficits
- Use data to make injustice visible, make community voices central to planning and mobilization, working to root out racist and discriminatory practices and replace them with equitable ones
Black Maternal Health Omnibus: creates opportunities to develop data-driven, evidence based practices and programs that value and trust the lives, knowledge, and leadership of black mothers. Invests in their health and creates opportunities for them to be heard
To create compassion: intentional change geared towards dismantling the systems and bringing attention towards intersecting oppressions
Policy recommendations that have been discussed to address racial disparities in maternal health:
- Comprehensive prenatal/postnatal care, community based maternal health programs: expand access to quality prenatal care, support programs that provide education on nutrition, pregnancy-related complications, and healthy lifestyle choices
- Implicit bias training: mandatory trainings for healthcare professionals to address racial and ethnic disparities in maternal health outcomes, promoting cultural competency to improve communication and understanding
- Data collection and reporting/review committees: enhancing data collection systems to capture and analyze racial disparities to ensure transparency and accountability, investigate and address root causes of maternal deaths
According to the JAMA article, Racial disparities in pain of children, are there racial disparities in opioid administration to children with appendicitis? What explains these disparities?
Implicit bias
- Unintentional biases that affect their clinical decision-making, including the assessment and treatment of pain
Historical context and trust
- Mistrust in the system stemming from a legacy of systemic racism can impact patient-provider relationships and influence healthcare decisions
Communication and advocacy
- Racial minorities can face communication barriers or be challenged when advocating for pain management needs
Socioeconomic factors/systemic inequities
- Impacting access to healthcare resources, barriers to timely and adequate pain relief
Do you think increased cultural competency in the healthcare system can improve access of certain disadvantaged groups to health care services? How? Are there some problems with this approach? Do you think the concept of cultural humility overcomes these problems?
- Problems with assuming all encompassing information about cultures can easily reinforce stereotypes
- Neglects intersectionality between different elements of individuals identity. Missed information can hurt clinical interaction
Good things that it does
- Improved communication–providers understanding diverse communication styles and preferences, better interactions with patients, enhanced trust, improved understanding of health information
- Reduced health disparities–training helps with the identification and elimination of disparities in health outcomes by addressing the unique needs and challenges faced by different cultural and ethnic groups
- Tailored care plans–providers can develop care plans that are culturally sensitive and aligned with patients values, beliefs, and preferences, leading to more effective patient-centered care
Cultural humility encourages providers to
- Recognize and challenge personal biases
- Approach each patient as an individual with unique experiences
- Be open to learning from patients and communities
- Acknowledge power imbalances and work collaboratively with patients to address healthcare needs
- This is a more nuanced and dynamic approach that encourages ongoing self-reflection and learning
What is the difference between sex and gender?
- Biological sex: defined as the classification of living things, generally as the male or female according to their reproductive organs and functions assigned by chromosomal complement
- Gender: socially created and learned distinctions that specify the ideal physical, behavioral, mental, and emotional traits characteristic of women, men, and people with non-binary identities
Socially prescribed norms, values, and behaviors and is a structural phenomenon, rooted in social relations of power
According to Morgan and colleagues, how are people of different genders impacted by COVID-19 and why (see table 1)?
Morgan et al.: authors argue that we need to use an unconventional approach
- Exploring how gender intersects with other social stratifiers including race, age, income, disability, sexual orientation
- This is important to better understand and address individual and group experiences and effects of the pandemic
- Conclusion was that gendered norms, roles, and behaviors can influence the risk of infection
Women:
- increased rates of infection
- incrased informal care
- economic insecurity
- violence
- limited access to SRHS
Men:
- increased disease severity and mortality
- increased vulnerability and risk
- mental health impacted by looming economic recession
- violence
- economic insecurity and household tensions
- gender imbalance in vaccination
- absence from policy agendas, not target
Gender/Sexual minorities
- risk of poor outcomes due to inequitable social contexts and healthcare discrimination
- increased vulnerability and risk
- access to services limited (HIV prevention, gender affirming surgeries)
- mental health burden (no social support)
- violence
- economic insecurity. overrepresented in nonessential services and within occupations that are risky like sex work
- stigma and discrimination, avoidance of testing etc
- legal and policy responses
Do you agree that your ZIP code may be more important for your health than your genetic code? What are some of the pathways that explain how your zip code impacts your health? How could we reduce health disparities through neighborhood interventions?
This idea is highlighting the significant impact of social determinants of health on wellbeing
Pathways:
- Access to healthcare: availability and accessibility to healthcare facilities, services, and providers in a specific area greatly influences health outcomes, limited access may result in delayed or inadequate care
- Environmental exposures: air/water quality, exposure to pollutants, availability of green spaces. Community safety, crime rates affecting both mental and physical well-being
- Educational opportunities: limited access to quality education may contribute to disparities in health literacy and health behaviors
- Neighborhood interventions: community health programs, affordable housing and safety initiatives, economic development in underserved areas, access to local food, improve access to services, educate and empower residents to make informed health decisions
Physical conditions, social conditions, and services available in high-poverty neighborhoods lead to poor health among residents. Do you think that historical factors such as discrimination play a role in the health disparities observed in these areas today? Do you think that this has to do with the issue of low public health funding, especially in areas that are already low-income?
Discriminatory policies and practices like redlining have left lasting impacts on neighborhood segregation and socio-economic disparities
- Slavery–harsh living conditions, inadequate nutrition, rough treatment that has contributed to health disparities
- Jim Crow era–racial segregation laws, separate and unequal facilities
- Redlining–discriminatory practice in housing and lending policies that excluded minority communities, led to residential segregation that impact access to quality education, healthcare, and neighborhood resources
Legacy of systemic inequalities, socioeconomic disparities, and mistrust in certain communities
According to the Negative Patient Descriptors article by Sun and colleagues, does the use of negative patient descriptions vary by patient race or ethnicity? If yes, how does bias/discrimination in the health care settings impact patient-provider relationship? Why does patient-provider relationship matter?
Bias manifests in disproportionately applied descriptors
How does it impact relationship
- Trust and communication: bias and discrimination erodes trust between patients and providers, patients who perceive bias may be less likely to openly communicate about their symptoms, concerns, or follow medical advice
- Quality of care: suboptimal treatment, delays in care, less likely to receive recommended interventions
Health outcomes: when patients feel valued, respected, and heard they are more likely to adhere to treatment plans
- Access and utilization: patients who perceive discrimination may avoid seeking care altogether or delay seeking help, leading to disparities in healthcare utilization
Why does the patient-provider relationship matter
- Trust and open communication, adherence to treatment plans, patient satisfaction, reducing health disparities
