Lecture 2: Upstream determinants

Question 1

Define an upstream determinant for obesity

Answer 1

An upstream determinant for obesity can be defined as any contextual characteristic that influences obesogenic behaviors

Upstream determinants can take form of tangible characteristics in the build or natural environment that surrounds us

Question 2

Health and disease is determined by… (determinants)

Answer 2

Exposome:
- political
- physical
- socio-cultural
- psychological
- behavioral

Genome:
- genetics
- hereditary

Exposome = all non hereditary influences

Question 3

What is the ANGELO framework?

Answer 3

Analysis Grid for Environments Linked to Obesity

A framework for identifying and prioritizing environmental interventions for obesity

Question 4

What are the different evironments and levels of the ANGELO framework?

Answer 4

Environments
- Socio-cultural
- Physical
- Economic
- Political

Levels:
- micro (settings)
- meso
- macro (sectors)

Question 5

What determinants of obesity according to the current evidence?

Answer 5

Socio-economic position
- social capital
- social network

Evidence is mostly from the economic field
- healthy diets are more costly
- pricing strategies are effective (taxing, discounts, especially if salient)

Question 6

Associations between the built environment and obesity?

Answer 6

For food and physical activity environments associations were generally very small or absent, although some characteristics within these domains were consistently associated with weight status suchs as fast-food exposure, urbanization, land use mix and urban sprawl. Risks of bias were predominantly high

Question 7

Built environmental characteristics and type 2 diabetes

Answer 7

1. Urban residance was associated with a higher risk of type 2 diabetes compared to living in rural areas
2. Green spaces were associated with a lower risk of type 2 diabetes
3. Walkability was associated with a lower risk of type 2 diabets

Question 8

What are challenges in upstream research?

Answer 8

1. Study designs
   - mostly cross-sectional
   - long time periods during which effects manifest themselves
2. Self-selection
   - people who like to walk live in a neigbourhood with good walkability
3. Area of exposure and defining exposure
4. Interactions (Interaction effects can be availability/ distance, barriers, etc.)

Question 9

Name 4 guidelines for dealing with complex adaptive systems (CAS)

Answer 9

1. Acknowledge complexity
2. Understanding (parts of) the system (e.g., combining relevant characteristics such as walkability and drivability)
3. Changing (parts) of the system/ implementing intervention within a system
4. Evaluating impact

Question 10

Name the 4 types of environments in which upstream determinants of obesity appear

Answer 10

1. Physical (what is available?)
2. Socio-cultural (What are the attitudes and beliefs)
3. Economic (what are the costs?)
4. Political (What are the rules?)

Question 11

According to Geoffrey Rose, what are the primary determinants of obesity?

Answer 11

“The primary determinants of obesity are mainly economic and socio-cultural”

Question 12

Whats is meant by downward causation?

Answer 12

When contextual factors such as the social and physcial environment influence individual behavior, phychology and physiology

Question 13

Upstream determinants are independent but…

Answer 13

…multiple, none operates in isolation, and they interact at different levels

Question 14

Name a few examples of upstream determinants in neigbourhoods and communities

Answer 14

• Social factors such as segregation and social networks
• Quality and content of houses, infrastructure, and facilities in neighbourhoods