Social Determinants of Health Flashcards
Lecture Objectives
1) Recognize key determinants of health and their relative impacts
2) Differentiate 5 domains of social determinants of health
3) Recall definition of health disparities
4) Recognize presence of a social gradient in health outcomes
5) identify how optometry can address health disparities
Clinical course of a disease (pre and post disease stages)
pre- biological onset of disease; start of clinical phase is symptoms, then diagnosis, therapy and initial outcome, post-longer term outcome/impact on family, work, and economic
Etiological phase (“before” pre-disease course)
social and environmental determinants + risk and protection factors
Risk and protective factors
personal, lifestyle, genetics, education, occupation, social supports
Key determinants of health
1) genes and biology
2) health behaviors
3) health services or medical care
4) physical environment or total ecology
5) social environment or social characteristics
T/F determinants of health cannot be considered in isolation from each other
true, exception research/academics
Describe social determinants of health
the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness
Approximately what percent of a person’s physical health is determined by social factors?
50%
Key social factors related to health outcomes:
early childhood development (adverse childhood experiences), educational level, employment status, type of employment, food security, access to health services, housing status, income, discrimination and social support
Healthy People 2030
project of the US Department of Health and Human Services
What are the 5 domains of social determinants of health from Healthy People 2030?
education access and quality, health care access and quality, neighborhood built environment, social and community context, economic safety
What are health outcomes?
mortality, morbidity, life expectancy, health care expenditures, health status, functional limitations
How many people do not have health insurance?
1 in 10 in the US
T/F no or poor insurance is associated w/ poor health
true, no or limited preventative care, delayed treatment for new problems, no or limited treatment for chronic conditions
Factors that worsen health
violence, air pollution, water pollution, noise pollution (airport, industry, roadway), limited opportunities for physical activity, limited public transportation options, unsafe workplaces
Factors that improve health
safety, clean air, clean water, parks, walking trails, bike lanes, good public transportation, low-cost private transportation, intact sidewalks, workplace safety regulations
social and community context
improving social connections improves health
Factors that improve social connectivity
decreasing stigma and discrimination, reducing incarceration, improving food security, parenting program, mentoring program, aging-in-place programs
How many people live in poverty?
1 in 10 in the US
Policies and programs that reduce poverty
nutrition assistance, housing assistance, affordable healthcare, high-quality education, employment
Factors that reduce employment opportunities
disability, injury
Factors that increase employment
job programs, career counseling, high-quality child care
T/F health improves with educational attainment
true
Factors that reduce educational attainment
low social economic status, disability, social discrimination
Health outcomes associated with low educational attainment
heart disease, diabetes, depression
Factors that increase educational attainment
tuition assistance, anti-bullying programs, early intervention programs, family income, student-teacher ratio, teacher training, language support for ESL students
Need for social determinants of health conceptual framework
factors cannot be considered in isolation from each other; interaction between socioeconomic and political context, social position, distribution of health and well-being
Health Disparities
a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
Health inequality
differences in health status or in the distribution of health determinants between different population groups
Characteristics historically linked to discrimination or exclusion:
race, religion, gender, mental health, sexual orientation, geographic location
Social gradient in health
based on income and life expectancy, a steady rise in longevity across income levels with poorest category living 7 years less than richest
Which race has the highest obesity prevalence?
Hispanics
Which gender has the highest suicide risk?
Men
Which sexual orientation has highest risk of assault?
LGBTQ
T/F SES is more strongly associated with diseases that are more highly preventable than with less preventable disease
true
What are examples of conditions with health disparities in the US?
heart disease, diabetes, elevated blood lead level, low birth weight, maternal mortality
Infant mortality and SES
post-neonatal mortality disadvantage is driven by poor birth outcomes among lower SES individuals
Ocular health disparity and race
black americans are less likely to receive cataract surgery than whites with equal reduction in VA; black and hispanic americans have higher rates of visual impairment than whites
Ocular health disparity and income
people with low SES are less likely to visit an eyecare provider than people with high SES; people with low SES are more likely to develop a visual impairment than people with high SES
Ocular health disparity and gender
women are more likely to be visually impaired than men, men are more likely to experience ocular trauma than women
Why should I care about health disparities?
professional obligation, morality, health disparities are expensive
How are health disparities expensive?
health disparities and premature death cost $1.24 trillion between 2003-2006; health disparities increased direct medical care expenditures by up to 50% for AA, A, and H
Indirect costs of health disparities
lost productivity, lower wages, lost tax revenue, additional services and benefits for families, lower quality of life for survivor
Major barriers to eye care for patients
insurance status, income and wealth, health literacy, trust/distrust of eye care providers, language, access
How do optometrists address health disparities?
understand health disparities in patient population, advocate for policies that address health disparities, increase diversity of optometric workforce, include cultural competence in optometric education, address health literacy in patient populations
How do communities address health disparities?
raise public awareness, identify and address local, non-medical social factors, improve the capacity and number of providers, expand health insurance coverage, increase the knowledge base about health disparities
