Social Determinants of Health

Question 1

Lecture Objectives

Answer 1

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

Question 2

Clinical course of a disease (pre and post disease stages)

Answer 2

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

Question 3

Etiological phase (“before” pre-disease course)

Answer 3

social and environmental determinants + risk and protection factors

Question 4

Risk and protective factors

Answer 4

personal, lifestyle, genetics, education, occupation, social supports

Question 5

Key determinants of health

Answer 5

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

Question 6

T/F determinants of health cannot be considered in isolation from each other

Answer 6

true, exception research/academics

Question 7

Describe social determinants of health

Answer 7

the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness

Question 8

Approximately what percent of a person’s physical health is determined by social factors?

Answer 8

50%

Question 9

Key social factors related to health outcomes:

Answer 9

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

Question 10

Healthy People 2030

Answer 10

project of the US Department of Health and Human Services

Question 11

What are the 5 domains of social determinants of health from Healthy People 2030?

Answer 11

education access and quality, health care access and quality, neighborhood built environment, social and community context, economic safety

Question 12

What are health outcomes?

Answer 12

mortality, morbidity, life expectancy, health care expenditures, health status, functional limitations

Question 13

How many people do not have health insurance?

Answer 13

1 in 10 in the US

Question 14

T/F no or poor insurance is associated w/ poor health

Answer 14

true, no or limited preventative care, delayed treatment for new problems, no or limited treatment for chronic conditions

Question 15

Factors that worsen health

Answer 15

violence, air pollution, water pollution, noise pollution (airport, industry, roadway), limited opportunities for physical activity, limited public transportation options, unsafe workplaces

Question 16

Factors that improve health

Answer 16

safety, clean air, clean water, parks, walking trails, bike lanes, good public transportation, low-cost private transportation, intact sidewalks, workplace safety regulations

Question 17

social and community context

Answer 17

improving social connections improves health

Question 18

Factors that improve social connectivity

Answer 18

decreasing stigma and discrimination, reducing incarceration, improving food security, parenting program, mentoring program, aging-in-place programs

Question 19

How many people live in poverty?

Answer 19

1 in 10 in the US

Question 20

Policies and programs that reduce poverty

Answer 20

nutrition assistance, housing assistance, affordable healthcare, high-quality education, employment

Question 21

Factors that reduce employment opportunities

Answer 21

disability, injury

Question 22

Factors that increase employment

Answer 22

job programs, career counseling, high-quality child care

Question 23

T/F health improves with educational attainment

Answer 23

true

Question 24

Factors that reduce educational attainment

Answer 24

low social economic status, disability, social discrimination

Question 25

Health outcomes associated with low educational attainment

Answer 25

heart disease, diabetes, depression

Question 26

Factors that increase educational attainment

Answer 26

tuition assistance, anti-bullying programs, early intervention programs, family income, student-teacher ratio, teacher training, language support for ESL students

Question 27

Need for social determinants of health conceptual framework

Answer 27

factors cannot be considered in isolation from each other; interaction between socioeconomic and political context, social position, distribution of health and well-being

Question 28

Health Disparities

Answer 28

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage

Question 29

Health inequality

Answer 29

differences in health status or in the distribution of health determinants between different population groups

Question 30

Characteristics historically linked to discrimination or exclusion:

Answer 30

race, religion, gender, mental health, sexual orientation, geographic location

Question 31

Social gradient in health

Answer 31

based on income and life expectancy, a steady rise in longevity across income levels with poorest category living 7 years less than richest

Question 32

Which race has the highest obesity prevalence?

Answer 32

Hispanics

Question 33

Which gender has the highest suicide risk?

Answer 33

Men

Question 34

Which sexual orientation has highest risk of assault?

Answer 34

LGBTQ

Question 35

T/F SES is more strongly associated with diseases that are more highly preventable than with less preventable disease

Answer 35

true

Question 36

What are examples of conditions with health disparities in the US?

Answer 36

heart disease, diabetes, elevated blood lead level, low birth weight, maternal mortality

Question 37

Infant mortality and SES

Answer 37

post-neonatal mortality disadvantage is driven by poor birth outcomes among lower SES individuals

Question 38

Ocular health disparity and race

Answer 38

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

Question 39

Ocular health disparity and income

Answer 39

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

Question 40

Ocular health disparity and gender

Answer 40

women are more likely to be visually impaired than men, men are more likely to experience ocular trauma than women

Question 41

Why should I care about health disparities?

Answer 41

professional obligation, morality, health disparities are expensive

Question 42

How are health disparities expensive?

Answer 42

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

Question 43

Indirect costs of health disparities

Answer 43

lost productivity, lower wages, lost tax revenue, additional services and benefits for families, lower quality of life for survivor

Question 44

Major barriers to eye care for patients

Answer 44

insurance status, income and wealth, health literacy, trust/distrust of eye care providers, language, access

Question 45

How do optometrists address health disparities?

Answer 45

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

Question 46

How do communities address health disparities?

Answer 46

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