Social Determinants of Health

Question 1

WHO definition of the social determinants of health

Answer 1

“the conditions in which people are born, grow, live, work and age.”

Question 2

Framework for understanding SDH

Answer 2

• Where were they born and what did they experience as a child?
• How do they earn a living?
• What do they eat, and why?
• What are their major sources of stress?

Question 3

Key features of well-performing models for mapping SDH

Answer 3

1. Cast a broad net and cover many potential factors
2. Account for interactions between and among these factors
3. Recognition of risk for social exclusion
4. Consider both an individual and community level
5. Recognize the importance of upstream social, political, and economic interventions

Question 4

Bay Area Regional Health Inequities Initiative Diagram

Answer 4

Question 5

Categories of observed race-based health disparities in the US

Answer 5

Unequal distribution of risk factors for disease, to timing and quality of diagnosis, access to effective treatment, and ultimate outcomes, and across all categories of disease

Question 6

Crux statement of race as the social determinant of health

Answer 6

By the time individuals of different races are adults they will be different, at the level of pathophysiology, not because they are from different races (in a genetic way), but because their bodies have been differently racialized. Their experience of the social phenomena of race has been internalized to become part of their bodies

Question 7

Critical race theory

Answer 7

A framework that analyzes the linked structures of race and racism in law, science, medicine, and society, and mobilizes support for interventions to offset racism and its effects

Question 8

The United States currently imprisons a larger percentage of its Black population than ___

Answer 8

The United States currently imprisons a larger percentage of its Black population than South Africa did during apartheid

Question 9

Dark-skinned individuals account for __% of drug users but __% of those incarcerated for drug possession.

Answer 9

Dark-skinned individuals account for 14% of drug users but 74% of those incarcerated for drug possession.

Question 10

100:1 policy of the 1986 Anti-Drug Abuse Act

Answer 10

Set a 100:1 disparity in sentencing for crack versus powdered cocaine—meaning possessing just 1 gram of crack cocaine carried the same sentence as 100 grams of powder cocaine—at a time when crack use was more common among communities of color

Question 11

__ of incarcerated pregnant women receive prenatal care.

Answer 11

Only half of incarcerated pregnant women receive prenatal care

Thisa deficit extends the harm of mass incarceration into the next generation.

Question 12

“redlining”

Answer 12

Denying housing loans to specific groups of people in order to maintain segregation

Common in Boston in the 1950’s and 1960’s. Similar discrimination persists today.

Question 13

cultural continuity

Answer 13

In cases of native Americans and Canadians, reflects the preserved autonomy and cultural connetion of the group.

Higher levels of cultural continuity are linked to much lower levels of suicide.

Question 14

“Thrifty Food Plan”

Answer 14

Built in the 1960s by the Social Security administration. Threshold based on the cost of food. Intended to be the bare minimum necessary to feed a “typical family.” The poverty line was set to 3x this cost, as it was assumed that ~1/3 of income should be spent on food.

This standard is still used, but is widely regarded by the academic community as outdated.

Question 15

Most common misconception about poverty in the US

Answer 15

That lack of employment causes poverty, so poverty can be reduced through employment.

In fact, around one third of people living in poverty in the United States are children, and the majority of working-age, non-disabled adults living in poverty are already in the labor force.

These low-wage jobs do not offer steady hours, health insurance, or job security, making it very difficult especially for families living in high-rent areas like Boston

Question 16

Throughout the world, ___ is associated with better health and longer life

Answer 16

Throughout the world, educational attainment is associated with better health and longer life

Question 17

poor health literacy in a patient does not indicate ___

Answer 17

poor health literacy in a patient does not indicate lack of interest in relevant health information

Question 18

Genderbread person diagram

Answer 18

Question 19

Doctors are more likely to diagnose ___ in men (63% vs. 47%) and more likely to diagnose ___ in women (31% vs. 16%)

Answer 19

Doctors are more likely to diagnose ischemic heart disease in men (63% vs. 47%) and more likely to diagnose mental health conditions in women (31% vs. 16%)

Question 20

__ of people in the United States identify as LGBT

Answer 20

4.5% of people in the United States identify as LGBT

Question 21

From a public health standpoint, sexual minority patients comprise a population that is at risk for both ___ and ___ health disorders

Answer 21

From a public health standpoint, sexual minority patients comprise a population that is at risk for both physical and mental health disorders

Question 22

Suicide in sexual minority populations

Answer 22

Sexual minority populations are three times more likely to have contemplated suicide and 5 times more likely to have attempted suicide

Question 23

Greatest sexual minority at risk

Answer 23

Adolescent LGBTQIA

Question 24

Major risk factors for LGBTQIA populations

Answer 24

1. Social stigma
2. Family rejection

Question 25

Obergefeller vs. Hodges decision

Answer 25

Supreme court decision in 2015 which legalized same-sex marriage in all 50 states.

Question 26

American Sociological Association study of same sex couples

Answer 26

Proved that “American children living within same-sex parent households fare just as well as those children residing within different-sex parent households over a wide array of well-being measures: academic performance, cognitive development, social development, psychological health, early sexual activity, and substance abuse.”

Question 27

CDC’s definition of disability

Answer 27

“any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions).”

Question 28

The disabled as an “unrecognized health disparity population”

Answer 28

Because of their disabled status, they are often excluded from participation in research studies. As a result, little is known about their health disparity.

Question 29

“There is no such thing as a single-issue struggle because . . .”

Answer 29

“There is no such thing as a single-issue struggle because we do not live single-issue lives.”

Question 30

Intersectionality

Answer 30

The additive, synergystic, or antagonistic effects of various factors, particularly social factors.

Question 31

Food deserts

Answer 31

Areas where people have very limited access to grocery stores, farmers’ markets, supermarkets, or similar venues that sell healthy, affordable food.

Question 32

USDA definition of a food desert

Answer 32

A community where “at least 500 people and/or at least 33 percent of the census tract’s population must reside more than one mile from a supermarket or large grocery store (for rural census tracts, the distance is more than 10 miles).”

Question 33

Where do food deserts tend to exist?

Answer 33

1. Low income neighborhoods where individuals cannot afford to own a motor vehicle and do not have access to public transportation
2. Neighborhoods where grocery stores do exist, but stock fewer healthier foods and have lower quality produce

Question 34

Sidewalks

Answer 34

Generally encourage physical fitness, social activity, and fresh air, but this is not so in neighborhoods with poor sidewalk safety (either from traffic or from crime).

Absence of sidewalks or presence of unsafe sidewalks is associated with worse health outcomes and higher rates of childhood obesity

Question 35

Some positive social determinants of health

Answer 35

• Social capital
• collective efficacy
• resilience

Question 36

Social capital

Answer 36

“features of social organization, such as trust, norms and networks, that can improve the efficacy of society by facilitating coordinated actions,” as well as improve the actions of individuals.

Question 37

Collective efficacy

Answer 37

A measurement of “the extent to which their neighbors are close-knit, are helpful, get along, share values, and are trustworthy.”

Question 38

Resilience

Answer 38

A set of protective characteristics that result in “(a) good mental health and developmental outcomes, despite (b) exposure to significant adversity.”

Question 39

Psychosocial stress is associated with ___.

Answer 39

Psychosocial stress is associated with chronic inflammation.