Social Determinants of Health Flashcards
WHO definition of the social determinants of health
“the conditions in which people are born, grow, live, work and age.”
Framework for understanding SDH
- 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?
Key features of well-performing models for mapping SDH
- Cast a broad net and cover many potential factors
- Account for interactions between and among these factors
- Recognition of risk for social exclusion
- Consider both an individual and community level
- Recognize the importance of upstream social, political, and economic interventions
Bay Area Regional Health Inequities Initiative Diagram
Categories of observed race-based health disparities in the US
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
Crux statement of race as the social determinant of health
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
Critical race theory
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
The United States currently imprisons a larger percentage of its Black population than ___
The United States currently imprisons a larger percentage of its Black population than South Africa did during apartheid
Dark-skinned individuals account for __% of drug users but __% of those incarcerated for drug possession.
Dark-skinned individuals account for 14% of drug users but 74% of those incarcerated for drug possession.
100:1 policy of the 1986 Anti-Drug Abuse Act
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
__ of incarcerated pregnant women receive prenatal care.
Only half of incarcerated pregnant women receive prenatal care
Thisa deficit extends the harm of mass incarceration into the next generation.
“redlining”
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.
cultural continuity
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.
“Thrifty Food Plan”
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.
Most common misconception about poverty in the US
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
Throughout the world, ___ is associated with better health and longer life
Throughout the world, educational attainment is associated with better health and longer life
poor health literacy in a patient does not indicate ___
poor health literacy in a patient does not indicate lack of interest in relevant health information
Genderbread person diagram
Doctors are more likely to diagnose ___ in men (63% vs. 47%) and more likely to diagnose ___ in women (31% vs. 16%)
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%)
__ of people in the United States identify as LGBT
4.5% of people in the United States identify as LGBT
From a public health standpoint, sexual minority patients comprise a population that is at risk for both ___ and ___ health disorders
From a public health standpoint, sexual minority patients comprise a population that is at risk for both physical and mental health disorders
Suicide in sexual minority populations
Sexual minority populations are three times more likely to have contemplated suicide and 5 times more likely to have attempted suicide
Greatest sexual minority at risk
Adolescent LGBTQIA
Major risk factors for LGBTQIA populations
- Social stigma
- Family rejection
Obergefeller vs. Hodges decision
Supreme court decision in 2015 which legalized same-sex marriage in all 50 states.
American Sociological Association study of same sex couples
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.”
CDC’s definition of disability
“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).”
The disabled as an “unrecognized health disparity population”
Because of their disabled status, they are often excluded from participation in research studies. As a result, little is known about their health disparity.
“There is no such thing as a single-issue struggle because . . .”
“There is no such thing as a single-issue struggle because we do not live single-issue lives.”
Intersectionality
The additive, synergystic, or antagonistic effects of various factors, particularly social factors.
Food deserts
Areas where people have very limited access to grocery stores, farmers’ markets, supermarkets, or similar venues that sell healthy, affordable food.
USDA definition of a food desert
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).”
Where do food deserts tend to exist?
- Low income neighborhoods where individuals cannot afford to own a motor vehicle and do not have access to public transportation
- Neighborhoods where grocery stores do exist, but stock fewer healthier foods and have lower quality produce
Sidewalks
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
Some positive social determinants of health
- Social capital
- collective efficacy
- resilience
Social capital
“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.
Collective efficacy
A measurement of “the extent to which their neighbors are close-knit, are helpful, get along, share values, and are trustworthy.”
Resilience
A set of protective characteristics that result in “(a) good mental health and developmental outcomes, despite (b) exposure to significant adversity.”
Psychosocial stress is associated with ___.
Psychosocial stress is associated with chronic inflammation.
