INTRODUCTION TO SOCIAL
DETERMINANTS OF HEALTH
By: Travis Howlette B.S., Jeff Wisniowski B.S.,
MPH and Kelsey Anilionis B.S.
Health Equity Peer Educator
Training (HEPE)
HDSC WEBSITE/FACEBOOK
|
|
Updates
p
to site affective April
p 15th:
http://enddisparities.org/HDSC/index.html
Join
J
i us on Facebook:
F
b k
http://www.facebook.com/#!/hdscneu
SPONSORS
STUDENT SPEAKER
|
Travis Howlette,, Health Science
Major (2011), Northeastern
University. ORISE Research Fellow
at the CDC.
CDC Pre-MD/MPH.
Pre MD/MPH
|
Jeff Wisniowski B.S./MPH Candidate
|
Kelsey Anilionis, Health Science B.S., 2011
Aim and Purpose of This Lecture Series
Be able to define health disparities
and identify current trends in
disparities among populations
Understand what social
determinants are and how they can
impact your health
Feel empowered as students who
can do something about these
i j i
injustices
TAKE-AWAYS FROM THIS LECTURE
Define
D
fi Social
S i l Determinants
D t
i
t off H
Health
lth and
d
list at least three that impacts your
personal health
p
The impact that racism in the US has had
on health
Understand what SES stands for and its
implications to health in the US
ACTIVITY: THE GAME OF LIFE
|
Pick a Piece ((announce y
your p
piece):
)
ACTIVITY: THE GAME OF LIFE
Blue: Lives in a 2bedroom leased
apartment, with a
family of five (no
spouse, a retired
grandparent, and
three children))
| Blue: Went to school
but did not finish high
school because the
first child was born.
|
ACTIVITY: THE GAME OF LIFE
Red: Lives in a 3bedroom condo, alone.
| Red: Has a high school
di l
diploma,
no college
ll
degree
|
ACTIVITY: THE GAME OF LIFE
Green: Lives in a
four bedroom
house, family of
five (spouse,
(spouse and
three children)
| Green: Has a high
school diploma,
some college
|
ACTIVITY: THE GAME OF LIFE
|
Remember y
your p
piece,, we will come back to this
activity at the end.
SOCIAL DETERMINANTS OF HEALTH
What are
they?
Can you
li t a few
list
f
you know?
DEFINITION
|
|
World Health Organization
g
((WHO):
) The social
determinants of health are the conditions in
which people are born, grow, live, work and age,
including the health system.
system
In our words
words- Breaking down the word
Social: your interactions with the external
environment (your friends, family, places, and
different systems)
y Determinants: Affecters or indicators… something
that is determined or influenced by…
y Health:
H l h we all
ll know
k
what
h health
h l h is,
i but
b we put it
i in
i
the context of physical, social, spiritual, and mental
health.
y
SOME EXAMPLES
Education
Income
and/or
Wealth
Environment
Access to
Health
Care/Specific
Services
Race
S i l Determinants
Social
D t
i
t off Health
H lth
EXPLANATION OF RACISM
|
Our context: Similar to Dr. Camara Jones three
forms of racism:
Internalized: this is the view you have on yourself.
Limiting yourself based on your own personal
perceptions to your race (ex: oreo: white on the inside,
black on the outside)
y PersonallyP
ll Mediated:
M di t d thi
this iis the
th one everyone is
i
familiar with. Believing something or acting
according to racial perceptions from one person to
another.
another
y Institutional: this is a systems approach to racism.
Much broader. (ex: voting rights in the 60’s, historical
economic
i differences
diff
amongstt th
the race))
y
ACTIVITY 1: FLOWER POT
|
Please choose one of the following
gp
pots ((announce
your pot number):
Flower Pot
1
Flower Pot
2
Flower Pot
3
ACTIVITY 1: FLOWER POT
Flower Pot
1
Flower Pot
2
Flower Pot
3
ACTIVITY 1: FLOWER POT
Flower Pot
1
Flower Pot
3
POST FLOWER POT ACTIVITY
SUMMARY/REASON FOR ACTIVITY
|
Pot 1: represents
p
what would be considered white
in America (perceived to have better health
outcomes, as we learned in the previous
webinar) The provision of soil was the emphasis
webinar).
on historical happenings in the U.S. (right to
vote, better paying jobs, etc.)
|
Pot 2: represents
p
the
other minorities that
tend to be “forgotten”
in the discussion of
race in America. While
the most dynamic and
extreme differences
ff
are
amongst black/white…
the concepts
p of racism
are not just a white vs.
black battle.
|
Pot 3: represents
p
the result of inequity,
q y, or
inequality. Bad soil= bad growing conditions.
QUESTIONS/COMMENTS
|
So…. Who is responsible?
DIFFERENT APPROACHES
Behavior approach to
health
o
Different influences
based on behavior
(more internal)
o
Systems approach to
health
o Different
influences
based on systems or
society (more
external)
healthy eating
o
Access to healthy foods
EDUCATION AND HEALTH
GRAPH 1: EDUCATION AND LIFE
EXPECTANCY
GRAPH 1 SUMMARY
|
Those with high
g school or less: 75 y
years old
|
Those with at least “some college”: 82 years old
|
Difference of 7 years
EDUCATION’S IMPACT ON HEALTH
|
Education can also be correlated with behaviors
Smoking rates
y Teen pregnancy
y Drug
D
usage
y
|
Education can be associated with systems
FinancesÆ access to health care
y Employment stability
y
|
Game of LIFE
INCOME (SOCIOECONOMIC STATUS)
|
Socioeconomic Status ((SES):
) is an economic and
sociological combined total measure of a person's
work experience and of an individual's or family’s
economic and social position relative to others,
others
based on income, education, and occupation.
In other words: Your social status and economic
status fused together in one word in respect to your
power or assets in society.
y Example: Lawyer vs. Janitor
y Game of LIFE example
y
|
SES is a big factor in health
y
Wh ?
Why?
FACTS ON ECONOMIC THEORY
|
Capitalist:
p
the means and p
production are
privately owned and operated for profit
y
|
This is a popular form of both medical care and
medical insurance in the US
Socialist: A more cooperative or public ownership
in business.
Focuses on the abolition of hierarchal structures
y Medicaid and Medicare
y
WHAT WOULD YOU CLASSIFY YOURSELF
AS?
THE UNITED STATES AND SES
|
|
Why
y Economic Theories for this lecture?
Neither capitalism or socialism is the answer, but
the two are important to understand and respect
in the US when talking about Social
Determinants of Health.
THE ENVIRONMENT AND HEALTH
|
Where y
you live as a factor of y
your health.
Type of housing: apartment, house, public housing
y Suburban, urban (city), rural (farms)
y
|
E i
Environmental
lh
hazards.
d
Pollution
y Construction
y Noise
y Violence/Crime
y
VIOLENCE AND CRIME (ENVIRONMENT)
Violence
C i
Crime
St
Stress
STRESS
|
We all know what stress is.
But how does it affect you other than making you
stay up long hours in the night trying to finish a
paper?
y Fight or Flight Response Concept (Dr. Michael Lu,
UCLA)
y
WHAT WOULD YOUR REACTION BE?
|
Type
yp what y
you would do?
Would you pet the big kitty?
y Would you just accept your fate?
y Would
W ld you hit and
d run??
y
Those who wish to p
pet the tiger….
g
Your either
crazy, love pets, or feel that petting the big angry
cat will make him/her like you.
| Those
Th
who
h wish
i h to
t acceptt their
th i fate…
f t
well
ll your
not crazy, but you are probably going to get what
you wish.
| Those who wish to hit and run… This is the most
realistic response when you are “frightened”…
This is the fight or flight response.
response
|
STRESS AND THE ENVIRONMENT
|
Think about when y
you are g
giving
g a speech
p
or
presentation in front of the class.
Heart is racing, you feel butterflies in your stomach,
your palms get sweaty.
sweaty
y This is a biological response or your body’s way of
saying “get me out of here!”
y
STRESS AND VIOLENCE
|
Stress is the same feeling,
g, and has the same
affect.
Chronic stress
y Weathering
W th i on your body
b d
y
Those that live in areas of crime and violence
tend to be more stressed then those in safer
neighborhoodsÆ Stress leads to chronic disease
(CVD, hypertension, and obesity)
| The
Th game off LIFE
|
ACCESS TO HEALTH CARE/SERVICES
|
Our Health Care system
y
is
flawed… to say the least
Privately run
y Left open to similar
marketing influences as
business
y More service,, more money
y
y
|
This social determinant
does not really have much
behavioral influence,
influence it is
mainly systemic.
Transportation
y Finances
y Facilities/Service Locations
y
ACCESS IS NOT THE ONLY ISSUE
|
Access is jjust a piece.
p
y
|
Quality/Equal Care
Famous study by Harvard:
“U
“Unequal
l Treatment”
T
”
Four patients (Black/White) who
were actually actors
y Differences in diagnosis,
difference in prescribed
treatment… solely
y based on race
y What does this say about what is
called “provider bias”?
y Is bias something that people can
over come?
y
ACTIVITY 2: THE GAME OF LIFE
|
Do y
you remember y
your p
piece?
ACTIVITY 2: THE GAME OF LIFE
Blue: Lives in a 2bedroom leased
apartment, with a
family of five (no
spouse, a retired
grandparent, and
three children))
| Blue: Went to school
but did not finish high
school because the
first child was born.
|
ACTIVITY 2: THE GAME OF LIFE
Red: Lives in a 3bedroom condo, alone.
| Red: Has a high school
di l
diploma,
no college
ll
degree
|
ACTIVITY 2: THE GAME OF LIFE
Green: Lives in a
four bedroom
house, family of
five (spouse,
(spouse and
three children)
| Green: Has a high
school diploma,
some college
|
ACTIVITY 2: THE GAME OF LIFE
|
Blue/Red/Green: Due to the economic crisis, all
three loss their jobs.
y
At the same time, they all had to go for surgery to
remove their appendix due to appendicitis (infection
of the appendix)
ACTIVITY 2: THE GAME OF LIFE
Blue: No insurance,, had
not filed for medicaid
(insurance coverage for
those who are below a
certain poverty level)
| Blue: Loses the
apartment and is forced
into public housing
(projects).
| Blue: Remains in public
housing (the projects),
one child falls victim to a
violent crime in the
neighborhood
|
ACTIVITY 2: THE GAME OF LIFE
Red: No insurance (does
(
not meet the poverty level
of medicaid).
| Red:
R d Loses
L
th
the condo,
d is
i
homeless
| Red: Eventually…Picked
up a managerial job and
now lives in a apartment.
|
ACTIVITY 2: THE GAME OF LIFE
Green: Covered by
y Blue
Cross Blue Shield health
insurance (a popular private
insurance company)
| Green: Spouse provides
financial support of the
household
| Green: Remains searching
for a job comparable to the
previous job, while the
spouse supports the
financial needs of the
household
|
POST GAME OF LIFE ACTIVITY
|
|
|
What happened
pp
to each p
person as they
y went
through the exact same issues?
How did it affect their health?
Can you see the
C
th relation
l ti between
b t
education,
d
ti
environment, social support, and finances when
it comes to health?
WHAT I HOPED YOU LEARNED
Define
D
fi Social
S i l Determinants
D t
i
t off H
Health
lth and
d
list at least three that impacts your
personal health
p
The impact that racism in the US has had
on health
Understand what SES stands for and its
implications to health in the US
CONTACT
|
For a free p
presentation p
presented by
yy
youth to a
group via webinar please email (with the subject
heading “HEPE presentation”):
y
|
[email protected]
For more information or follow up to anything
presented in this slide please contact:
y
Travis Howlette: [email protected]