(HEPE) Introduction To Social Determinants Of Health (Hepe) 1

INTRODUCTION TO SOCIAL DETERMINANTS OF HEALTHBy: Travis Howlette B.S., Jeff Wisniowski B.S., MPH and Kelsey Anilionis B.S.

Health Equality Peer Educator Training (HEPE)

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SPONSORS

STUDENT SPEAKER

Travis Howlette, Health Science Major (2011), Northeastern University. Pre-MPH/MD.

Jeff Wisniowski B.S./MPH Candidate

Kelsey Anilionis, Health Science B.S., 2011

Aim and Purpose of This Lecture Series

TAKE-AWAYS FROM THIS LECTURE

ACTIVITY: THE GAME OF LIFE

Pick a Piece (announce your piece):


Blue: Lives in a 2- bedroom 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.


Red: Lives in a 3- bedroom condo, alone.

Red: Has a high school diploma, no college degree


Green: Lives in a four bedroom house, family of five (spouse, and three children)

Green: Has a high school diploma, some college


Remember your piece, we will come back to this activity at the end.

SOCIAL DETERMINANTS OF HEALTH

DEFINITION

World Health Organization (WHO): The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.

In our words- Breaking down the word Social: your interactions with the external

environment (your friends, family, places, and different systems)

Determinants: Affecters or indicators… something that is determined or influenced by…

Health: we all know what health is, but we put it in the context of physical, social, spiritual, and mental health.

SOME EXAMPLES

Social Determinants of Health

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)

Personally- Mediated: this is the one everyone is familiar with. Believing something or acting according to racial perceptions from one person to another.

Institutional: this is a systems approach to racism. Much broader. (ex: voting rights in the 60’s, historical economic differences amongst the race)

ACTIVITY 1: FLOWER POT

Please choose one of the following pots (announce your pot number):

Flower Pot 1

Flower Pot 2

Flower Pot 3


Flower Pot 1 Flower Pot

2Flower Pot 3


Flower Pot 1 Flower Pot

3

POST FLOWER POT ACTIVITY

SUMMARY/REASON FOR ACTIVITY

Pot 1: represents 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 on historical happenings in the U.S. (right to vote, better paying jobs, etc.)

Pot 2: represents the other minorities that tend to be “forgotten” in the discussion of race in America. While the most dynamic and extreme differences are amongst black/white… the concepts of racism are not just a white vs. black battle.

Pot 3: represents the result of inequity, or inequality. Bad soil= bad growing conditions.

QUESTIONS/COMMENTS

So…. Who is responsible?

DIFFERENT APPROACHES

o Different influences based on behavior (more internal)

o healthy eating

oDifferent influences based on systems or society (more external)

o Access to healthy foods

Behavior approach to health

Systems approach to health

EDUCATION AND HEALTH

GRAPH 1: EDUCATION AND LIFE EXPECTANCY

GRAPH 1 SUMMARY

Those with high school or less: 75 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 Teen pregnancy Drug usage

Education can be associated with systems Finances access to health care Employment stability

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, 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.

Example: Lawyer vs. Janitor Game of LIFE example

SES is a big factor in health Why?

FACTS ON ECONOMIC THEORY

Capitalist: the means and production are privately owned and operated for profit 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 Medicaid and Medicare

WHAT WOULD YOU CLASSIFY YOURSELF AS?

THE UNITED STATES AND SES

Why 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 you live as a factor of your health. Type of housing: apartment, house, public

housing Suburban, urban (city), rural (farms)

Environmental hazards. Pollution Construction Noise Violence/Crime

VIOLENCE AND CRIME (ENVIRONMENT)

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?

Fight or Flight Response Concept (Dr. Michael Lu, UCLA)

WHAT WOULD YOUR REACTION BE?

Type what you would do? Would you pet the big kitty? Would you just accept your fate? Would you hit and run?

Those who wish to pet the tiger…. Your either crazy, love pets, or feel that petting the big angry cat will make him/her like you.

Those who wish to accept their fate… well 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.

STRESS AND THE ENVIRONMENT

Think about when you are giving a speech or presentation in front of the class. Heart is racing, you feel butterflies in your

stomach, your palms get sweaty. This is a biological response or your body’s way

of saying “get me out of here!”

STRESS AND VIOLENCE

Stress is the same feeling, and has the same affect. Chronic stress Weathering on your body

Those that live in areas of crime and violence tend to be more stressed then those in safer neighborhoods Stress leads to chronic disease (CVD, hypertension, and obesity)

The game of LIFE

ACCESS TO HEALTH CARE/SERVICES Our Health Care system is

flawed… to say the least Privately run Left open to similar

marketing influences as business

More service, more money This social determinant

does not really have much behavioral influence, it is mainly systemic. Transportation Finances Facilities/Service Locations

ACCESS IS NOT THE ONLY ISSUE

Access is just a piece. Quality/Equal Care

Famous study by Harvard: “Unequal Treatment” Four patients (Black/White) who

were actually actors Differences in diagnosis,

difference in prescribed treatment… solely based on race

What does this say about what is called “provider bias”?

Is bias something that people can over come?

ACTIVITY 2: THE GAME OF LIFE

Do you remember your piece?


Blue: Lives in a 2- bedroom 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.


Red: Lives in a 3- bedroom condo, alone.

Red: Has a high school diploma, no college degree


Green: Lives in a four bedroom house, family of five (spouse, and three children)

Green: Has a high school diploma, some college


Blue/Red/Green: Due to the economic crisis, all three loss their jobs. 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


Red: No insurance (does not meet the poverty level of medicaid).

Red: Loses the condo, is homeless

Red: Eventually…Picked up a managerial job and now lives in a apartment.


Green: Covered by 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 to each person as they went through the exact same issues?

How did it affect their health?

Can you see the relation between education, environment, social support, and finances when it comes to health?

WHAT I HOPED YOU LEARNED

(HEPE) Introduction To Social Determinants Of Health (Hepe) 1

Health & Medicine

Transcript of (HEPE) Introduction To Social Determinants Of Health (Hepe) 1