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Health Disparities: Basic Theories, Concepts, and Hypotheses

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Anne Gaglioti

on 5 January 2015

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Transcript of Health Disparities: Basic Theories, Concepts, and Hypotheses

Health Disparities:
Basic Theories, Concepts, and Hypotheses

Social Determinants of Health and
Health Disparities

There are differences in health outcomes

Why might this be?
How do we as physicians feel about the reasons why?
Why we might want to challenge the concept of health and healing we have grown up with


Objectives:
Health disparities exist
Upstream versus downstream
Individual versus the community
Role of inequality
Discuss these ideas in the context of current events
Health Disparities Exist
Three Important Phases
Biologic
*Age, sex, genetic composition
How does Inequality Fit in to These Concepts?
-Impacts all phases


Income as a Determinant of Health
Adults living in poverty are 5x more likely to report fair to poor health versus non-poor adults
Even in the non-poor there is still a clear linear relationship between health and income
If the mortality rates of the richest white population were applied to the entire country between 1960 and 2002, 30% of premature deaths in the black community would have been prevented
In 2009, white households had twenty times the net worth of black households
Woolf, Steven and Braveman, Paula. Where Health Disparities Begin: The Role of Social and Economic Determinants—And Why Current Policies May Make Matters Worse. Health Affairs. October, 2011.
Education as a Determinant of Health
Adults without a HS diploma are three times as likely to die before age 65 when compared to those with a college education
Approximately 50% of all male deaths and 40% of all female deaths of adults age 25-64 would not occur if everyone had the mortality rate of college graduates
Stark racial disparities exist in educational attainment
Some ways education and income affect health:
-lack job, health insurance, disposable income
-basic needs
-smoking three times more prevalent in those
without a HS diploma vs college educated
-similar pattern for inactivity
Anne Gaglioti, MD
Department of Family Medicine, University of Iowa
Downstream
*Access to care
*Health Behaviors
*Environmental Exposure
Upstream
*Resources like education and income
*Environment: where we live, work, think and socialize
Biologic Pathways
Stress can impair immune function and promote inflammation
Exposures in childhood, utero can impact adult behavior and development
Epigenetics
Social and physical environment can activate the expression of disease-promoting genes
Also....genetic composition, age, sex in a more traditional sense
inherited risk factors
sex-specific diseases
age dependent diseases
Where we live affects our health
Physical and Social Environment
Food deserts
Green space
safety
education system
toxin and allergen exposure
access to health care
poverty
unemployment and crime
advertising for alcohol, tobacco, fast food
social cohesion
Woolf, Steven and Braveman, Paula. Where Health Disparities Begin: The Role of Social and Economic Determinants—And Why Current Policies May Make Matters Worse. Health Affairs. October, 2011
-Income gap between rich and poor
widening since 1968
-Over the last decade rising food insecurity, housing cost burden, and homelessness
Questions for Discussion
-What do you see as your advocacy role as a physician?
*How might these concepts change that?
-Discuss how you think health care reform might impact health disparities
-Other questions?
Policy and Societal Structure
In order to effect some social determinants of health, there is little physicians, health plans or public health departments can do
High impact avenues for change lie in policy change
smoking rates changed when smoking bans were instituted widely and cigarette prices increased
But...
Do not underestimate the importance
of impacting
individuals
with your
care.
This is
vitally
important
work.
"Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.“
-Martin Luther King, Jr.
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