1 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)
2 HDSC WEBSITE/FACEBOOK Updates to site affective April 15 th : Ji F b k Join us on Facebook:
4 STUDENT SPEAKER Travis Howlette, Health Science Major (2011), Northeastern University. ORISE Research Fellow at the CDC. Pre-MD/MPH.
5 Jeff Wisniowski B.S./MPH Candidate Kelsey Anilionis, Health Science B.S., 2011
6 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 injustices i
7 TAKE-AWAYS FROM THIS LECTURE Dfi Define Social il Determinants Dt t of Health and list at least three that impacts your personal health The impact that racism in the US has had on health Understand what SES stands for and its implications to health in the US
8 ACTIVITY: THE GAME OF LIFE Pick a Piece (announce your piece):
9 ACTIVITY: THE GAME OF LIFE 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.
10 ACTIVITY: THE GAME OF LIFE Red: Lives in a 3- bedroom condo, alone. Red: Has a high school diploma, no college degree
11 ACTIVITY: THE GAME OF LIFE Green: Lives in a four bedroom house, family of five (spouse, and three children) Green: Has a high school diploma, some college
12 ACTIVITY: THE GAME OF LIFE Remember your piece, we will come back to this y p, activity at the end.
13 SOCIAL DETERMINANTS OF HEALTH What are they? Can you list a few you know?
14 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 h is, but we put it in the context of physical, social, spiritual, and mental health.
15 SOME EXAMPLES Education Income and/or Wealth Environment Access to Health Care/Specific Services Race Social Determinants t of Health
16 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- Mditd 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)
17 ACTIVITY 1: FLOWER POT Please choose one of the following gp pots (announce your pot number): Flower Pot Flower Pot 1 Flower Pot 2 3
18 ACTIVITY 1: FLOWER POT Flower Pot 1 Flower Pot Flower Pot 2 3
19 ACTIVITY 1: FLOWER POT Flower Pot 1 Flower Pot 3
20 POST FLOWER POT ACTIVITY
21 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.)
22 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.
23 Pot 3: represents the result of inequity, or p q y, inequality. Bad soil= bad growing conditions.
24 QUESTIONS/COMMENTS So. Who is responsible?
25 DIFFERENT APPROACHES Behavior approach to health Systems approach to health o Different influences based on behavior (more internal) o healthy eating o Different influences based on systems or society (more external) o Access to healthy foods
26 EDUCATION AND HEALTH
27 GRAPH 1: EDUCATION AND LIFE EXPECTANCY
28 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
29 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
30 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?
31 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
32 WHAT WOULD YOU CLASSIFY YOURSELF AS?
33 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.
34 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
35 VIOLENCE AND CRIME (ENVIRONMENT) Violence Ci Crime Stress
36 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)
38 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?
39 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.
40 STRESS AND THE ENVIRONMENT Think about when you are giving g 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!
41 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
42 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
43 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?
44 ACTIVITY 2: THE GAME OF LIFE Do you remember your piece?
45 ACTIVITY 2: THE GAME OF LIFE 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.
46 ACTIVITY 2: THE GAME OF LIFE Red: Lives in a 3- bedroom condo, alone. Red: Has a high school diploma, no college degree
47 ACTIVITY 2: THE GAME OF LIFE Green: Lives in a four bedroom house, family of five (spouse, and three children) Green: Has a high school diploma, some college
48 ACTIVITY 2: THE GAME OF LIFE 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 At the same time, they all had to go for surgery to remove their appendix due to appendicitis (infection of the appendix)
49 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
50 ACTIVITY 2: THE GAME OF LIFE 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.
51 ACTIVITY 2: THE GAME OF LIFE 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
52 POST GAME OF LIFE ACTIVITY What happened to each person as they went through the exact same issues? How did it affect their health? C th l ti b t d ti Can you see the relation between education, environment, social support, and finances when it comes to health?
53 WHAT I HOPED YOU LEARNED Dfi Define Social il Determinants Dt t of Health and list at least three that impacts your personal health The impact that racism in the US has had on health Understand what SES stands for and its implications to health in the US
54 CONTACT For a free presentation presented by youth to a group via webinar please (with the subject heading HEPE presentation ): For more information or follow up to anything presented in this slide please contact: Travis Howlette:
Medical Sociology Twelfth Edition William C. Cockerham Chapter 3 The Social Demography of Health: Social Class Introduction In the United States, the poor face substantial barriers in life: Typically have
Diversity in the USA (Nakamura, 2003) Health Concerns of the 21 st Century Diversity, Health & Stress KIN 169 Dr. Matthew Masucci Definition: Health psychology focuses on health and behavioral issues related
Family Caregiver Guide The First Step in Care: Becoming a Family Caregiver The United Hospital Fund s Next Step in Care guides (www.nextstepincare.org) are designed to help family caregivers and health
49. INFANT MORTALITY RATE Wing Tam (Alice) Jennifer Cheng Stat 157 course project More Risk in Everyday Life Risk Meter LIKELIHOOD of exposure to hazardous levels Low Medium High Consequences: Severity,
Cuyahoga County Community Health Data Dashboard Presentation to MetroHealth November 22, 2013 1 Meeting Goals & Agenda Community Health Data Dashboard Cuyahoga County Community Health Data Dashboard (C3HD2)
Planning & Action February 2008 9 By Mark Salling, Ph.D., and Michele Egan Health Needs Analysis, Assessment Looks at the Region Last year, The Center for Health Affairs (CHA) asked Community Solutions
Health Disparities in New Orleans New Orleans is a city facing significant health challenges. New Orleans' health-related challenges include a high rate of obesity, a high rate of people without health
Disparities in Health in the United States A conceptual framework for a multi-disciplinary approach to understanding health disparities and proposing policy solutions towards their elimination First Draft
Talking About Living Kidney Donation with Family and Friends Purpose of this guide Y ou may be a person who has kidney disease. Perhaps you know someone with kidney disease. Talking about kidney disease
Finding safety Support during or after living with an abusive partner Introduction The Bill of Rights in this country tells us that we all deserve to be safe, treated as equals and respected. We live with
Privately Sponsored Refugee Resettlement in Canada PSR Information Bulletin You are interested in resettling to Canada and your application has received an initial review by Canadian officials. Now you
What moms had to say: I couldn't get an appointment earlier in my pregnancy. Maternal Health Services Utilization I think that there should be some sort of affordable insurance for self-employed farmers.
Human Development Report Office OCCASIONAL PAPER The Impact of Health Insurance Coverage on Health Disparities in the United States Rowland, Diane and Catherine Hoffman. 2005. 2005/34 Inequality and health
Single Payer 101 Training Universal Health Care for Massachusetts http://masscare.org What s Wrong With Our Health Care System? (the easy part) U.S. Has Lowest Life Expectancy in the Industrialized World
Autism: A Family Perspective Shannon M. Haworth, MA, QMHP Former Virginia LEND Trainee Family Discipline Background Mother of a child with Autism Spectrum Disorder Former VA-LEND Trainee, Family Discipline
First, we would like to ask you a few questions about the time before your new baby was born. Please check the box next to the best answer. 1. Before your new baby, did you No- Go to Question 4 ever have
The Community Health Center Movement As Congress seeks to get health spending under control and the number of people losing health coverage rises, community health centers (CHC) have become vitally important.
The Effects of Domestic Violence on Children: Picking Up The Pieces Kristy Nelson & Andrea Link Legacy House Overview of the Adverse Childhood Experiences (ACE) Study PowerPoint & Research Adapted from
Emotional Wellness Emotional wellness is being able to look forward to the future and feel good about you. Also, when you are under stress or you are having a bad day, it is about being able to recover
CHILD CUSTODY QUESTIONNAIRE CHILD CUSTODY LITIGATION CLIENT QUESTIONNAIRE Note: Please regard references to ex as your spouse, other parent, or caretaker. Please apply the reference to child or children
Conflict Resolution / Behavior Management Notes - New I have found that one of the major stressors for mentoring ministry staff is dealing with conflict and behavioral issues. Mentoring is all about developing
Working with Your Doctor When You Suspect Memory Problems Hope & Help for those with memory loss: Creating a partnership with your doctor. Hope & help for those with memory loss 1 Table of Contents Working
STOP BULLYING Taken from Kidscape Preventing Bullying document Bullying can be: Physical: pushing, kicking, hitting, pinching and any other forms of violence. Verbal: name-calling, sarcasm, spreading rumours,
2014 State of the State Poverty in Missouri Missourians to End Poverty Coalition Data Sources U.S. Census Bureau - 2012 American Community Survey table s1701- Poverty Status in the last 12 months, table
Health risk assessment: a standardized framework February 1, 2011 Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Leading causes of death in the U.S. The 5 leading causes
Quality Meets the CEO Jeffery E. Payne firstname.lastname@example.org Reliable Software Technologies Corporate management does not care about quality. This is the cold, hard reality of the software world. Management
Reference document Stress management Table of Contents Introduction 2 Definition of stress 2 Causes of stress at work 2 Categories of stress: positive and negative stress 2 Forms of stress: physiological
Camai Community Health Center Needs Assessment Report 4/11/2016 In an effort to better serve the community, Camai Community Health Center conducted a community needs assessment. The results of this assessment
Hello. This is AJ Hoge again. Welcome to the vocabulary lesson for Health Care. Let s start. * * * * * At the beginning of the conversation Joe and Kristin talk about a friend, Joe s friend, whose name
Ten Actions ALL Parents Can Take to Help Eliminate Bullying Bullying Special Edition, copyright 2012, www.education.com/bullying The latest research shows that one in three children is directly involved
State Health Assessment Health Priority Status Report Update June 29, 2015 Presented by UIC SPH and IDPH 1 Health Priority Presentation Objectives 1. Explain context of how this discussion fits into our
Presents Test Anxiety! And How to Deal With It Effectively What is Test Anxiety? My head feels like it s in a clamp. My stomach hurts. I m sweating. I studied this stuff yesterday, why can t I remember?
Durham County Community Health Assessment This document presents key findings from the 2011 Durham County Community Health Assessment. The goal of the assessment was to provide a compilation of valid and
Factsheet 4. Coping with Stress and Anxiety What do we mean by stress and feeling anxious? Anxiety is an emotion you feel when your body thinks there is a threat. Negative thoughts relating to particular
ABOUT THIS QUESTIONNAIRE This questionnaire is a part of The Irish LongituDinal Study on Ageing (TILDA). We greatly value your participation in our study, and we hope that you will find this questionnaire
Healthy Relationship Activities INTRODUCTION REMEMBER!!! BE ENERGETIC! This is about creating an experience for the participants. GOOD EYE CONTACT SPEAK CLEARLY AND LOUDLY WITH ENERGY TAKE YOUR TIME Activity
SIGNPOSTS II A Survey of the Social Issues and Needs of Calgarians RECENT IMMIGRANTS THEME REPORT SIGNPOSTS II RECENT IMMIGRANTS THEME REPORT Project Team: Report Design: Lisa Davis (City of Calgary) Lionel
Implementation Plan for Needs Identified in the Community Health Needs Assessment for Spectrum Health Hospitals d/b/a Spectrum Health Grand Rapids FY 2013-2015 Covered Facilities: Spectrum Health Hospitals
SUBJECTS ABORTION Abortion : opposing viewpoints Abortion : statutes, policies, and public attitudes the world over Abortion : violence & extremism The abortion controversy The ethics of abortion CHILDREN
Unlocking the understanding of Social Determinants of Health And it s effect on health outcomes Deborah Wyatt-O Neal, MSN Meghan Murphy, MSW April 30, 2016 1 Presentation Objectives Describe social determinants
Guide to Writing Your Primary Research Paper Your Research Report should be divided into sections with these headings: Abstract, Introduction, Methods, Results, Discussion, and References. Introduction:
Icebreaker: Fantastic Four 1. Break the group into groups of 4. 2. Each team must come up with four things that they all have in common. They may be as simple or as complex as they want (example: we all
USING SAMPLE PROMPTS WRITING In addition to developing topics to assign students and encouraging students to develop their own topics, teachers may assign topics from the sample prompts listed on the following
Criminal Justice and the Planner s Role Beth Altshuler Raimi + Associates April 18, 2015 American Planning Association Seattle, WA 2 Public Health Social Sustainability & Climate Change Equity Community
75 Expository Prompts TEACHING NOTE #1: Stress in expository topics that the main part of the essay should be devoted to the last thing asked. Usually this is to propose solutions or to explain why. Descriptions
The 2015 Self-Assessment Guide For Long Term Care Insurance A JOINT PUBLICATION BY: SHIP State Health Insurance Assistance Program And Indiana Partnership Long Term Care Insurance Program Both of the Indiana
Sponsored by Abusive Relationships One in three women will experience at least one physical assault by a partner. The most prevalent age range of women that suffer violence from a partner is 19-29. Mark
Volume 19 Issue 1 Spring 2010 Illinois Wesleyan University Magazine Article 3 2010 To See Without Judging Tim Obermiller Illinois Wesleyan University, email@example.com Recommended Citation Obermiller, Tim
If you live in Lubbock A Statistical Review A report given to the Board of Health, City of Lubbock, March 2011 Brian D. Carr, Ph.D., Board Member *denotes areas of possible intervention Population Total
Smoking Cessation Questionnaire Congratulations on deciding to become a non-smoker once again. In order that we can support you in achieving your goal, please complete this form as fully as possible to
A workshop sponsored by Abusive Relationships One in three women will experience at least one physical assault by a partner. The most prevalent age range of women that suffer violence from a partner is
Understanding and Recognizing Alzheimer s Disease This article is about Alzheimer's disease and other types of dementia. It presents information for patients, family members, and other caregivers. It talks
TAKE AND TEACH LESSON Change: Loss, Opportunity and Resilience PURPOSE This lesson includes activities to supplement the online course, "Change: Loss, Opportunity and Resilience." Job Club personnel and
The Stack of the Deck: an Illustration of the Root Causes of Poverty This is an example of an educational activity that uses three volunteers and a series of guided exchanges of playing cards to illustrate
PROGRAM TITLE: Youth Health and Wellness Clinic Name of Health Department: Grand Traverse County Health Department, Michigan Short Description: The Grand Traverse County Health Department s Youth Health
Canada s Health Care Debate The Impact on Newcomers Many have called the recent Supreme Court decision regarding access to private health care a wake-up call to governments, to work faster and better to
INTERVIEW WITH SISTER SHIVANI ON GHETTO RADIO The current situation in the country is such that most have lost hope in the government, relationships, finding job. The disparity makes it so hard to be motivated.
PLANNING FOR YOUR FUTURE CARE March 2009 A Guide Planning for your future care - a guide There may be times in your life when you think about the consequences of becoming seriously ill or disabled. This
Lesson Plan: Dealing with Stress Objective: Identify effects of stress on everyday issues and strategies to reduce or control stress. Time: 45-60 minutes Structure: On-line homework before class (Stress
HE Leaflet 70 Rev. January 2009 S T R E S S Lesson 5 From Family Stress to Family Strengths Sometimes a family is like a circuit box. When too many things go wrong, the circuits overload and throw a breaker.
PART I : NAVIGATING HEALTH CARE SECTION ONE Hospitals, Clinical Trials & Ambulance Service 1. Should my dad just sign all those hospital consent forms or actually question them? 2. What is a hospital Patient
Taking Charge of Your Depression Take charge of your health. Learn as much as you can. It s one of the most important things you can do for yourself. Depression is more than just feeling down or blue for
Environmental Justice Environmental Justice Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the
Key Policy Issues in Incorporating Health Equity into Health Care Reform Dennis P. Andrulis, PhD, MPH Senior Research Scientist, Texas Health Institute & Associate Professor, University of Texas School
BMO Insurance Critical Illness Why Critical Illness insurance? Are you and your family financially prepared to survive a critical illness? Many people know someone affected with a critical illness. You
Writing Topics Topics in the following list may appear in your actual test. You should become familiar with this list before you take the computer-based TOEFL test. Remember that when you take the test
PARTNERING WITH YOUR DOCTOR: A Guide for Persons with Memory Problems and Their Care Partners Alzheimer s Association Table of Contents PARTNERING WITH YOUR DOCTOR: When is Memory Loss a Problem? 2 What
Overview ` Why Is This Indicator Important? Physical inactivity can lead to obesity and type 2 diabetes. Physical activity can help control weight, reduce the risk of heart disease and some cancers, strengthen
From Families USA Minority Health Initiatives May 2010 Moving toward Health Equity: Health Reform Creates a Foundation for Eliminating Disparities Racial and ethnic health disparities continue to persist
Violence: Public Health View NYC May 24, 2013 Robert Sege MD, PhD Boston Medical Center The problem Frameworks Research issues Implications for research Overview Homicide A group of 10 to 12 teens at the
Prescription drugs are the 3 rd most commonly abused drugs amongst teens in Nebraska, and the same statistic holds true on a national level. The rise in prescription drug abuse is becoming increasingly
Help for the Grieving Student: Giving Hope for Healing Barbara Fraser Licensed Professional Counselor 11/13/15 Objectives Identify different types of losses. Define the grief process for school age population.
Be Strong in the Lord Ephesians Chapter 6: 10-20 Day 1 Be Strong in the Lord: Ephesians 6:11 Put on the whole armor of God, that you may be able to stand against the wiles of the devil. Weapons of Peace
Got test anxiety? Most people do. But some people have it really bad! Is it in your head or in your body? Either way you can take control! It s an illusion that you can kick to the street! Test anxiety
10-PART VIOLENCE PREVENTION SERIES LEADER S GUIDE PeaceTalks PROGRAM #3 MANAGING YOUR ANGER Distributed by: Copyright 1997 HeartLand Media All rights reserved. No portion of this work can be reproduced
Health Education Core ESSENTIAL QUESTIONS It is health that is real wealth, and not pieces of gold and silver. Gandhi Increased Focus Classroom Real Life Connection Student Reflection Student Assessment
Planning for your future care A GUIDE 2 Planning for your future care Planning for your future care A GUIDE There may be times in your life when you think about the consequences of becoming seriously ill
Healthy Relationships for teens Relationships are difficult & take time to get right! Presented by: Developed by Prevention & Promotion Mental Health & Addiction Services, Western Health Types of Relationships
Newspaper Activities for Students Newspaper Activities for Students Page 2 Higher Learning By the year 2010, millions of the jobs available in the United States will require more than a high school diploma.
ISSUE BRIEF Education: It Matters More to Health than Ever Before Americans with fewer years of education have poorer health and shorter lives, and that has never been more true than today. In fact, since
Coping with financial stress Looking after yourself and your family/whanau during tough economic times Our economy has been affected by the global economic recession, and this is making life more difficult
Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll
Substance Abuse 214-215 Chapter 1: Substance Abuse 265 214-215 Health of Boston Substance Abuse Substance abuse involves the excessive use of alcohol or illicit substances (e.g., marijuana, cocaine, heroin,
For parents Children, armed conflict and flight Children s reactions to armed conflict and flight An increasing number of families and children are affected by armed conflict, and are being forced to flee.
Animal Education and Rescue, NFP BIRD ADOPTION QUESTIONNAIRE P.O. Box 7343 Libertyville, IL. 60048 Please complete the entire application (failure to do so may result in the application not being processed).
Explaining Separation/Divorce to Children By: Liana Lowenstein, MSW (Tel) 416-575-7836 (email) firstname.lastname@example.org (Web) www.lianalowenstein.com General Tips Prepare yourself before addressing the issue
Your consent to our cookies if you continue to use this website.