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)
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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:
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