Determinants of Health

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Determinants of Health

• Catalysts Towards Community Health
• June 2, 2008

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Biological Determinants

• Genes much to learn
• Immunities or disposition
• Varying estimates of nature- effect on
  longevity.
• Age

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US Mortality by Age
(per 100,000)
Source National Center for Health
Statistics,CDC 2005
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Health Care Determinants

• CDC estimates that 10 of premature mortality is
  due to inadequate health care.
• 98 of health are for health care instead of
  prevention.
• Increasing differences in access based on
  deductibles, co-pays, etc.
• Lower access to tests, specialty care for low
  income patients.

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Environmental Determinants

• Biochemical effects (lead paint, diesel fumes.)
• Often overlooked rural-based pollutants
• New interest in the effects of the Built
  Environment the use, layout design of a
  communitys physical structures
• Urban high crime and traffic
• Suburban pedestrian unfriendly
• Rural ?

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Behavioral Determinants

• Tobacco (400,000 deaths)
• Nutrition and Physical Activity (325,000)
• Alcohol (85,000)
• Violence
• What is the origin or cause of behavior?

Source Mokdad, et. al. JAMA
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Cigarette Smoking by Education
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Physical Activity

• Blacks (19), Hispanics (24) and Asians (38)
  less likely to engage in physical activity than
  Whites.
• Men 30 more likely than women.
• Married individuals 19 less likely than single
  individuals.

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Physical Activity/Nutrition
Source USDA, 2006
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Social Determinants

• Gender
• Race
• Marital status
• Physical abilities (also biological)
• Education

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U.S. Mortality by Gender
(per 100,000)
Source National Center for Health Statistics,
CDC, 2005
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U.S. Mortality by Race
(per 100,000)
National Center for Health Statistics, CDC, 2005
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Social Determinant Education
Source National Health interview Survey,2001-05
Robert Wood Johnson Foundation, 2008
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Education and Mortality
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Parent Education and Childrens Health
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The Big Sort

• Social and geographic segregation
• People have migrated to socially isolated areas.
• Divided by race, income, social perspectives.
• Possible adverse health effects?

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Economic Determinants

• Intersection between social (e.g. job) and
  economic (income) determinants is fuzzy.
• Concept of social class is less accepted here.
• Social status is more than income, though income
  is an important determinant.
• Status Syndrome (Marmot)

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Premature mortality by Income
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Health and Wealth
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Income Gap Widens
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Income Changes
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Effects of Disparities

• Complex relationship between determinants and
  outcomes.
• Some determinants are likely outcomes of
  others.
• Parental income associated with educational
  attainment and health of child. Low education
  associated with high tobacco use. Tobacco use
  associated with..

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Social effects of Disparities

• Discrimination?
• Stress?
• Low self-esteem?
• High-risk behaviors
• ??