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18 Cards in this Set
- Front
- Back
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SDH |
CONTEXT 1. Social Environment 2. Economic Environment 3. Physical Environment |
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Economic Env |
a. Socioeconomic status b. poverty -->resource availability : food security= availability and access to healthy nutrition access to safe spaces access to health care |
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Physical Env (Environmental Determinants of Health) |
a. common spaces b. air quality c. housing quality |
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Impact of SDH: conds commonly present locally, nationally, globally |
x |
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Approaches to SDH: patient-level |
Screen their situation and see how can intervene: -home env. healthy & safe? --> write landlord, community partnering-resource access? --> set up medicaid rides/home health pathway-medication delivery**Consult community agencies=SDH experts --> Medical Legal Partnerships, Child HeLP, United Way, Freestone Food Bank MLP: benefit enrollment, housing concerns, educational conflicts |
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Approaches to SDH: population-level |
MLP: protect unmet legal needs, advocate for system-level change |
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Action steps to be taken on behalf of patients (What we can do) |
1. Understand SDH's broad effects 2. Work toward Sustained Improvement --> prevention, health>health care 3. Consistent risk assessment and ID (ask during family visit about benefits, housing, depression, dom violence, geographic vital signs=geomarkers) 4. Know communities risks and assets 5. advocate on behalf of patients 6. research and quality improvement (QI) |
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Economic Env: a. socioeconomic status (SES) |
position w/n social hierarchy based on prestige and resource access 1. income (salary) and wealth (assets) --> security, health promoting resource access 2. education --> health knowledge, status and greater future prospects 3. occupation -->social support, stress, work time, status |
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absolute poverty |
1.based on if basic needs are met or a set value 2.easy to assess across regions and time 3. developing countries 4. doesn't capture complete picture (Ohio =/= Cali) |
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relative poverty |
1. basic needs + what is necessary to have a decent life 2. more complete picture 3. difficult to compare across regions (USA =/= Africa) |
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income inequality |
Gini coefficient 0=total equality, 1=total inequality |
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social capital |
networks of relationships among people who live and work within a society |
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health equity vs. equality |
equality: everyone given the same help --> some still fall short equity: everyone given the help they need --> everyone is at the same level in the end |
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Maslow's Hierarchy of Needs |
Achieving Potential Esteem & Respect Belonging Safety Physiologic (all within context) Docs try to achieve their patients max potential by focusing on their Physiologic needs.. but everything else must be addresses |
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Social Environment |
a. social capital and cohesion b. discrimination |
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Social Env: a. social capital and cohesion |
-togetherness -social orgs., diffusion of info, trust, collective action -adverse exposures affect (crime) -->Stress (toxic=prolonged) -->ACEs |
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Adverse Childhood Experiences (ACEs) |
1.experience of/exposure to: neglect, domestic violence, mental illness, substance abuse, crime etc. 2.CDC study: 10 ACEs exposure to 6 or more--> 20 yr decrease in life expectancy 3.Violent crime rate and asthma rate in Cinci |
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Social Env: b. Discrimination |
1.based on race, gender, religion etc 2. types: a. institutional: access to resources b. personally-mediated: assumptions/stereotypes c. internalized: stigma of own ability/worth 3. racial disparities and asthma: 2x readmission rate difference bw/n af.am. and white children, adjust for SDH-->disparity disappears |
