NOTES

Module 7: Social Determinants of Health

Social Determinants PPT

- Social determinants: circumstances in which people are born, grow up, live, work and
age (wider set of forces: economics, social policies, politics)
- Social environment (families smoking, drinking)
- Friends vaping makes it harder to quit, roommates
- Vic encouraged me to go to the gym three times a week
- Preference- taste, time
- Advertisements
- Convenience (time as a student, fast food is quicker than buying and preparing
healthy meals)
- Money (healthy foods)
- PERCEPTION OF RISK → who would die in an accident, speed, past incidents
(did someone you know die), what kind of car, policy in diff cities
Factors that influence our health: Tuskegee Study (conducted by US Public health service,
tuskegee institute)
- 1932-1972
- Thought they were being treated for syphilis, wanted to see what it would be like for long
term untreated syphilis
- Neurological impacts, ends with death
- 600 black men (399 w/ syphilis)
- Black doctors, manipulated trust of someone that looks like you to keep patients involved
in the study for this long
- Lasted 40 years, patients did not receive informed consent
- Impact: distrust in US government, specifically by African Americans, leads into 2021
distrust in vaccinations and mandates
Changed Research Practices after Tuskegee
- $10M settlement to living participants (1975 added wives, widows, and offspring)
- 1974 National Research Act
- Est. National Commission for the protection of human subjects in biomedical and
behavioral research
- VOLUNTARY INFORMED CONSENT required from ALL persons taking part in
studies
- Required est of Institutional Review Boards (IRBs) that review and decide
whether studies meet ethical standards
- Have to know benefits, risks, issues (give informed consent)
- Incentives cannot outweigh your decision to participate
- Balance → is $50 too much?? $1200? Try to persuade someone to do
something they don’t want to do
- COVID vaccine? Are the prizes USC offers too much?
 - Determinant is trust in the government, recognize that this is difficult but strides have
been made to rectify these trust issues (having a family in Tuskegee study would be a
determinant)
- General PH → acknowledge people’s hesitation, meet them with facts and validating
their opinions instead of dismissing them
Adverse Childhood Experiences (before age 18)
- Abuse → physical, emotional, sexual
- Neglect → physical, emotional
- Household dysfunction → mental illness, mother treated violently, divorce, substance
abuse, incarcerated relative, substance abuse
- CDC-Kaiser study
- ⅔ reported at least one ACE
- 0=36%, 1=26%, 2=16%, 3=9.5%, 4=12.5%
- Impact!!!
- Changes in decision making, learning and growth, forming healthy relationships
- More at risk for negative health and well-being outcomes
- More likely to have
- traumatic injuries
- Suicide, PTSD, depression
- Unintended pregnancy, complications, fetal death, maternal death
- Greater risk for HIV, STDs
- Cancer
- Alcohol and drug use
- Less likely to pursue education or have high income
- It's all connected, ACEs influence more than 40+ health outcomes
- Biological plausibility: prolonged release of stress hormones activates SNS (what
is SNS) resulting in release of stress hormones (ex. cortisol) → heart attack,
heart disease
- Neg impact on HPA axis, amygdala, prefrontal cortex, hippocampus
- Children have little control, more stress, starts at age 3-5 leads to heart
disease at 45 (monkeys?)
- Life expectancy: ppl w 6 or more ACEs die 20 yrs earlier on average than those
without any ACEs
- Prevention
- Strengthen economic supports to families
- Promote social norms that protect against violence and adversity
- Ensure a strong start for children
- Teach skills
- Connect youth to caring adults and activities
- Intervene to lessen immediate and long term harms
- Witnessing alc/drug abuse, spouse abuse, lack of love/support → all lead to a
lack of sense of control
- How do we address these determinants?
 - Loving supporting adults in a child's life (school, community (rec.
Center, neighbor, afterschool programs), sports teams/coaches,
role models, mentor programs)
- Strengthen economic supports to families
- Promote social norms that protect against violence and adversity
- Ensure a strong start for children
- Teach skills
- Connect youth to caring adults
- Intervene to lessen immediate and long-term harms
How does this affect the health care system today?
Potential determinants of disparities
- Patient level:
- Knowledge and attitudes
- Behavior intention and social norms
- Perceived susceptibility to health problem → how fast you’re driving, what roads
youre on rural vs. highway (perceived risk)
- Use birth control if you feel like youre likely to get pregnant
- Theory of Magical Thinking among adolescents: thinking youre above
being at risk, “it’s not gonna happen to me” (car accident, pregnancy)
- Mistrust
- Provider level:
- Training and skills
- Knowledge at attitudes
- Bias and stereotyping
- Approach young people in a casual way that isn’t demeaning, rudeness
leads to patients not being honest
- System level
- Access to healthcare
Prevention strategies?
- Leveraging the best available evidence
- CDC programs to change conditions in which people live to improve their health
outcomes