Social Determinants of Health UNIV 241– Winter 2012 Stephen F. Gambescia, PhD, MEd, MBA, MHum, MCHES Associate Professor Health Services Administration College of Nursing and Health Professions. Faculty Perspective in the Course.

1796- Smallpox vaccination First state board of health Antiseptic surgery U.S. Marine Hospital Service, Forerunner of Public Health Service Age-adjusted Deaths per City Health Departments Pasteurization of Milk Public Health Campaigns Insulin Sulfa Drugs Penicillin Anti-TB Drugs Open Heart Surgery Polio Vaccine Coronary Care Units Heart Implants Coronary Care Surgery Lifestyle Programs Taking Hold Age of Medicine Age of Environment Age of Lifestyle Core Concepts, Mayfield, 1990

ORGANISMHUMAN DISEASE DISEASE CAUSE AND EFFECT

HOST AGENT ENVIRONMENT Epidemiological Triangle

Web of Causation

The Ecological Model of Health

Listed and Actual Causes of Death Leading Causes – Heart Disease – Cancer – Cerebrovascular Disease – Unintentional Injuries – Chronic Lung Disease – Pneumonia/Influenza – Diabetes Actual – Tobacco – Diet/Activity Patterns – Alcohol – Certain Infections – Toxic Agents – Firearms – Sexual Behavior – Motor Vehicles – Drug Use McGinnis and Foege, (1993) JAMA, 270(18). RED is not part of citation Ecological for Tobacco – Parental/Family – Peer/ Neigborhood – Socio-Cultural – Workplace – Movies – Advertising – Access – Availability – Cost

… the solution to many of today’s medical problems will not be found in the research laboratories of our hospitals, but in our Parliaments. For the prospective patient, the answer may not be cure by incision at the operating table, but prevention by decision at the Cabinet table Sir George Young, Parliamentary Undersecretary of State for Health, Department of Health and Social Security, London, 1979

Treatment--example Diabetes – Medicinal – Dietary – Behavioral via exercise Ongoing monitoring of patient… Diabetes treatment as a “cognitive” disease

Patient Action--example (Aerobic) Exercise – What?—some form of locomotion Nature—moderate “impact” aerobic Extent—(30,40, 50 minutes—continuous) – When?– fit to individual – How—walk, bike, swim, exercise machines – How often—4 times a week; no more than 2 successive days without exercise – Where– fit to individual