Determinants of Health

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Presentation transcript:

Determinants of Health Catalysts Towards Community Health June 2, 2008

Biological Determinants Genes: much to learn Immunities or disposition Varying estimates of “nature”- effect on longevity. Age

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

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.

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 community’s physical structures Urban: high crime and traffic Suburban: pedestrian “unfriendly” Rural: ?

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

Cigarette Smoking by Education

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.

Physical Activity/Nutrition Source: USDA, 2006

Social Determinants Gender Race Marital status Physical abilities (also biological) Education

U.S. Mortality by Gender (per 100,000) Source: National Center for Health Statistics, CDC, 2005

U.S. Mortality by Race (per 100,000) National Center for Health Statistics, CDC, 2005

Social Determinant: Education Source: National Health interview Survey,2001-05 Robert Wood Johnson Foundation, 2008

Education and Mortality

Parent Education and Children’s Health

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

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)

Premature mortality by Income

Health and Wealth

Income Gap Widens

Income Changes

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…..

Social effects of Disparities Discrimination? Stress? Low self-esteem? High-risk behaviors ??