1. 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.

2. 1796- Smallpox vaccination 1855- First state board of health 1867- Antiseptic surgery 1870- U.S. Marine Hospital Service, Forerunner of Public Health Service Age-adjusted Deaths per 1000 1885 1905 1925 1945 1965 1985 2005 10 20 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

3. ORGANISMHUMAN DISEASE DISEASE CAUSE AND EFFECT

4. HOST AGENT ENVIRONMENT Epidemiological Triangle

5. Web of Causation

6. The Ecological Model of Health

8. 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

9. … 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

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

11. 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