Social determinants of health could be interrelated and   could be the reason for unhealthy or risky health behaviors and attributes   that lead to negative outcomes. Public health officials must cons

PUH 5301, Public Health Concepts 1 Cou rse Learning Outcomes for Unit VII Upon completion of this unit, students should be able to: 2. Analyze key public health concepts and principles. 2.1 Discuss how behaviors and attitudes affect public health outcomes in the community. 4. Explain the role of government regarding public health practice and policy. 4.1 Evaluate government’s role in implementing laws to curb social determinants of health issues. 5. Evaluate the impact of social determinants of health on population health. 5.1 Explain how social determinants of health contribute to health risks and outcomes in t he community. Course/Unit Learning Outcomes Learning Activity 2.1 Unit Lesson Chapter 13: Do People Choose Their Own Health? Video: CDC: Tips From Former Smokers - Terrie Don't Smoke Ad Unit VII Case Study 4.1 Unit Lesson Chapter 14: How Psychosocial Factors Affect Health Behavior Unit VII Case Study 5.1 Unit Lesson Chapter 13: Do People Choose Their Own Health? Chapter 14: How Psychosocial Factors Affect Health Behavior Article: “Identifying the Impact of Social Determinants of Health on Disease Rat es Using Correlation Analysis of Area -Based Summary Information” Video: CDC: Tips From Former Smokers - Terrie Don't Smoke Ad Unit VII Case Study Reading Assignment Chapter 13: Do People Choose Their Own Health? Chapter 14: How Psychosocial Factors Affect Health Behavior Additional Required Materials: In order to access the following resources, click the links below. Song, R., Hall, H. I., Harrison, K. M., Sharpe, T. T., Lin, L. S., & Dean, H. D. (2011). Identifying the impact of social determinan ts of health on disease rates using correlation analysis of area -based summary information. Public Health Reports, 126 (Suppl 3), 70 –80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/ar ticles/PMC3150132/ UNIT VII STUDY GUIDE Social Determinants of Health, Health Disparities, Health Equity, and the Impact on Community PUH 5301, Public Health Concepts 2 UNIT x STUDY GUIDE Title Centers for Disease Control and Prevention. (2014, June 24). CDC: Tips from former smokers - Terrie don't smoke ad [Video file]. Retrieved from https://www.youtube.com/watch?v= OFQ6YoDAoeY Click here to access the transcript for the above video. Please note: This video includes a very ill woman. If this disturbs you, please avoid it. Unit Lesson Leading Versus Actual Cause of Death Imagine a type 2 diabetic patient comes to the hospital with extremely low blood sugar . After the patient has been stabilized, it is discovered that the patient has not had a decent meal in three days; the patient is homeless, living in a high risk community, is unemployed, and does not have an emergency person to call.

The patient’s type 2 diabetes or medical issue is being controlled in the hospital, but how will his social issues be handled, which in part affect his medical outcome? When pondering on the social determinants of health, in reality no one determinant is exclusively responsible for a particular health risk or situation. S ocial factors usually make up a complex system of causes and effects, including biol ogical or genetic factors, which eventually lead to health outcomes. While public health officials have focused on infectious disease in the past, the late 20 th century proved that chronic diseases are on the rise. Heart diseases and cancer, for example, are the top listed causes of death in the 21st century, causing public health officials to rethink strategies of reducing disease in the community (Schneider, 2017). Researchers started to look at the root cause and not just the leading cause of disease that results in morbidity and/or mortality. Researchers began to focus on the genetic and external factors, including tobacco use, physical inactivity, poor diet, alcohol abuse, education, and drug abuse, among other things. This approach brought them to th e actual causes of death, including risky sexual behavior, toxic agents, firearms, and motor vehicles. For example, someone in the community could come from an abusive home. As a result, he starts abusing tobacco, alcohol, and drugs. He is also on a poor d iet because of his lifestyle and because he cannot keep a job due to his addictions. Later on, he contracts lung cancer as a result of his smoking. He falls into depression and finally commits suicide using a firearm. In a situation like this, his leading cause of death would be cancer and depression, but the root or actual cause of his death would be trauma experienced as a child; abuse of alcohol, drugs, and tobacco; poor diet; and firearm. A breakdown below shows the actual causes of death in present co mmunities. W hile this is not an exhaustive list, it shows how long -term problems and the environment could lead to many problems:  Tobacco causes lung cancer and cardiovascular diseases;  physical inactivity/poor diet can lead to obesity, stroke, heart dise ases, and cancer;  alcohol misuse can cause motor vehicle fatalities, home and work injuries, and liver diseases;  toxic/environmental agents can cause cancer; and  firearm violence can lead to PTSD, death, and long - and/or short -term disability. Reducing Human Health Due t o Health Behavior Through Education and Regulation Education is extremely important in the quest for a healthy community. Many people have changed their lifestyles to healthy ones as a result of education or information about healthier options, often from a public health official or public health informati on. For example, some quit smoking after the Surgeon General’s office linked smoking to the cause of many cancer -related fatalities in 1964 (Schneider, 2017). Another example is the Food and Drug Administration (FDA) Study, (E ducation), and Health Care (Palex66, 2015) PUH 5301, Public Health Concepts 3 UNIT x STUDY GUIDE Title requirement for all foods to include la bels containing the daily nutritional value per serving of the prepared food (Schneider, 2017). In the last four decades, sex education has been important, yet it has been controversial among public health officials and policy makers in the United States (Hall, Sales, Komro, & Santelli, 2016). W ith the rising concern of adolescent pregnancy and sexually transmitted illnesses, mainly HIV/AIDS, public health officials have looked for ways to curb the pandemic (Hall et al., 2016). One of the ways is through s exual and reproductive health education classes in schools and communities on condoms, contraception, and sexually transmitted infections (STIs). While education has proven to be successful, there are still limitations as to who receives the information i n school, and there is controversy as to what is appropriate content for education in schools (Schneider, 2017).

Texas, for example, has ranked in the top five in the nation for the highest number of teen births since 2015.

Martin, Hamilton, Osterman, Dris coll, and Drake (2018) posited that data from Texas showing 31 births per 1,000 women between ages 15 -19. More than 80% of school districts in Texas offer no sex education or provide abstinence only education (W eissert, 2017). Research has shown that child ren provided with sex education are more proactive than those without sex education. Another example showing that education could address problems in society is smoking. As explained above, smoking has decreased in the United States due to education , but a n alarming one in five people still smoke (Schneider, 2017). Education has been extended to advertising. Commercials on television on smoking, driving without a seat belt, driving while using your phone, and the HPV vaccine are tools public health officia ls have used to educate the communities about certain diseases and behaviors in the community. One striking video from the Centers of Disease Control and Prevention (CDC) is Terrie’s video of how she was diagnosed with oral and throat cancer after smoking for most of her life. To view Terrie’s video, access the link below: Center s for Disease Control and Prevention . (2014, June 24). CDC: Tips from former smokers - Terrie don't smoke ad [Video file]. Retrieved from https://www.youtube.com/watch?v=OFQ6YoDAoeY Click here to access the transcript for the above video. Please note: This video includes a very ill woman. If th is disturbs you, please avoid it. Health education is also delivered during doctor visits or by a doctor recommending a community education outreach program. Many more physicians are encouraged to promote patient education and engagement to improve health literacy specifically on diseases that have been diagnosed or could potentially be diagnosed (Paterick, Patel, Tajik, & Chandrasekaran, 2017). When patients are said to be pre -diabetic, for example, their physician could educate and try to establish a rap port with them and make sure that they understand their health and how to change certain lifestyles, especially eating healthier and exercising more. The physician may also refer them to a nutritionist or dietitian to assist in that process. Every governm ent tries to regulate the behavior of their communities through the passing and enforcement of laws. Traffic laws, for example, are meant to reduce the number of roa d accidents. Other laws restrain tobacco and alcohol use in certain areas and during certai n periods (Schneider, 2017). Driving under the influence and smoking at restaurants or in public areas are serious crimes , since both can cause harm to another person. Like any other laws, there is always some controversy. Many people attribute gun violen ce to mental health rather than the easy ability to purchase guns, the types of guns purchase d, and the first amendment rights to regulate who can own what type of guns. W hile these controversies arise, public health officials are always working with the g overnment to make sure that the good of the community is preserved at the end of the day. One controversy that plagued the late 19th century and the early 20th century was the U.S . Government 's attempt to pass prohibition laws. The prohibition laws attempted to ban alcohol due to its connection with so many atrocities in the society like violence, liver problems, and accidents at work, at home, and on roads PUH 5301, Public Health Concepts 4 UNIT x STUDY GUIDE Title (Schneider, 2017). Despite the efforts by the government to regulate these unhealthy behaviors , poor diets, physical inactivity, smoking, and reckless firearm use are still on the rise. Dealing With the Social Determinants o f Health and Minority Populations Social determinants of health (SDOH) are conditions in the places where a community lives, learns, works, and plays, and they encompass how that environment contributes to health risks and outcomes (CDC, n.d. -b). A poverty -stricken community will have limited access to safe neighborhoods and healthy foods. Education rates might also be low as a result of the poverty -stricken area. Some SDOH include low or no income, poor education, unstable or poor housing, unsafe neighborhoods, and unhealthy food. Five determinants of health generally recognized by Healthy People 2020 include health services, s ocial environments, physical environment, individual behavior, and biological or genetic factors (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). While working on these SDOH, it would also be important to work on health equity and health disparity. Health disparities are simply impediments that are historically connected to discrimination or exclusion due to geographic location, ethnicity or race, religion, mental health, socioeconomic status, gender, and sexual orientation (CDC, n.d. -b). In 2014 for example, there were about 14 per 100,000 people diagnosed with HIV/AIDS, and Blacks or African Americans weighed in at about 50% (CDC, n.d. -a). In the same year, more than 55% of patients infected with gonorrhea were diagnosed among African Am ericans. Healthy People 2020 defines health equity as attaining the highest level of health for an entire community (ODPHP, n.d.). This would mean everyone in the community would be equally valued while avoiding inequalities and contemporary and historica l injustice while also eliminating health disparities. Socioeconomic status (SES) is an ultimate health predictor. It is a concept that encompasses occupational status, education, and income, which most of the time are intertwined. SES accounts for most o f the differences in health by marital status, race, and gender as well as education and health insurance. It is believed that education is the key to healthy behaviors. For example, 25% of those without a high school diploma smoked, which is much higher t han the rate of those with at least a bachelor’s degree at 7% (Schneider, 2017) . In addition, 15 -20% of the population who have low SES lack health insurance. In the United States, ethnicity and race play a role in the overall health of the population. Li fe exp ectancy, for example, is about 75 years for Blacks, while it is about 79 years for Whites (Schneider, 2017). Mor eover, Black men die at 2.3 times the rate of White men with prostate cancer. These SES disparities make it extremely difficult for public health interventions to be implemented. Those with low SES are also prone to high levels of stress and lack of social support, particularly within their communities. Stress, for example, is a major contributor to cardiovascular dis eases (Schneider, 2017) . Stressors, like large amounts of debt or lack of money, issues with childcare, unsafe neighborhoods, undependable cars, and others, contribute to unhealthy habits due to frustration or depression. Applying Health Promotion and Disease Prevention Models and Theories Public health cannot necessarily change SES status, social networks/support, and stressors in life, but public health officials need to understand these SES statuses in order to provide better interventions for the community. That usually inv olves applying theories and ecological models of health behavior. The two major theories of health behavior used are the health belief model and the transtheoretical model of change. These models are aim ed at recognizing factors that influence people’s he alth behavior s and using those factors to identify the likelihood that individuals would engage in particular behaviors . Such behaviors include understanding the severity of the change needed and making those changes. An example is the video of people suff ering from consequences of smoking as seen in Terrie’s video. These videos play with the psychological part of individuals’ minds. The ecological model points specifically to interpersonal communications, social environment, community, public policy, and organizational factors that will encourage healthy or unhealthy behaviors. It does not just focus on individual factors that could cause unhealthy behaviors but also on the environment. For example, an individual may be debating about being screened for a mammogram. Then she may talk to a friend who PUH 5301, Public Health Concepts 5 UNIT x STUDY GUIDE Title encourages her to. Then her doctor will refer her to resources in the community that will assist her in preparing for the mammogram exam. Then her insurance will also make sure that it is included in her physica l free of charge. All these factors would contribute to whether she decides to screen for the exam or not. Conclusion Health is a correlation of behavior and attitudes, so public health officials should be able to understand what would influence individu als to live healthy or unhealthy lives. Effective public health interventions should be able to influence individuals’ beliefs to a certain degree so that a favorable social environment would be created to improve healthier behaviors. The San Francisco’s A IDS prevention program, for example, is a great intervention program that has successfully reduced the rates of HIV/AIDS transmission in that community. This is because the intervention focused on the SDOH in the community before implementing the intervent ion. References Centers for Disease Control and Prevention. (n.d. -a). Health disparities in HIV/AIDS, viral hepatitis, STDs, and TB. Retrieved from https://www.cdc.gov/nchhstp/healthdisparities/africanamericans.html Center s for Disea se Control and Prevention. (n.d. -b). Social determinants of health: Know what affects health . Retrieved from https://www.cdc.gov/social determinants/ Hall, K. S., Sales, J. M., Komro, K. A., & Santelli, J. (2016). The state of sex e ducation in the United States. Journal of Adolescent Health, 58 (6), 595 –597. http s://doi.org/10.1016/j.jadohealth.2016.03.032 Martin, J. A., Hamilton, B. E., Osterman, M. J. K., Driscoll, A. K., & Drake, P. (2018). Births: Final data for 2016. National Vital Statistics Reports, 67 (1). Retrieve d from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf Office of Disease Prevention and Health Promotion. (n.d.). Disparities. Retrieved from https://www.healthypeople.gov/2020/about/foundation -health -measures/Disparities Palex66 . (2015). Study, (education) and health care (ID 65555864) [Photograph]. Retrieved from https://www.dreamstime.com Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving health outcomes through patient education and partnerships with patients. Ba ylor University Medical Center Proceedings, 30 (1), 112 –113. http s://doi.org/ 10.1080/08998280.2017.11929552 Schneider, M. -J. (2017). Introduction to public health (5th ed.). Burlington, MA: Jones & Bartlett Learning. Weissert, W. (2017, February 14). Most Texas school districts have scant sex education, study says. STAT . Retrieved from https://www.statnews.com/2017/02/14/texas -sex -education/