An admirable goal, but a PHS 795 student notes the limitations of focusing on disease rather than determinants of health. She writes:
I came across this article while reading the BBC news. Zuckerberg and Chan recently created a Chan Zuckerberg Initiative, pledging 3 billion dollars to “cure prevent or manage all diseases by the end of the century”. While this is a very generous financial contribution to biomedical research, he and his wife are making a large claim that I’m not buying. They are looking at “disease” in a very narrow biological sense without taking into account the social determinants of health. It goes back to Evans and Studdart’s article “Producing Health, Consuming Healthcare” where they critique the healthcare system for focusing too heavily on expensive and timely healthcare interventions rather than addressing larger social conditions. If Zuckerberg is going to cure, prevent or manage all disease, this megabillionaire needs to come up with a plan to fix things like poverty, the housing crisis, and unemployment, all in a decade.
Here’s an article that ties together many of the themes we have been discussing (and some we are about to discuss) — from fetal brain development and early childhood origins of disease to economic choice and behavior. Can a policy intervention as simple as transferring cash from wealthy areas to poor areas improve long term outcomes? PHS 795 student Alexandra Bryant writes:
Dr. Jim Yong Kim, President of the World Bank, says that childhood stunting is not only an issue of decreased height, but it also leads to diminished mental capacity in children. He calls health professionals around the world to start paying more attention to this issue and innovative ways to combat this problem. Dr. Kim continues to say that the diminished mental capacity further leads to negative consequences in social capital for the entire nation those children live in.
In Peru, policial and social instabilities in the 1990s are believed to have contributed to 1 in every 3 children suffering from effects of chronic malnutrition. I applaud Dr. Kim for his retrospective look at SES and political factors that contributed to damaging health outcomes. There was a turn from 2007-2015; however, Peru cut stunting by half – from 29% to 14% through the use of conditional cash transfers. This brought my attention back to Dr. Robert’s lecture and her brief example about moving families out of poor neighborhoods, or providing money to families to improve their health. Peru did it right: the conditions were pre- and post-natal care, child vaccinations, supplements (folic acid, iron, Vit A) and older children had to be in school at least 85% of the time. The Juntos project invested in human capital in a major way, and incentivized health behavior improvements to an extremely successful end. I implore communities in the US to look into programs such as these that provide resources and establish accountability in efforts to increase wealth, and therefore, health.
Following on our discussion from Chapter 7 of Evicted, a PHS student writes:
Last week was Prescription Opioid and Heroin Epidemic Awareness Week, and the Obama administration emphasized the necessity for congress to fully fund a $1.1 billion effort battling the opioid and heroin addiction crisis. Among interventions geared towards expanding access to treatment, facilitating research, monitoring prescription distribution, improving mental health and substance use disorder treatment, advancing physician engagement, disposing of opioids safely and assisting rural and tribal communities was also facilitating housing support for the recovering population. I find this last portion that targets the housing environment extremely important as it likely draws many parallels to the “Evicted” chapter we all read. I also find this article interesting given it is an example of how large policy initiatives originate. The number of different organizations that fall under the web of the federal government and are prominent players is astonishing, as noted by the myriad councils, departments, administrations and services mentioned in the article. I will be very interested to see what congress decides!
More recent news reiterating the importance of this topic and more focused initiatives can be found on all major news venues. The link provided details an overview of the plan as of July 2016.
Note in particular the plan to address homelessness as an integral component of opioid and heroin use disorders. This echoes calls to establish “housing first” as a way to stabilize individuals so they can address their health needs (see for example, United Way of Dane County’s program here: https://www.unitedwaydanecounty.org/housing-first/).
PHS 795 student Lisa Charron brings attention to a study in the Chicago Public Schools using mindfulness interventions to improve educational outcomes (and eventually, health).
There is convincing evidence that chronic stress at least partly explains the connection between socio-economic status and health (both mental health and physical health). I’ve long been interested in mindfulness and have experienced both personally and second-hand the transformations in self regulation, emotional awareness, and coping that mindfulness practice can elicit. Studies on mindfulness have proliferated over the last few years, but none quite so large as the one described in this article. With so much research interest in both mindfulness and the poverty-stress-health connection, it seems an obvious extension to test whether or not mindfulness practice can successfully protect children from the deleterious effects of poverty-induced stress. I’ve read about studies that test the effectiveness of mindfulness-based interventions on youth and on underprivileged youth, but I’ve never read a study that compared the effect sizes for people of different socio-economic statuses. If I could encourage the researchers in this new study to look at one thing, it would be that. I also just read that SAMHSA awarded $5 million to Baltimore City for a combination of mindfulness/yoga, community building, and youth development programs. Seems like the Baltimore Health Department (and SAMHSA) have been reading the research connecting stress and social capital to health disparities, and are acting on it.
In this part of the course, we are learning how deep and strong the connections between socioeconomic status and population health really are. A number of factors (culture, institutional and public policy, individual beliefs and behaviors) have led to stratification of our local community in Madison; stratification that has produced and deepened disparities in health. Poverty is a concept that can be defined at multiple levels and has effects at multiple levels: individuals and communities can both suffer from poverty.
A PHS 795 student found an example of local stakeholders stepping up and calling for action to reduce poverty in the Latino community of Madison. They write:
Dane County Latino leaders issue call to action
This article relates to the lecture last week about socio-economic status, poverty, and health. It’s about how Latino community leaders in Madison are advocating for a “holistic, multi-generation strategy” to reduce poverty. The article explains how the Latino community is the largest non-white demographic in Madison, but they earn less than 46 percent of what white households earn. The Latino community has a 30 percent high school graduation rate and an increasing poverty rate. This local issue fits the Grossman model as discussed in lecture due to the incorporation of income, education, and racial groups. The community has goals to eliminate disparities in Madison such as increasing youth education services and providing more preventive health education programming.
Retirement is a fascinating area of discussion for its population health implications. The culmination of a life of experience both inside and outside of the formal workplace, retirement represents a critical life transition. It is both determined by and a determinant of health. Socioeconomic status also dictates the timing and terms of our retirement — key determinants being whether we have personally accrued enough economic resources to maintain an acceptable standard of living (including health), and whether or not social supports (including availability of health care) are available to allow retirement. For those of you interested in a research career, the Health and Retirement Study has served as an excellent source of data on this topic.
A PHS 795 student found this excellent discussion of the interaction between SES, health and retirement. They write:
||When Retiring Early Is Not a Choice
Both job prospects and health are increasingly tilted in favor of those who are relatively high on the ladder.
This article discusses the implications of health on the ability to retire early. As several articles we have read discussed, those with the lowest SES in our population often are faced with worse health outcomes. Working longer would provide more necessary income from Social Security, but due to their poor health, those that most desperately need this money do not have the luxury of pushing back their retirement. I thought this was a difficult situation that shows the struggle of poverty and health in a real-life application. In addition, it demonstrates the lack of policy action to address the issue, which is a problem we are also learning more about as we continue our public health studies. Here is a link to the original study as well:
PHS 795 student Kerry Zimdars writes:
This article is about an outbreak of Hand, Foot, and Mouth disease that was just identified on the Florida State University campus. It’s a bit unique as this is an infection seen more often in children. However, the recent environmental condition changes caused by the hurricane may help explain why we are now seeing this outbreak amongst a less common demographic. Not only is the physical environment involved but also the social environment–for example, people being crowded together at home making transmission easier. It ties into our discussion of the interacting and complex nature of the determinants and factors of health.
Hand, foot and mouth outbreak strikes Florida university
So, here’s a question for you all. Given what we have learned about the importance of interactions between individual and environmental factors, what kind of interventions should FSU consider to get this under control? How might other schools have plans in place to prevent outbreaks?
Very interesting article suggested by PHS 795 student David Mallinson. David writes:
Our discussion on Tuesday about applications of the Social Ecological Framework reminded me of an NPR long piece on suicide in Greenland (published April 2016): http://www.npr.org/sections/goatsandsoda/2016/04/21/474847921/the-arctic-suicides-its-not-the-dark-that-kills-you
Greenland has the highest annual suicide rate in the world at 83 cases per 100,000 people (it’s nearly double that of Guyana, which has the second highest rate at ~44 cases per 100,000 people), and this investigation suggests that Denmark’s* decision to shut down small villages and centralize Greenland’s Inuit population in the 1960s-70s was the causal mechanism to this crisis (read more about centralization here: http://greenlandtoday.com/urbanization/?lang=en). The mass centralization was an “unprecedented cultural interference” that attempted to assimilate Inuit communities to Danish culture (children were pressured to speak Danish at school, the absence of physicians who spoke their native language, etc.) while simultaneously segregating them by moving them into concrete apartment blocks. As a result, younger generations of Greenland’s Inuit population felt stripped of their identity — disconnected from their heritage but unaccepted by urbanized Greenlanders — and that rift degraded their communal and familial support systems. This breakdown spurred increased child neglect, physical abuse, and alcoholism, all of which are associated with suicide. In the context of the Social Ecological Framework, I believe this phenomenon to be a relevant and explicit example of how an institutionalized culture shock prompt a public health dilemma.
*Note: Greenland ceased being a colony of Denmark in 1953. Although autonomous, it is not entirely independent as it is part of the Danish Realm. I’m not familiar enough with the topic to provide greater details.
A PHS 795 student writes:
Displaying an interesting relationship to findings from the Moving to Opportunity Housing Mobility Experiment described in Dr. Stephanie Robert’s lecture, a study in the department of psychiatry at the University of Michigan found that fear of violence in neighborhoods at age 15 was predictive of increased BMI a decade later for females, but not for males. Just as males were less likely to be positively influenced by a change in neighborhood in the Moving to Opportunity Housing Mobility Experiment, males were less likely to be negatively influenced by negative aspects of their neighborhoods in this study. It would be interesting to study what the contributing factors may be to male resilience to the positive or negative effects of their surroundings. Another interesting detail of the experiment was that victims or observers of violence did not display the same prediction of BMI as those who simply feared violence. A follow-up study as to how chronic vs acute fear plays into body weight may be useful to understanding the effects of neighborhoods on physical and mental wellbeing. This study reinforces the idea that your neighborhood can be a key factor in predicting your health outcomes, even years after you have moved away.
Interesting observation about fear possibly playing a role (mediator? moderator?). It reminds me of work by PHS graduate Dr. Abiola Keller that suggested stress was associated with morbidity and mortality but only for those who believed that stress was harmful to health (we will see a related video in Dr. Paul Creswell’s upcoming lecture). It also reminds me of this:
“I must not fear.Fear is the mind-killer.Fear is the little-death that brings total obliteration.I will face my fear.I will permit it to pass over me and through me.And when it has gone past I will turn the inner eye to see its path.Where the fear has gone there will be nothing. Only I will remain.” (Frank Herbert. Litany Against Fear. Dune)
(but then again, I am a total nerd)
PHS 795 student Scott Reetz writes:
Dr. David Blumenthal of the Commonwealth Fund has authored a prospective paper in the most recent issue of the New England Journal of Medicine which I found to be a current example representing the public health frameworks discussed in class. In the article, Dr. Blumenthal raises the concern that in our current health care environment, 5% of patients account for 50% of healthcare expenditures in our country – a figure that is likely to worsen according to his estimations. These High Need High Cost patients, as he labels them, represent a diverse population of patients and as such requires an equally diverse understanding of these patients’ varying health care needs and the factors contributing to their ailments. I found this article particularly optimistic because Dr. Blumenthal felt confident that the transition from a fee-for-service reimbursement model to a value-based payment system in American healthcare may incentivize providers to take a more collaborative multi-disciplinary approach to target the social support and environmental factors that have led to adverse health outcomes for these patients. There is an accompanying interview with Dr. Blumenthal that I found to be equally thought-provoking, as well.