March 8, 2015

Health services determinants have the strongest influence on individual health status and outcomes.  Therefore, health-care professionals need to develop their practice to influence health service determinants in order to decrease the prevalence of diseases. Cardiovascular disease affects a disproportionate number of racial and ethnic minorities, many of whom possess a higher incidence of cardiovascular disease risk factors (American Heart Association, n.d.).  According to Healthy People 2020, the leading modifiable risk factors for heart disease and stroke include: high blood pressure, high cholesterol, cigarette smoking, diabetes, poor diet, physical inactivity, being overweight, and obesity (Healthy People 2020, 2013). Each of these risk factors is difficult, if not impossible, to modify without access to quality health services. The Nebraska Heart Disease and Stroke Plan recognizes this issue by addressing health disparities in targeted populations. Priority populations include African Americans, Native Americans, and low socioeconomic populations (Nebraska Department of Health and Human Services, 2007).  Provision of high quality, low cost health-care services to these underserved populations is an example of a modifiable health service determinant.  

According to the American Heart Association (AHA) (n.d.), more than half of the uninsured are people of color.  Additionally, members of minority groups are less likely to have a regular source of medical care. The AHA also acknowledges that possession of health insurance improves individuals’ access to and quality of health care services.  Therefore, lack of a health insurance and a primary health-care provider places these individuals at higher risk for health complications (American Heart Association, n.d.).  Other underserved populations of interest include: Hispanics, rural Nebraskans, women, and middle aged adults (Nebraska Department of Health and Human Services, 2007).  According to WHO (n.d.), access to and utilization of health-care services is a major health service determinant that could be improved by providing all individuals with health insurance.  The provision of health insurance to all Americans can not only ensure every individual has access to quality health-care services but also greatly reduce the incidence of cardiovascular disease and other health disparities.  According to Kreatsoulas and Anand (2010) the social determinants of health share a large responsibility for the inequalities in health, and therefore may be a factor in the rise in cardiovascular disease around the world.

With regard to access to health services and primary care, studies have shown that in areas with fewer primary care physicians and limited access to primary care,  rates of hospitalizations have increased (American College of Physicians, 2008).  Numerous studies evaluating the role of health services on the health of populations have found that by enhancing primary care, establishing a strong primary care system, and practice characteristics have a beneficial impact on the population’s health and longevity (Tyrovolas, Polychronopoulos, Tountas, & Panagiotakos, 2010).  Finally, the American College of Physicians (2008) states that with increased primary care physicians populations have better health outcomes, including decreased mortality from cancer, heart disease, or stroke and a better lifespan.

March 8th, 2015

According to the Centers for Disease Control (2015), health inequalities exist within societies that increase the risk of health disparities and poor health outcomes. The United States government created an initiative called Healthy People 2020 that identified many categories consisting of factors that affect the quality of health among populations (Healthypeople.gov, 2015). These categories include social factors, individual behaviors, genetics, and health services. All of the categories are important, interconnected, and all influence health. Some public agendas focus on health services and ensuring people have access to adequate health services as the biggest factor influencing the health of a population. However, giving people access to care does not ensure that the population will receive health care and that it will eliminate disparities. Several social determinants need to be addressed first, such as education, income, culture and beliefs about whether they want to use the health care they have access to.

According to the CDC (2015), social conditions and the economy not only affect the risk of illness but also how to treat illness after it occurs. Simply providing access to health services will not eliminate the social risk factors and discrimination that leads to poor health outcomes. Some examples of social determinants include the physical environment, exposure to environmental toxins or crimes, access to quality foods and social support, and availability of resources such as schools, transportation, and jobs. These examples lead to increased risk of diseases and epidemics such as cancer, asthma, lead toxicity, or obesity. Other examples of social determinants include social norms and attitudes or physical disabilities that relate to discrimination. The points in this debate will examine how discrimination and environmental factors of social determinants are key contributors that negatively impact a population’s health.

March 8, 2015

Individual health outcomes can be highly influenced by a person’s racial/ethnic group.  Discrimination is a large determinant of health. Williams & Jackson (2005) compare the white vs. black population differences on issues such as mortality, education, socioeconomic status, and medical illnesses. Black death rates today are comparable to white death rates 30 years ago.  In 2000, homicide death rates were six times higher in blacks than whites. Death rates from coronary disease are also higher in blacks than whites.  Blacks have a higher incidence of cancer, lower education levels, and higher levels of chronic stress (Williams & Jackson, 2005).

“All of the indicators of SES are strongly patterned by race, such that racial differences in SES contribute to racial differences in health” (Williams & Jackson, 2005, p. 2). The minority population tends to have a lower income than their white counter parts.  SES directly influences access to education and employment. “Because of segregation, middle-class blacks live in poorer areas than whites of similar economic status, and poor whites live in much better neighborhoods than poor blacks” (Williams & Jackson, 2005, p. 3). The neighborhood in which one lives has an impact on their health. Less affluent neighborhoods tend to have less access to healthy food options.  Tobacco and alcohol companies tend to market themselves more in these areas as well.  Finally, lower income neighborhoods have fewer recreational facilities to choose from. Therefore, people tend to exercise less (Williams & Jackson, 2005). An individual’s health can be influenced by their access to health services.  However, in order to solve many of these disparities against minorities, specifically African Americans, discrimination must end. 

March 10, 2015

A key contributing factor to social determinants of health is the physical environment in which people live. Since the 19th century, the increase and improvement in life expectancy has been related to environmental living conditions, such as improved nutrition, sanitation, and clean water (Braveman & Gottlieb, 2014). Providing adequate health care facilities and universal health insurance still does not address the issue that environmental social determinants plays in the health of the population. The list of negative health effects from environmental social determinants resulting in disease and illness is cumbersome. Neither health care providers, the government, nor the general public are prepared for the impact of environmental health. Environmental exposures from air and water pollution, chemicals and toxins in consumer products and foods all place the population at risk for disease and illness (Cowen & Moorhead, 2011).

For example, living in unsafe neighborhoods has a negative effect on the physical activity of the population, thus putting them at risk for obesity, hypertension, diabetes, and stroke. “Exposure to violence can increase the likelihood that young people will perpetrate gun violence” (Braveman & Gottlieb, 2014, p. 23). Living in an area with poor shelter or no access to clean, healthy foods will decrease the population’s health and will continue to suffer year after year. Cancer is one of the leading causes of death in many Americans. Research has linked cancer to stressful situations and exposure to toxins. Living in poor neighborhoods where crime is high and the housing is below adequate is stressful on an individual. Toxins, chemicals, and added preservatives added into American's foods and products can build up in the body and lead to immune depression, thus resulting in diseases like cancer (WHO, 2015). Infant mortality, lead exposure, and high STD and HIV rates have been linked to people living in lower socioeconomic statuses, thus resulting in poorer physical living conditions. “For instance, lead ingestion in substandard housing contributes to low cognitive function and stunted physical development in exposed children; pollution and allergens, also more common in disadvantaged neighborhoods, can exacerbate asthma” (Braveman & Gottlieb, 2014, p. 22). Environmental pollution and tobacco use in lower socioeconomic populations has been known to cause exacerbations of asthma in children and adults. These examples are just a small portion of poor health outcomes and diseases caused and affected by social determinants.