Intro to Public Health

❤️‍🩹Intro to Public Health Unit 5 – Social & Behavioral Health Determinants

Social and behavioral health determinants shape our well-being from birth to death. These factors, like income, education, and environment, influence health outcomes and contribute to disparities between different groups. Understanding these determinants is crucial for addressing health inequities. By examining social factors, behavioral risks, and intervention strategies, public health professionals can work towards creating healthier, more equitable communities for all.

Key Concepts and Definitions

  • Social determinants of health encompass the conditions in which people are born, grow, live, work and age
  • Health equity is the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically
  • Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged populations
  • Behavioral risk factors are habits or behaviors that increase an individual's likelihood of developing a disease or injury (smoking, poor diet, lack of physical activity)
  • Social epidemiology is the study of the distribution and determinants of health and disease in human populations, with a focus on the role of social factors
    • Examines how socioeconomic status, race/ethnicity, gender, and other social factors influence health outcomes
  • Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
  • Social capital refers to the networks of relationships among people who live and work in a particular society, enabling that society to function effectively

Historical Context

  • In the 19th century, public health focused on sanitation and controlling infectious diseases through measures like quarantine and vaccination
  • The 20th century saw a shift towards addressing chronic diseases and recognizing the role of lifestyle factors (diet, exercise, smoking)
  • The Alma-Ata Declaration of 1978 emphasized the importance of primary healthcare and identified social, economic, and political determinants of health
  • The Ottawa Charter for Health Promotion (1986) highlighted the importance of healthy public policy and creating supportive environments for health
  • The WHO Commission on Social Determinants of Health (2005-2008) drew global attention to the impact of social factors on health and the need for action across sectors
    • Called for closing the health gap between socioeconomic groups within a generation
  • The Rio Political Declaration on Social Determinants of Health (2011) reaffirmed global commitment to addressing social determinants and achieving health equity

Major Social Determinants of Health

  • Socioeconomic status (income, education, occupation) is a key determinant of health, with lower SES associated with poorer health outcomes
    • Influences access to resources, exposure to stressors, and health behaviors
  • Race/ethnicity is associated with health disparities, often due to systemic racism and discrimination
    • Racial/ethnic minorities often experience worse health outcomes compared to majority populations
  • Gender influences health through biological differences, social roles and expectations, and differential access to resources and power
  • Social support and social networks can buffer the impact of stress and promote healthy behaviors
  • Early childhood experiences and development lay the foundation for lifelong health
    • Adverse childhood experiences (ACEs) are associated with increased risk of chronic diseases and mental health problems in adulthood
  • Neighborhood and built environment factors (housing quality, access to healthy food, green spaces) influence health behaviors and outcomes
  • Access to quality healthcare services is essential for preventing and managing health conditions

Behavioral Factors Influencing Health

  • Tobacco use is a leading cause of preventable death and disease (lung cancer, heart disease, stroke)
  • Poor diet and lack of physical activity contribute to obesity, diabetes, and other chronic conditions
  • Excessive alcohol consumption can lead to liver disease, cancer, and injuries
  • Sexual behaviors (unprotected sex, multiple partners) increase the risk of sexually transmitted infections and unintended pregnancies
  • Sleep habits (insufficient sleep, poor sleep quality) are associated with obesity, diabetes, and cardiovascular disease
  • Stress management and coping strategies influence mental and physical health
    • Chronic stress can lead to inflammation, weakened immune function, and increased risk of chronic diseases
  • Adherence to medical treatments and preventive measures (vaccination, screening) is important for managing and preventing health conditions

Health Disparities and Inequities

  • Health disparities are often rooted in social, economic, and environmental disadvantages
    • Poverty, discrimination, and lack of access to resources contribute to health inequities
  • Racial/ethnic minorities often experience higher rates of chronic diseases (diabetes, hypertension), infant mortality, and shorter life expectancy compared to white populations
  • Rural populations may face barriers to accessing healthcare services and have higher rates of certain health problems (obesity, tobacco use)
  • Sexual and gender minorities (LGBTQ+ individuals) experience disparities in mental health, substance use, and access to culturally competent care
  • Individuals with disabilities may face barriers to accessing preventive services and have higher rates of chronic conditions
  • Health literacy disparities can lead to poorer health outcomes and less effective use of healthcare services
    • Limited English proficiency can be a barrier to accessing and understanding health information

Theoretical Models and Frameworks

  • The social-ecological model emphasizes the interplay between individual, interpersonal, community, and societal factors in shaping health behaviors and outcomes
  • The life course perspective recognizes the cumulative impact of social, economic, and environmental factors across the lifespan
    • Critical periods (early childhood, adolescence) can have lasting effects on health
  • The fundamental cause theory posits that social conditions are the root causes of health inequities, as they shape access to resources and exposure to risk factors
  • The health belief model focuses on individual perceptions and beliefs (perceived susceptibility, severity, benefits, barriers) as determinants of health behaviors
  • The theory of planned behavior emphasizes the role of attitudes, subjective norms, and perceived behavioral control in shaping intentions and behaviors
  • Community-based participatory research (CBPR) involves collaboration between researchers and community members to address health issues and promote health equity
    • Emphasizes community engagement, shared decision-making, and action-oriented research

Research Methods and Data Analysis

  • Observational studies (cohort, case-control, cross-sectional) are commonly used to investigate associations between social factors and health outcomes
    • Cohort studies follow a group of individuals over time to assess the incidence of health outcomes
    • Case-control studies compare individuals with a specific outcome (cases) to those without the outcome (controls) to identify potential risk factors
  • Randomized controlled trials (RCTs) are used to evaluate the effectiveness of interventions in reducing health disparities
  • Mixed-methods approaches combine quantitative and qualitative data to provide a more comprehensive understanding of social determinants and health outcomes
  • Geographic information systems (GIS) are used to map and analyze the spatial distribution of health outcomes and social determinants
  • Health impact assessments (HIAs) are used to evaluate the potential health consequences of policies, programs, and projects
  • Statistical methods (regression analysis, multilevel modeling) are used to examine the relationships between social factors and health outcomes while controlling for potential confounders

Interventions and Policy Approaches

  • Health in All Policies (HiAP) is an approach that systematically considers the health implications of decisions across sectors (education, housing, transportation)
  • Place-based interventions target specific geographic areas (neighborhoods, communities) to address social determinants and improve health outcomes
    • Examples include community development initiatives, built environment interventions, and school-based programs
  • Policy interventions aim to create healthier environments and reduce health disparities through legislation, regulations, and resource allocation
    • Examples include tobacco control policies, nutrition standards for school meals, and affordable housing initiatives
  • Healthcare system interventions focus on improving access to and quality of care for underserved populations
    • Examples include expanding insurance coverage, implementing cultural competency training for providers, and establishing community health centers
  • Community-based interventions engage community members in the planning, implementation, and evaluation of health promotion programs
    • Examples include peer support programs, community health worker initiatives, and faith-based interventions

Case Studies and Real-World Applications

  • The Adverse Childhood Experiences (ACE) Study demonstrated the long-term health impacts of childhood trauma and has informed interventions to prevent and mitigate the effects of ACEs
  • The Whitehall Studies of British civil servants revealed the social gradient in health, with lower occupational status associated with higher rates of chronic diseases and mortality
  • The Moving to Opportunity experiment provided low-income families with vouchers to move to higher-income neighborhoods, resulting in improved mental health and well-being for adults and children
  • The Healthy Food Financing Initiative (HFFI) has supported the development of grocery stores and other healthy food retailers in underserved communities, increasing access to nutritious foods
  • The Community Asthma Initiative in Boston has reduced asthma-related hospitalizations and emergency department visits among children through home visits, education, and environmental assessments
  • The Nurse-Family Partnership program provides home visits by nurses to low-income, first-time mothers, improving maternal and child health outcomes

Future Directions and Challenges

  • Addressing the root causes of health inequities will require sustained, multi-sectoral efforts to improve social, economic, and environmental conditions
  • Climate change poses significant threats to health, particularly for vulnerable populations, and will require adaptation and mitigation strategies
  • The COVID-19 pandemic has highlighted and exacerbated existing health disparities, underscoring the need for equitable public health responses and long-term investments in social determinants
  • Advances in technology and data science offer opportunities for better understanding and addressing social determinants, but also raise concerns about privacy and potential misuse
  • Implementing evidence-based interventions and policies at scale will require political will, resources, and community engagement
  • Evaluating the long-term impact of interventions on health equity will require robust monitoring and evaluation systems and a commitment to continuous improvement
  • Building a diverse and culturally competent public health workforce is essential for effectively addressing social determinants and promoting health equity


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© 2024 Fiveable Inc. All rights reserved.
AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.