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Many youth leaders are compelled to do work with community based non-profit and local public health agencies as both a service learning and philanthropic component in their development as young professionals. However, despite invaluable experiential learning, students often don\'t comprehend key overarching issues such as health disparities, social determinants of health, health policy and community organizing. To address this gap and optimize their community based work, the Health Disparities Student Collaborative (HDSC), a Boston-based student group under Critical MASS for eliminating health disparities and the Center for Community Health Education Research and Service Inc. (CCHERS), developed a curriculum for students designed to broaden their perspectives while working with local public health, non-profit/community organizations and to develop their interest and ability to visualize the power of their collective voice as students and contributors to social justice work. The curriculum utilizes peer education and webinar software and covers three main topics: Current State of Health Disparities, Social Determinants of Health, and Youth Activism on Health Disparities/Social Determinants of Health. HDSC has collaborated with local partners CCHERS/Critical MASS and the Community Based Public Health Caucus (CBPHC) Youth Council to develop this comprehensive “Health Equality Peer Education” training.
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INTRODUCTION TO SOCIAL DETERMINANTS OF HEALTHBy: Travis Howlette B.S., Jeff Wisniowski B.S., MPH and Kelsey Anilionis B.S.
Health Equality Peer Educator Training (HEPE)
HDSC WEBSITE/FACEBOOK
Updates to site affective April 15th: http://enddisparities.org/HDSC/index.html
Join us on Facebook: http://www.facebook.com/#!/hdscneu
SPONSORS
STUDENT SPEAKER
Travis Howlette, Health Science Major (2011), Northeastern University. Pre-MPH/MD.
Jeff Wisniowski B.S./MPH Candidate
Kelsey Anilionis, Health Science B.S., 2011
Aim and Purpose of This Lecture Series
TAKE-AWAYS FROM THIS LECTURE
ACTIVITY: THE GAME OF LIFE
Pick a Piece (announce your piece):
ACTIVITY: THE GAME OF LIFE
Blue: Lives in a 2- bedroom leased apartment, with a family of five (no spouse, a retired grandparent, and three children)
Blue: Went to school but did not finish high school because the first child was born.
ACTIVITY: THE GAME OF LIFE
Red: Lives in a 3- bedroom condo, alone.
Red: Has a high school diploma, no college degree
ACTIVITY: THE GAME OF LIFE
Green: Lives in a four bedroom house, family of five (spouse, and three children)
Green: Has a high school diploma, some college
ACTIVITY: THE GAME OF LIFE
Remember your piece, we will come back to this activity at the end.
SOCIAL DETERMINANTS OF HEALTH
DEFINITION
World Health Organization (WHO): The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.
In our words- Breaking down the word Social: your interactions with the external
environment (your friends, family, places, and different systems)
Determinants: Affecters or indicators… something that is determined or influenced by…
Health: we all know what health is, but we put it in the context of physical, social, spiritual, and mental health.
SOME EXAMPLES
Social Determinants of Health
EXPLANATION OF RACISM
Our context: Similar to Dr. Camara Jones three forms of racism: Internalized: this is the view you have on
yourself. Limiting yourself based on your own personal perceptions to your race (ex: oreo: white on the inside, black on the outside)
Personally- Mediated: this is the one everyone is familiar with. Believing something or acting according to racial perceptions from one person to another.
Institutional: this is a systems approach to racism. Much broader. (ex: voting rights in the 60’s, historical economic differences amongst the race)
ACTIVITY 1: FLOWER POT
Please choose one of the following pots (announce your pot number):
Flower Pot 1
Flower Pot 2
Flower Pot 3
ACTIVITY 1: FLOWER POT
Flower Pot 1 Flower Pot
2Flower Pot 3
ACTIVITY 1: FLOWER POT
Flower Pot 1 Flower Pot
3
POST FLOWER POT ACTIVITY
SUMMARY/REASON FOR ACTIVITY
Pot 1: represents what would be considered white in America (perceived to have better health outcomes, as we learned in the previous webinar). The provision of soil was the emphasis on historical happenings in the U.S. (right to vote, better paying jobs, etc.)
Pot 2: represents the other minorities that tend to be “forgotten” in the discussion of race in America. While the most dynamic and extreme differences are amongst black/white… the concepts of racism are not just a white vs. black battle.
Pot 3: represents the result of inequity, or inequality. Bad soil= bad growing conditions.
QUESTIONS/COMMENTS
So…. Who is responsible?
DIFFERENT APPROACHES
o Different influences based on behavior (more internal)
o healthy eating
oDifferent influences based on systems or society (more external)
o Access to healthy foods
Behavior approach to health
Systems approach to health
EDUCATION AND HEALTH
GRAPH 1: EDUCATION AND LIFE EXPECTANCY
GRAPH 1 SUMMARY
Those with high school or less: 75 years old
Those with at least “some college”: 82 years old
Difference of 7 years
EDUCATION’S IMPACT ON HEALTH
Education can also be correlated with behaviors Smoking rates Teen pregnancy Drug usage
Education can be associated with systems Finances access to health care Employment stability
Game of LIFE
INCOME (SOCIOECONOMIC STATUS)
Socioeconomic Status (SES): is an economic and sociological combined total measure of a person's work experience and of an individual's or family’s economic and social position relative to others, based on income, education, and occupation. In other words: Your social status and economic
status fused together in one word in respect to your power or assets in society.
Example: Lawyer vs. Janitor Game of LIFE example
SES is a big factor in health Why?
FACTS ON ECONOMIC THEORY
Capitalist: the means and production are privately owned and operated for profit This is a popular form of both medical care and
medical insurance in the US
Socialist: A more cooperative or public ownership in business. Focuses on the abolition of hierarchal structures Medicaid and Medicare
WHAT WOULD YOU CLASSIFY YOURSELF AS?
THE UNITED STATES AND SES
Why Economic Theories for this lecture?
Neither capitalism or socialism is the answer, but the two are important to understand and respect in the US when talking about Social Determinants of Health.
THE ENVIRONMENT AND HEALTH
Where you live as a factor of your health. Type of housing: apartment, house, public
housing Suburban, urban (city), rural (farms)
Environmental hazards. Pollution Construction Noise Violence/Crime
VIOLENCE AND CRIME (ENVIRONMENT)
STRESS
We all know what stress is. But how does it affect you other than making you
stay up long hours in the night trying to finish a paper?
Fight or Flight Response Concept (Dr. Michael Lu, UCLA)
WHAT WOULD YOUR REACTION BE?
Type what you would do? Would you pet the big kitty? Would you just accept your fate? Would you hit and run?
Those who wish to pet the tiger…. Your either crazy, love pets, or feel that petting the big angry cat will make him/her like you.
Those who wish to accept their fate… well your not crazy, but you are probably going to get what you wish.
Those who wish to hit and run… This is the most realistic response when you are “frightened”… This is the fight or flight response.
STRESS AND THE ENVIRONMENT
Think about when you are giving a speech or presentation in front of the class. Heart is racing, you feel butterflies in your
stomach, your palms get sweaty. This is a biological response or your body’s way
of saying “get me out of here!”
STRESS AND VIOLENCE
Stress is the same feeling, and has the same affect. Chronic stress Weathering on your body
Those that live in areas of crime and violence tend to be more stressed then those in safer neighborhoods Stress leads to chronic disease (CVD, hypertension, and obesity)
The game of LIFE
ACCESS TO HEALTH CARE/SERVICES Our Health Care system is
flawed… to say the least Privately run Left open to similar
marketing influences as business
More service, more money This social determinant
does not really have much behavioral influence, it is mainly systemic. Transportation Finances Facilities/Service Locations
ACCESS IS NOT THE ONLY ISSUE
Access is just a piece. Quality/Equal Care
Famous study by Harvard: “Unequal Treatment” Four patients (Black/White) who
were actually actors Differences in diagnosis,
difference in prescribed treatment… solely based on race
What does this say about what is called “provider bias”?
Is bias something that people can over come?
ACTIVITY 2: THE GAME OF LIFE
Do you remember your piece?
ACTIVITY 2: THE GAME OF LIFE
Blue: Lives in a 2- bedroom leased apartment, with a family of five (no spouse, a retired grandparent, and three children)
Blue: Went to school but did not finish high school because the first child was born.
ACTIVITY 2: THE GAME OF LIFE
Red: Lives in a 3- bedroom condo, alone.
Red: Has a high school diploma, no college degree
ACTIVITY 2: THE GAME OF LIFE
Green: Lives in a four bedroom house, family of five (spouse, and three children)
Green: Has a high school diploma, some college
ACTIVITY 2: THE GAME OF LIFE
Blue/Red/Green: Due to the economic crisis, all three loss their jobs. At the same time, they all had to go for surgery
to remove their appendix due to appendicitis (infection of the appendix)
ACTIVITY 2: THE GAME OF LIFE Blue: No insurance, had
not filed for medicaid (insurance coverage for those who are below a certain poverty level)
Blue: Loses the apartment and is forced into public housing (projects).
Blue: Remains in public housing (the projects), one child falls victim to a violent crime in the neighborhood
ACTIVITY 2: THE GAME OF LIFE
Red: No insurance (does not meet the poverty level of medicaid).
Red: Loses the condo, is homeless
Red: Eventually…Picked up a managerial job and now lives in a apartment.
ACTIVITY 2: THE GAME OF LIFE
Green: Covered by Blue Cross Blue Shield health insurance (a popular private insurance company)
Green: Spouse provides financial support of the household
Green: Remains searching for a job comparable to the previous job, while the spouse supports the financial needs of the household
POST GAME OF LIFE ACTIVITY
What happened to each person as they went through the exact same issues?
How did it affect their health?
Can you see the relation between education, environment, social support, and finances when it comes to health?
WHAT I HOPED YOU LEARNED