POWERPOINTS TO ACCOMPANY
A Population Health Approach to Health Disparities for
Nurses: Care of Vulnerable Populations
Faye A. Gary & Marilyn J. Lotas
EDITORS
Chapter 4: Major Public Health Issues
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Learning Objectives
1. Describe the CDC SDOH framework as an organizing framework for major public health problems.
2. Examine the impact of the specific social determinants of economic stability, social and community
context, and neighborhood and built environment on persistent health disparities that are related to the
selected major public health issues.
3. Describe the relationship of racism with economic stability, social and community context, and the built
environment.
4. Discuss how poverty, unemployment, and underemployment relate to child and family health.
5. Explain how housing instability affects health outcomes including mental illness, chronic health
conditions, substance use, and high-risk health behaviors.
6. Identify the specific interventions, advocacy strategies, and research that public health professionals
can develop and implement to address economic stability, social and community context, and the
neighborhood and built environment as related to public health issues.
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Social Determinants of Health Discussed in this Chapter
I. Economic Stability
II. Social and Community Context
III.
III. Neighborhood and Built Environment
I.
II.
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Racism
• Racism is an integral factor in the SDOH and is defined as:
1. “a system of dominance, power, and privilege based on racial Racism
group designations;
2. “rooted in historical oppression of a group defined or perceived by Education Health Care
dominant group members as inferior, deviant or undesirable Access and Access and
Quality Quality
3. “occurring where members of the dominant group create or Neighborho
Economic od and Built
accept their societal privilege by maintaining structures, Stability Environmen
t
ideology, values, and behaviors that:
Social and
4. “have the intent or effect of leaving the non-dominant group Community
Context
members relatively excluded from power, esteem status and/or
equal access to societal resources”
(Harrell, 2000; Hicken et al., 2018)*
*Reference found in Chapter 4 Reference List
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SDOH
Economic Stability
Employment
The components of Economic
Stability are: Poverty
Food
Economic Insecurity
Stability
Instability
Housing
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2021 POVERTY GUIDELINES FOR THE 48 CONTINGOUS STATES AND THE DISTRICT OF COLUMBIA
For families/households with more than 8 persons, add $4,540 for each additional person
PERSONS IN FAMILY/HOUSEHOLD POVERTY GUIDELINE
1 $12,800
2 $17,420
3 $21,960
4 $26,500
5 $31,040
6 $35,580
7 $40,120
8 $44,660
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What is ALICE?
• ASSET LIMITED
• No safety net for emergiences
INCOME
ASSETS LIMITED
CONSTRAINED EMPLOYED
No safety net for
Can’t Afford Basic Working, but can't
emergencies
Necessities afford the cost of
living
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Major Health Issues Related to Economic Stability
• Financial uncertainty and poverty have been shown to have significant negative impacts on
health including stress related conditions including depression and maternal child outcomes.
• Families living with economic instability often have limited safe space for outdoor activity,
high adult unemployment and to attend schools with limited resources which perpetuates the
conditions leading to poverty.
• Unemployment and Underemployment both lead to limited access to health care.
• Children without safe space for outdoor activity and with food insecurity are vulnerable to
developing early onset obesity, a precursor to many adult health problems.
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Social and Community Context and Health: Social Cohesion
Social Cohesion can be defined as:
1. “the vertical and horizontal interaction among members of society that include:
a. Trust
b. Sense of belonging
c. Willingness to participate and help.” **
OR
2. “extent of connectedness and solidarity among groups in society” and includes:
a. “a sense of belonging to a community
b. the relationships among members within the community itself.” ***
** Chan and Chan (2006, p. 290)
***Kawachi and Berkman (2000) References are found in the Chapter 4 Reference List
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Major Health Issues Related to Social and Community Context
• A sense of community and belonging appears to have a protective effect against physical and
mental disease.
• Social cohesion may also impact the ability of older adults in the community to live
independently in their homes by supporting their ability to perform essential activities of daily
living (ADL).
• A sense of community may mitigate against a sense of isolation, reduce stress and incidence
of depression.
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Determinant III: Neighborhood and Built Environment
Components of Neighborhood and Built Environment Include:
Open space/green space/parks
Quality of housing/condition and cleanliness of streets
Pollution/toxic substances/noise pollution
Violence and safety of the neighborhood
Availability of services including Healthcare, transportation, markets
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Major Health Issues Related to Neighborhood and Built Environment
Impact of Neighborhoods and Built Environment on Health
• Living in neighborhoods close to toxic waste and air pollution leads to increased incidence of childhood
asthma. Lead poisoning rates are much higher in areas of older housing, higher % of rental units.
• Availability of transportation, healthcare facilities and supermarkets has a positive effect on overall health.
• Availability of greenspace is associated with lower levels of aggression and violence, improved stress
response to experiencing violence. It also mitigates urban heat, air pollution, and is associated with
decreased mortality from cancer, respiratory conditions and renal disease.
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WAYS TO SUPPORT THE SDOH
Community and Society
Support initiatives to
Levels improve healthcare
of
Support
Healthcare System
Advocate for Social Policies
that improve healthcare
Individual
Incorporate SDOH into
Patient History
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