Greetings, all! This is where students from the Public Health Institute will be posting their "homework." Check out the comments section to find a host of references, links and resources that document the intersection of place, systems/structures/environments, bias AND health.
More framing of this work to come!
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Shaylene Baumbach
ReplyDeleteTitle: TOBACCO RETAILER NUMBER, DENSITY & LOCATION- Effects on Youth and Other Vulnerable Populations
Link: http://www.tobaccopolicycenter.org/documents/Number%20Density%20Location_Oct%202013.pdf
Whether you are a parent or simply know a child or young adult, we have all at one point explained to them the various ways to stay healthy. We take pride in knowing that we have taught our younger generation facts that many of us wish we had known while we were growing up. It frustrates many then, to learn about industries that are specifically targeting our children and trying to reverse all that we have taught them.
One specific industry that continues to work hard to target our children is the tobacco industry. If a person does not start using tobacco by the age of 18, they probably never will start. Nobody understands this better than the tobacco industry.1 It is urgent then, for the tobacco industry to glamorize tobacco usage to those under 18. With tobacco retailers being a major hub for adverting and marketing of their product it is no surprise that they would focus their efforts heavily around schools. Sadly, this method is working for the industry as research shows that schools with higher rates of student smoking tend to be surrounded by a larger number of tobacco retailers in the neighborhood around the school. 1
We continue to educate our children about tobacco’s harm, however, their walk to and from school every day tries to discredit all that they have learned. It is important for all of us to start noticing the tobacco industry’s tactics. With support from local and state government, policies focused on zoning ordinances to restrict tobacco retailers or the amount of tobacco advertising from areas frequented by children would reduce the number of children exposed and misled by the tobacco industry’s shameless ploy to addict our children into becoming their new customer.
Source:
1. TOBACCO RETAILER NUMBER, DENSITY & LOCATION- Effects on Youth and Other Vulnerable Populations retrieved on June 6, 2014 from http://www.tobaccopolicycenter.org/documents/Number%20Density%20Location_Oct%202013.pdf
John Fieger
ReplyDeleteHow to Close the LGBT Health Disparities Gap
http://americanprogress.org/issues/lgbt/report/2009/12/21/7048/how-to-close-the-lgbt-health-disparities-gap/
This article provides data on the multitude of health disparities that LGBT face. Many of these issues are rooted in the fact that society has not fully accepted homosexuality/non-traditional sexual orientations. For example, LGBT people are less likely to have health insurance due to workplaces lack of insurance for same sex partnerships (Things have improved since this article has been written but many states still don’t recognize gay marriage). In addition, discrimination in the workplace may result in LGBT people being fired for no reason other than being gay.
The other major issue that LGBT people face is the psychological impact of society’s negative views of them. This manifests in a much higher risk of suicide, increased drug use, a higher probability of getting into fights and an overall increase of risky behavior in LGBT youth. As stated by the article, these feelings are often a result of the “adverse, punitive, and traumatic reactions from parents and caregivers in response to their children’s LGB identity”. The health disparities faced by LGBT people are amplified by those who are also part of an ethnic/racial minority. Unfortunately, they often must deal with the social stigmas imposed by society and the concurrent issues of poverty. The article comments on the lack of health data for the LGBT community and suggests that this must change in order to begin to address the multitude of health disparities that exist. Improved data can be used to create better government programs to help the LGBT community.
Overall I don’t believe this article does a great job of using framing and instead it mostly just lists the facts. However, it is written in a way that does not “blame” LGBT people for their health issues and instead focuses on the social and environmental problems that lead to them. Lastly, the use of “LGBT” instead of gay/queer/homosexual may help to lessen some of the negative emotions/thoughts that may be invoked by people (especially since those words are often used as insults).
Justine O’Malley
ReplyDeleteTitle - Racism: Combating the root causes of health disparities
Link - http://www.gih.org/usr_doc/Issue_Focus_Racism_4-19-10.pdf
Citation: Grantmakers in Health. “Racism: Combating the Root Cause of Health Disparities.” Issue Focus. 19 April 2010, pg 1-3.
This article discusses racism and how it leads to health disparities. It defines racism and gives specific examples of health outcomes. It also includes examples of funders and the programs that they have created to help eliminate racism. It concludes by saying racism needs to be discussed in order to end the associated disadvantages and that this will require patience and funders/stakeholders. This article exemplifies structural bias and how it has led to health inequalities. It points out that minorities have been persecuted before and after the civil rights movement. Even after desegregation, structural bias created residential areas where only minorities could live. These neighborhoods are in located in areas with increased exposure to pollutants and environmental toxins. Additionally, it leaves the people living there with limited access to health care facilities, transportation, recreation, and food. These isolated communities also limit peoples educational and employment opportunities. Thus, there is increased violence and crime in addition to a low socioeconomic status. All of these disadvantages combined leads to increased stress which has been proven to influence physical and psychological health outcomes, for example early death and increased severity of disease. When it comes to framing, this article is very straight forward and uses an “interconnected” approach to examine health disparities. It is clear that racism is going to be discussed and that it creates health disparities. Additionally, it blames policy makers for the “structural bias” that exists today. However, it does propose solutions and gives specific examples programs that have already contributed to the battle.
Gayl Gustafson
ReplyDeleteTitle: US counties with low black male mortality rates
Link: http://www.ncbi.nlm.nih.gov/pubmed/23260504
The authors identified 1307 counties across the US that the National Center for Health Statistics determined had reliable mortality data for African American and white men who were 25 to 64 years old. They then identified 66 counties that had African American mortality rates that were comparable to white mortality rate for that demographic and compared these two groups. Their analysis was for 1999-2007.
In their analysis they found that all 66 counties were outside metropolitan areas and 64 of these had a military installation in that county or an adjacent county, as compared to 37% of the higher mortality counties. In those 66 counties there were also no disparities in heart, lung and liver disease, accidents, and mental disorders associated with drug use. Further, the lower mortality rate had been present for 30 years and since 1998 had actually dropped to under the white male mortality rate.
They also compared the African American men in the 2 county groups for socioeconomic status indices. They found greater per capita income ($18,470 v. $11,606), greater educational achievement (80% v. 69% with HS degree) and less poverty (16% v. 27%) in the 66 counties.
This study strongly refutes the notion that personal health is dependent on behavior and personal choice but that it rather depends on location, location, location.
Rachel Salzmann; Rachel.salzmann@gmail.com
ReplyDeletehttp://pediatrics.aappublications.org/content/117/2/417.full
Inequality in the Built Environment Underlies Key Health Disparities in Physical Activity and Obesity by Gordan et al. Found in Pediatrics: Official Journal of the American Academy of Pediatrics
Type of study: nationally representative prospective cohort
This is an excellent article that highlights (geographic/physical/social) environmental factors and suggests a causative role between these and lack of physical activity (PA), which then leads to obesity. Clearly there is a health disparity related to access of recreational facilities, safe streets and parks hence would impact and lessen PA in low income/high violence communities; this makes sense then that these factors would affect patterns of obesity especially in US adolescents.
This study found that higher-SES groups had significantly greater relative odds of having 1 or more exercise facilities, where low-SES and high-minority groups were less likely to have one facility, even in a larger radius! The study also found that an increase number of facilities were associated with a decreased overweight proportion along with an increase in trend of ≥5 bouts per week of moderate-vigorous PA.
Hence in summary, conclusions were that lower-SES and high-minority groups had reduced access to facilities, which in turn caused decreased PA and increased overweight adolescents. This article shows an excellent example of how inequality in availability of PA facilities contributes to ethnic and SES disparities in health and obesity patterns. Also to note, this article is presented in a factual manor without any framing; it used ‘no-no’ terms such as ‘inequalities, injustices, disparities, etc.’ I liked it more for that—it seemed straight-forward and honest.
Lauren O’Brien
ReplyDeleteGirls in the ‘Hood: the Importance of Feeling Safe
Citation: Popkin, S. J. (2008). Girls in the 'hood: the importance of feeling safe.
This study specifically focuses on the outcomes and differences between girls who live in high-poverty neighborhoods with higher rates of violence and crime and those who live in neighborhoods with lower rates of crime and violence as well as lower rates of poverty. The study reports that youth who grow up in neighborhoods of “concentrated poverty” are at a greater risk of delinquency, poor physical and mental health, and risky sexual behavior. The Moving to Opportunity (MTO) grant was launched in 5 cities in 1994 and specifically targeted families living in the poorest, most high-crime neighborhoods in Baltimore, Boston, Chicago, LA, and New York. Participation in MTO was voluntary and those who participated were “randomly assigned” to one of three treatment groups: a control group, a Section 8 voucher group, or a group that received a voucher that was only redeemable in a low-poverty neighborhood. The study found that girls benefited the most from moving out of high-poverty neighborhoods and the article gives a variety of reasons for this finding, including less fear produced by harassment and pressure to engage in sexual behavior.
Nadine Yacoub
ReplyDeleteLink: http://www.humboldt.edu/ccrp/wp-content/uploads/2013/10/Oral-Health-Care-Disparities-in-the-Redwood-Coast-Region.pdf
Citation: Van Arsdale J, Eap, Stewart C. Oral Health Care Disparities in the Redwood Coast Region. Humbolt State University: California Center For Rural Policy, January 2010
A survey was conducted evaluating the impact of several factors on access to oral health in rural communities. The Rural Health Information survey showed that the county or place where a person lives, predicts a poor oral health outcome. Several members of dental desert counties explained that they had to leave the country in order to seek dental care. Due to the limit in number of available dentists and on top of that the handful of those dentists who will see patients who do not have insurance, people do not have options. Among those surveyed that did not receive routine cleaning, living in a place with no accessible dentist was the most reported reason.
This exemplifies the discussion we had in class surrounding the issue of place and access to services. This creates a disparity in oral health based on the opportunities individuals have to live in a community with access to these resources. Several elements to this problem exist. It is an issue of race and ethnicity because a larger percent of those groups live in impoverished communities. It also illuminates the issues of a structural bias based on employment and socioeconomic class due to the ability of individuals to live and work in well-off communities. When individuals come from a low-paying job, they are going to be more likely to live in such health desert counties based on the economic class of the community. Based on the data in the paper and conclusions made, an individual’s chance to receive oral health were reduced if they lived in a rural community where there are a limited number of dentists. Although this paper discusses rural communities, the diaparity exists among urban communities as well. The reasons people live in such communities where there are limited dental resources range from ethnic and racial classifications to socioeconomic factors. All of which lead to a gap in dental care and oral health for those people who are able to live in better off counties and those who cannot.
This comment has been removed by the author.
ReplyDeleteDave Dvorak
ReplyDeleteTitle: “In Texarkana, Uninsured and on the Wrong Side of a State Line”
Citation: NY Times, Lowrey A, June 8, 2014
Link: http://www.nytimes.com/2014/06/09/business/economy/uninsured-on-the-wrong-side-of-a-state-line.html?emc=eta1&_r=0
This recent New York Times article depicts the contrast in Medicaid health coverage for low-income, homeless residents living in Texarkana, a city that straddles the state line between Texas and Arkansas. Texas has declined the opportunity to expand Medicaid coverage offered under the Affordable Care Act, while Arkansas has opted in to the expanded coverage. As a result, those low-income residents who happen to reside on the Arkansas side of the state line have Medicaid coverage; those who live on the Texas side remain uninsured.
Most Americans believe in a society that enables social and economic mobility, a society in which individuals have the opportunity to better themselves and improve their circumstances. This article illustrates how those who live with a host of economic challenges—low wage jobs, unemployment, homelessness, chronic disease—face another major hurdle when they are unable to afford and access necessary health services. It is a stark illustration of how place matters in health disparities, how the difference of merely a few blocks determines whether one has health coverage or not.
The article illuminates how political considerations have real impact on the lives and health of citizens. As a homeless individual in the articles states, “They need to quit playing games with people’s lives. Rich people. Government people.” There is an implicit recognition that progressive social policy has the ability to improve the health access of economically disadvantaged citizens, such that they have the opportunity to live healthier, more productive lives.
Jake Brandvold, jbrandvold@vetmed.wsu.edu
ReplyDeleteGordon-Larsen, P., Nelson, M.C., Page, P., and Popkin, B.M. 2006. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics (117): 417-424 http://pediatrics.aappublications.org/content/117/2/417.short
It is well recognized among academic circles and health providers that environmental factors play a major role in human health. The authors of this study explored how disparity of access to and the geographic and social distribution of physical activity facilities could underline obesity patterns in the United States. Groups with higher socioeconomic status had a significantly greater chance of having one or more physical activity facility in their area. Both low-income socioeconomic groups and groups with a high minority population were less likely to have facilities. When facilities were present, there was a decreased chance of a person in the study area being overweight and increased odds achieving greater than 5 workouts per week.
This paper highlights a structural bias and its effect on a health disparity. Disparities in physical activity and overweight patterns among low socio-economic and high minority group populations may be impacted by access to physical activity facilities. Included in this study were facilities such as public facilities, youth organizations, parks, YMCAs, and schools. If gyms were only facility focused on by this study, then the disparity of access might make sense, since lower socio-economic status populations might be less likely to pay for a gym membership. A disparity in access to parks and school is more worrisome. This identifies a structural bias, and because we know that access to these facilities is associated with more physical activity and decreased rate of obesity, this reduced access is potentially having a direct impact on human health. Quality, including safety, and accessibility are also factors that may play a role in availability of physical activity facilities to certain population. And other factors such as access to grocery stores, neighborhood safety, land-use, and community design all build on one another to create the environmental health factors of a community.
Elizabeth Kapella
ReplyDeleteThe hard lives--and high suicide rate--of Native American children on reservations
http://www.washingtonpost.com/world/national-security/the-hard-lives--and-high-suicide-rate--of-native-american-children/2014/03/09/6e0ad9b2-9f03-11e3-b8d8-94577ff66b28_story.html
Suicide is an epidemic for American Indian youth: What more can be done?
http://investigations.nbcnews.com/_news/2012/10/10/14340090-suicide-is-epidemic-for-american-indian-youth-what-more-can-be-done
These articles describe the suicide epidemic among American Indian/Alaskan Native (AI/AN) young people. The suicide rate among young AI/ANs is more than three times national average. That number can jump to more than ten times on some reservations. The articles discuss many of the known risk factors that contribute to high suicide rates: extreme poverty, unemployment hunger, alcoholism and other substance abuse, and exposure to violence. Compared to national averages, more young AI/ANs live in poverty, experience substance abuse, and are exposed to trauma, abuse and neglect. The AI/AN high school graduation rate is lower and unemployment on some reservations reaches 80 percent. In many communities, young AI/ANs see suicide as an acceptable option when life gets difficult. I was shocked to read that suicide has become so ordinary, young boys will dare each other to do it. Not only are many young people dying as a result of depression and hopelessness, some are dying in response to a dare.
Though suicide ultimately comes down to an individual behavior, these articles clearly illustrate the array of environmental factors that play into that decision. Attempts to assimilate AI/ANs by the U.S. government introduced violence and abuse in many forms, and crushed the ways of life and traditions of AI/AN people. Living conditions on reservations are sometimes compared to that of third-world countries. The Indian Health Service is consistently underfunded to address physical, emotional, and mental health needs of AI/AN people.
These articles emphasize the importance of tradition and culture in finding solutions—solutions that come from within the communities themselves. Community-level changes have the greatest impact on AI/AN suicide rates, such as creating a supportive environment where young people feel valued, interact with elders and learn their people’s traditions, and have adequate resources to make healthy choices.
Kristin E.
ReplyDelete"Study: Structural racism to blame for health disparities in state"
http://bringmethenews.com/2014/01/31/study-structural-racism-blamed-for-health-disparities-in-state/
This news article reported on the Minnesota Department of Health's report to the Legislature regarding structural racism that was released in January 2014. The article mentions differences in health outcomes among various racial groups in Minnesota. For instance, "African-American babies are twice as likely to die during infancy in the first year than white babies." The article also points out that the report doesn't call for specific steps to resolve the issues, but "encourages people to work together to improve the health of all individuals statewide." The article concludes by calling out that Nonprofit Quarterly named Wisconsin as the worst state in terms of racial equality. This same source said but that Minnesota is worse off than Wisconsin as far as "incarceration rates, family poverty, individuals without health insurance and educational attainment.”
This article focuses on the individual components of the Health Department's report rather than the systems. The topic of place/environment and health are mentioned but not discussed. The article brings up many "elephants", including the inefficiency of government, education, crime, poverty and Minnesota's rivalry with Wisconsin. Bringing up these points redirects readers from the purpose of the original report. The article should have focused on the intent of the report, which is to address the systems that are not fair to everyone and how it affects the entire community.
Obafemi Ayantuga
ReplyDeleteTitle: The Epidemiology of End Stage Renal Disease among African Americans. Martins, D MD; Tareen, N. MD; Norris, K. C. MD' American Journal of the Medical Sciences, February 2002, Volume 323, Issue 2, pp 65-71.
http://journals.lww.com/amjmedsci/Fulltext/2002/02000/The_Epidemiology_of_End_Stage_Renal_Disease_among.2.aspx
This article discussed disparities in health outcomes among African Americans when compared with whites. While disparities with respect to diabetes mellitus, cardiovascular disease, cancer and infant mortality have been demonstrated, the most dramatic disparity is with respect to kidney diseases. End Stage Renal Disease (ESRD) occurs almost 4 times more commonly in African Americans than in whites.
The two leading causes of ESRD are diabetes mellitus and hypertension, which, together account for more than 70% of individuals with ESRD. The authors conclude that the higher prevalence of hypertension and diabetes mellitus in African Americans accounts 'in part' for the greater incidence of ESRD. They mention that race has been proposed as an independent biologic variable to account for the much higher rates of kidney diseases found in African Americans.
Cultural, environmental, and psychosocial factors, access to health care, insurance status, education, family income have been associated with ESRD, as the authors acknowledge. Understanding how these related factors impact outcomes is important in developing effective strategies to address disparities among African Americans when compared to whites with respect to ESRD.
Erin Bodeau
ReplyDeleteCitation: Rudolph, K.E., Stuart, E.A., Glass, T.A., Merikangas, K.R. (2013). Neighborhood disadvantage in context: the influence of urbanicity on the association between neighborhood disadvantage and adolescent emotional disorders. Social Psychiatry and Psychiatric Epidemiology, 49. doi: 10.1007/s00127-013-0725-8
Link: http://www.ncbi.nlm.nih.gov/pubmed/23754682
This study investigated the role of urbanicity in the relationship between neighborhood disadvantage and adolescent mental health; specifically, the authors hypothesized that the positive correlation between neighborhood disadvantage and adolescent mental health is greater in urban areas relative to non-urban areas. Researchers utilized data from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a nationally representative survey of mental health syndromes and disorders. Respondent’s addresses were coded to the corresponding US Census tract and data was analyzed for both contextual and individual measures. Contextual measures included neighborhood disadvantage and urbanicity. Individual measures included presence of a mental health disorder and demographic variables. Logistical regression was used to calculate the impact of urbanicity on the relationship between neighborhood disadvantage and adolescent mental health.
Results show that urbanicity modifies the relationship between neighborhood and mental health. Living in a disadvantaged neighborhood was associated with an emotional disorder when the neighborhood was in an urban center but not when the neighborhood was in a rural or urban fringe area. This finding can be explained by the higher incidence of risk factors of poor mental health in urban disadvantaged areas relative to non-urban disadvantaged areas, such as exposure to noise, violence and residential instability.
This study illuminates the relationship between geographic location and health outcomes not only by providing evidence for the relationship but by also increasing our understanding of the complexity of that relationship. By providing a more nuanced view of this relationship, the impact of geographic location on health can be addressed in a more holistic manner through the use of policies designed to decrease the previously identified risk factors for poor mental health. These findings expand the dialogue to encompass quality of life indicators independent of income, thus indicating that protective factors are not dependent on a neighborhood’s socioeconomic status.
what needs to be improved from the current health facilities?
ReplyDelete