Hello Lauri and all,
Isn't it strange, we talk so much about the SDOH, but are still not sure
how to explain or present it right. For sure it is a big disadvantage in
selling ourselves to the public or to decision makers! Looking forward to
the input of others - how do you explain the SDOH and their impact?
Concerning a graphic, here you can find the simple but catchy one by
Schroeder 2007:
http://yglesias.thinkprogress.org/wp-content/uploads/2009/01/healthdeterminants1.jpg
It was published in the NEJM and the data were adapted from McGinnis 2002.
Again, it is not complete and most distal determinants are missing.
And I am still unsure, are 30% genetically determined? Does health care
contribute just 10%? Does anybody know some studies on these issues?
And, if the SDoH would be part of this graph, would it be a big part or a
small part - because the main impact of education, income, etc is mediated
through health behaviours/lifestyle?! It was already mentioned, this is an
issue of complexity and inter-dependence...
Schroeder SA. Shattuck Lecture. We can do better--improving the health of
the American people. N Engl J Med. 2007 Sep 20;357(12):1221-8. (
http://www.ncbi.nlm.nih.gov/pubmed/17881753)
McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy
attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93. (
http://www.ncbi.nlm.nih.gov/pubmed/11900188)
Best wishes,
Florian
On Sun, Sep 9, 2012 at 6:59 PM, Lauri Andress <[log in to unmask]> wrote:
> Hi All,
>
> I think as researchers we can all agree that this is an interesting
> discussion.
>
> What I like most about it is that none of us is willing to close our
> minds down to possibilities --theories and that we acknowledge the
> interrelatedness of myriad factors.
>
> That said ...........what do you recommend as the best way to explain this
> to a community when your objective is to have them understand the role of
> behavior in the production of health?
>
> So...........the idea is to develop a short hand story, narrative, diagram
> that quickly explains why interventions need to extend beyond health care
> and behavioral programs.
>
> I need the simplest way to explain this complexity of which we are
> speaking in a community meeting.
>
>
>
> Lauri Andress, MPH, J.D., Ph.D.
> Managing Partner
> Andress & Associates, LLC
>
> 713-553-8192
> Bridging the Health Gap
>
> Visit Dr. Andress' website at
> http://www.bridgingthehealthgap.com
> Consulting Health Equity Analyst
> Center to Eliminate Health Disparities
> University of Texas Medical Branch
>
> Adjunct Instructor
> Department of Urban Planning and Environmental Policy
> Barbara Jordan – Mickey Leland School of Public Affairs
> Texas Southern University
>
>
>
>
>
> On Sun, Sep 9, 2012 at 10:05 AM, Sandra L. Campbell <[log in to unmask]
> > wrote:
>
>> Hi all. I am enjoying this discussion particularly as it relates to
>> non-linearity and complexity. My PhD dissertation used chaos theory to
>> analyse decision making power in long term care settings. I could not agree
>> more with Kenneth. Each element is tied to each other element whether or
>> not it appears to be so. ****
>>
>> ** **
>>
>> I will use the health care decision making table as an example. The power
>> held by each decision maker at the board table, for example, is not only
>> related to their personality, position and experience. Their power can also
>> be related to the power held by the persons the decision maker represents.
>> ****
>>
>> ** **
>>
>> At that health care decision making table, the person representing a long
>> term care organization, for example, may have considerably less power in
>> the decision dynamics than the person representing an acute care
>> organization. The power one holds at that decision table emerges from many
>> variables simultaneously and in non-linear ways. While it may not seem to
>> be based in logic, some of the variables include the power held by the
>> patient served (based on their level of frailty, their age, their nearness
>> to death, etc). These indicators, also, are in addition to more typical
>> and visible power indicators such as the cost of each type of care and the
>> prevalence of science and technology in the care provided. I play out this
>> example to demonstrate another aspect of the non-linearity of health
>> environments. ****
>>
>> ** **
>>
>> I absolutely agree that social determinants must be on the health table
>> at every turn. When we are able to accomplish this, our dollars will be
>> better spent and our expertise will be better expressed. With this sort of
>> change we will enhance the “health” of those served and move further toward
>> a holistic view of health recognizing “Health is a state of complete
>> physical, mental and social well-being and not merely the absence of
>> disease or infirmity” (World Health Organization Constitution. 1946). ***
>> *
>>
>> http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf ****
>>
>> ** **
>>
>> Sandra ****
>>
>> ** **
>>
>> Sandra Loucks Campbell****
>>
>> www.commonpoint.ca****
>>
>> 519.885.3016****
>>
>> ** **
>>
>> The content of this email message including any attachments is the
>> confidential property of Commonpoint Service Inc and is intended for our
>> use. This email message including any attachments may not be copied,
>> modified, retransmitted, or used for any purpose except by the intended
>> recipient. If you are not the intended recipient, please delete all copies
>> and notify Commonpoint immediately. ****
>>
>> ** **
>>
>> ** **
>>
>> *From:* Social Determinants of Health [mailto:[log in to unmask]] *On Behalf
>> Of *Kenneth Thompson
>> *Sent:* September-09-12 9:44 AM
>>
>> *To:* [log in to unmask]
>> *Subject:* Re: [SDOH] need reference, a slide or diagram****
>>
>> ** **
>>
>> Depends what you mean by biology. As long as its complex and non-linear
>> I agree!
>>
>> Ken Thompson MD****
>>
>> 4127608483****
>>
>> Sent from my iPhone****
>>
>>
>> On Sep 9, 2012, at 9:06 AM, Maria Ines Azambuja <[log in to unmask]>
>> wrote:****
>>
>> And Kenneth, to make things a little more complex, even our political
>> positions may be biologically driven... There have been some papers on it
>> recently...
>>
>> Maria Inęs Azambuja****
>>
>> ** **
>>
>> ** **
>>
>> 2012/9/9 Kenneth Thompson <[log in to unmask]>****
>>
>> Hi All****
>>
>> This is where non-linearity and complexity thinking must be brought in.
>> None of the factors- behavior, environment, biology, health care- are
>> independent of the others. In fact, as suggested below some very useful
>> work might be done demonstrating how reality fits together, rather then
>> using our categories to try to take it apart. By this I mean that our
>> categories trick us in to thinking that they are some how sacrosanct and
>> not inter-penetrated by each other. Biology is actually made up of
>> behavior and the environment and culture and more. it is not exclusive to
>> the properties of cells. ****
>>
>> ** **
>>
>> Here I think is another critical point. The key factor we are missing-
>> in my opinion- is some way to bring mind and minds into the picture. By
>> mind I mean the capacity we have to apprehend and shape our individual and
>> collective environment - to experience and share. This is where reality
>> comes together for us and where we can either take it apart or put it
>> together. Mostly we have been taking it apart. ****
>>
>> ** **
>>
>> Ken
>>
>> Ken Thompson MD****
>>
>> 4127608483****
>>
>> Sent from my iPhone****
>>
>>
>> On Sep 8, 2012, at 10:12 PM, "Goldberg, Daniel" <[log in to unmask]>
>> wrote:****
>>
>> To add to the nice discussion, I also think the linear, almost
>> logic-model-type approach has some drawbacks, as easy-to-understand and as
>> familiar as it likely is to a public health audience.****
>>
>> ****
>>
>> Namely, even if we agree that risky behaviors comprise a significant
>> component of population health, there is excellent evidence that social &
>> economic conditions are major drivers of the distribution of such behaviors
>> among the most materially deprived. To put it another way, assuming that,
>> e.g., Stringhini et al.’s 2010 reinterpretation of some of the data from
>> Whitehall II is correct, it does not show that risky behaviors are
>> independently more significant than social & economic conditions, because
>> their analysis suggests that the gradient of risky behaviors itself is a
>> mechanism by which social inequalities produce health inequalities. ****
>>
>> ****
>>
>> To me, this is what it means to say that behaviors mediate health. **Shameless
>> self-promotion alert**: I discuss this a bit in a recent paper.****
>>
>> ****
>>
>> Anyway, the linearity of the diagram does not reflect this
>> interdependency between social & economic factors and risky behaviors.
>> This is not meant as any criticism of the *County Health Rankings, *which
>> * *I have used in my teaching and research and have found to be an
>> exciting and valuable resource.****
>>
>> ****
>>
>> But I do think the general unwillingness in the U.S. to understand the
>> connection between social/economic conditions and the distribution of
>> behaviors is an enormous problem inasmuch as it funnels support to agentic
>> interventions premised on individual behavioral change and away from
>> interventions targeted at structural factors. The former do not work and
>> also tend to expand health inequities, as I’m sure most people on this
>> listserv well know!****
>>
>> ****
>>
>> JMO.****
>>
>> ****
>>
>> *Daniel S. Goldberg, J.D., Ph.D*****
>>
>> Assistant Professor****
>>
>> Department of Bioethics & Interdisciplinary Studies****
>>
>> Brody School of Medicine****
>>
>> East Carolina University****
>>
>> 600 Moye Blvd, Mailstop 641****
>>
>> Greenville, N.C. 27834****
>>
>> [log in to unmask]<https://legacypiratemail.ecu.edu/owa/UrlBlockedError.aspx>
>> ****
>>
>> http://www.ecu.edu/cs-dhs/medhum/goldberg.cfm<https://legacypiratemail.ecu.edu/owa/redir.aspx?C=d56a9b9043504f2087c41dfe6562e184&URL=http%3a%2f%2fwww.ecu.edu%2fcs-dhs%2fmedhum%2fgoldberg.cfm>
>> ****
>>
>> Twitter: @prof_goldberg <https://twitter.com/prof_goldberg>****
>>
>> _______________****
>>
>> Tel: 252.744.5699****
>>
>> Fax: 252.744.2319****
>>
>> ****
>>
>> ****
>>
>> ****
>>
>> *From:* Social Determinants of Health [mailto:[log in to unmask]] *On Behalf
>> Of *Melissa Raven
>> *Sent:* Saturday, September 08, 2012 9:45 PM
>> *To:* [log in to unmask]
>> *Subject:* Re: [SDOH] need reference, a slide or diagram****
>>
>> ****
>>
>> My immediate reaction was that it was great. But then I noticed that
>> there is no mention of biological/genetic factors. I strongly object to
>> biological reductionism, but I think it is untenable to claim that biology
>> has no influence.****
>>
>> ****
>>
>> The text says the health factors are 'based upon a review of the
>> literature and expert input' – which literature?****
>>
>> ****
>>
>> In 2001, the (Canadian) Standing Senate Committee on Social Affairs,
>> Science and Technology included ignored biological/genetic factors, but
>> ignored health behaviours, estimating:****
>>
>> ****
>>
>> Health Care System - 25% [bit more - vs 20%]****
>>
>> Biology and Genetic Endowment - 15%****
>>
>> Physical Environment - 10% [same]****
>>
>> Social and Economic Environment - 50% [more – vs 40%]****
>>
>> ****
>>
>> Standing Senate Committee on Social Affairs, Science and Technology.
>> (2001). *The health of Canadians: The federal role, volume one: The
>> story so far*. Ottawa: Senate of Canada.
>> http://www.parl.gc.ca/Content/SEN/Committee/371/pdf/interim-soci-e.pdf***
>> *
>>
>> ****
>>
>> Again, I object to the usual lifestyle/behavioural attribution, but I do
>> think lifestyle/health behaviours play a role.****
>>
>> ****
>>
>> Are there any models that include all five factors (social/economic
>> environment, physical environment, lifestyle/behaviours, healthcare,
>> biology/genetics? ****
>>
>> ****
>>
>> Thanks****
>>
>> Melissa****
>>
>> ****
>>
>> Melissa Raven
>> Research Fellow
>> Primary Health Care Research & Information Service (PHC RIS)
>> Discipline of General Practice, Flinders University, GPO Box 2100
>> ADELAIDE SA 5001 AUSTRALIA
>> phone +61 8 7221 8510 fax +61 8 7221 8544 ****
>>
>> *J* Over 200 abstracts and presentations from the 2012 PHC Research
>> Conference are on-line, browse and be inspired, *
>> www.phcris.org.au/conference/2012/<http://www.phcris.org.au/conference/2012/index.php?promoid=504>
>> *****
>>
>> PHC RIS excels in sharing information and knowledge to support Australian
>> primary health care to improve health outcomes.****
>>
>> ****
>>
>> ****
>>
>> *From:* Social Determinants of Health [mailto:[log in to unmask]<[log in to unmask]>]
>> *On Behalf Of *Dennis Raphael
>> *Sent:* Sunday, 9 September 2012 7:48 AM
>> *To:* [log in to unmask]
>> *Subject:* Re: [SDOH] need reference, a slide or diagram****
>>
>> ****
>>
>> great slide!!!****
>>
>> ****
>>
>> dr****
>>
>> ****
>>
>>
>>
>> Get a free copy of Social Determinants of Health: The Canadian Facts at
>> http://thecanadianfacts.org
>>
>> See what Jack Layton had to say about my books!
>>
>> http://www.cbc.ca/news/canada/story/2011/04/10/cv-election-ndp-layton-platform.html
>> at 27:20
>>
>> Dennis Raphael, PhD
>> Professor of Health Policy and Management
>> York University
>> 4700 Keele Street
>> Room 418, HNES Building
>> Toronto, Ontario M3J 1P3
>> 416-736-2100, ext. 22134
>> email: [log in to unmask]
>> http://www.atkinson.yorku.ca/draphael
>>
>> Of interest:
>>
>> * New * Poverty in Canada, 2nd edition,
>> Forewords by Rob Ranier and Jack Layton
>> http://www.cspi.org/books/poverty_canada
>>
>> About Canada: Health and Illness
>> http://tinyurl.com/2c2tm6l
>>
>> Health Promotion and Quality of Life in Canada: Essential Readings
>> http://tinyurl.com/3C8zteu
>>
>> Social Determinants of Health: Canadian Perspectives, 2nd edition,
>> Forewords by Carolyn Bennett and Roy Romanow
>> http://tinyurl.com/3fkbr8u
>>
>> Staying Alive: Critical Perspectives on Health, Illness, and Health Care,
>> 2nd edition
>> Foreword by Gary Teeple
>> http://tinyurl.com/4xlu4up
>>
>> See a lecture! The Politics of Population Health.
>>
>> http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d
>>
>> Also, presentation at the University of Toronto on how Canada stacks up
>> again other nations in providing citizens with economic and social security.
>> http://vimeo.com/33346501****
>>
>>
>>
>> -----Social Determinants of Health <[log in to unmask]> wrote: -----****
>>
>> To: [log in to unmask]
>> From: Mark Gamsu
>> Sent by: Social Determinants of Health
>> Date: 09/08/2012 06:14PM
>> Subject: Re: [SDOH] need reference, a slide or diagram
>>
>> Hi Laurie****
>>
>> ****
>>
>> Duncan Selbie (the new Chief Executive for Public Health England is
>> quoting material from the University of Wisconsin.****
>>
>> ****
>>
>> The 2012 County Health Rankings have a nice chart on page 3 of the
>> document *here*<http://uwphi.pophealth.wisc.edu/programs/match/wchr/2012/CHR2012_WI.pdf>
>> ****
>>
>> ****
>>
>> Mark****
>>
>> ****
>>
>> Mark Gamsu FFPH
>> Visiting Professor - Leeds Metropolitan University
>> [log in to unmask]
>> 07557375028****
>>
>> ****
>>
>> WEBSITE - www.localdemocracyandhealth.com****
>>
>> TWITTER - @markgamsu
>>
>> SKYPE - mark.gamsu5****
>>
>> ****
>>
>> On 8 Sep 2012, at 22:59, Lauri Andress <[log in to unmask]> wrote:****
>>
>> ****
>>
>> Hi,****
>>
>> ****
>>
>> .........does anyone have the most recent diagram, data or reference (in
>> a PowerPoint slide) describing the factors that make up health and to what
>> degree: behavior, environment, health care, etc.?****
>>
>> ****
>>
>>
>> ****
>>
>> ****
>>
>> Lauri Andress, MPH, J.D., Ph.D.
>> Managing Partner
>> Andress & Associates, LLC
>>
>> 713-553-8192
>> Bridging the Health Gap
>>
>> Visit Dr. Andress' website at
>> http://www.bridgingthehealthgap.com****
>>
>> Consulting Health Equity Analyst
>> Center to Eliminate Health Disparities
>> University of Texas Medical Branch****
>>
>> ****
>>
>> Adjunct Instructor****
>>
>> Department of Urban Planning and Environmental Policy ****
>>
>> Barbara Jordan – Mickey Leland School of Public Affairs
>> Texas Southern University****
>>
>> ****
>>
>>
>> To leave, manage or join list:
>> https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 ****
>>
>> ****
>>
>> ****
>>
>> To leave, manage or join list:
>> https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 ****
>>
>> To leave, manage or join list:
>> https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 ****
>>
>> To leave, manage or join list:
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>>
>> To leave, manage or join list:
>> https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 ****
>>
>>
>>
>> ****
>>
>> ** **
>>
>> -- ****
>>
>> *Prof. Adjunta*****
>>
>> *Departamento de Medicina Social*****
>>
>> *Faculdade de Medicina da*****
>>
>> *Universidade Federal do Rio Grande do Sul*****
>>
>> ****
>>
>> Rua Ramiro Barcelos, 2600, 4/420****
>>
>> 90035-003, Porto Alegre, RS****
>>
>> [log in to unmask] ****
>>
>> ** **
>>
>> To leave, manage or join list:
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>>
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>>
>>
> To leave, manage or join list:
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>
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--
--------------------
Dr. Florian Stigler, MPH
JAMÖ Board Member 2009-2011 (Young GPs of Austria, www.jamoe.at)
IFMSA Board Member 2008-2010 (International Federation of Medical Students'
Associations, www.ifmsa.org)
AMSA Board Member 2005-2009 (Austrian Medical Students' Association,
www.amsa.at)
Email: [log in to unmask]
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