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: >> 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 **** >> >> >> >> **** >> >> ** ** >> >> -- **** >> >> *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: >> 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: > https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 > > -- -------------------- 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] GSM: + 43 650 5432 432 Skype: "medflo" Twitter: "FlorianStigler" To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1