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)
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 BranchAdjunct InstructorDepartment of Urban Planning and Environmental PolicyBarbara 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
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
Depends what you mean by biology. As long as its complex and non-linear I agree!
Ken Thompson MDSent 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 Inês 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.
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
http://www.ecu.edu/cs-dhs/medhum/goldberg.cfm
Twitter: @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 8544J Over 200 abstracts and presentations from the 2012 PHC Research Conference are on-line, browse and be inspired, www.phcris.org.au/conference/2012/
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]] 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
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.comConsulting 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
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