Part 1: Reaction Paper
The part of the reading that caught my attention regarding the “mechanisms” that link the social determinants of health to health disparities is Barr’s claim that the problem has little to do with the health care system and more to do with the individual’s position in the social hierarchy. The section motivated me to look deeper into our society to understand why some people suffer more from lifestyle diseases, such as cardiovascular conditions.
The “mechanism” that links a social determinant of health to adverse health outcomes, such as high rates of cardiovascular conditions, is income. Structural inequities are created by interpersonal, institutional, and systemic biases that sort people along with their income level. They place members in resource-rich or resource-poor neighborhoods (Baciu et al., 2017). One of the health outcomes of such a mechanism includes higher rates of cardiovascular conditions due to intake of poor diets and lack of access to quality care checkups due to lack of resources among those in resource-poor neighborhoods.
When reading the section, I felt sort and angry at the same time. I felt angry about the government and other policymakers for failing to create policies to address the disparities. I felt sorry for the people who lack access to healthy meals and quality access to preventive care and treatment simply due to biases that create disparaging policies and practices.
Public Health community-level interventions can help to address the problems associated with income to improve health outcomes. Community empowerment targeting the resource-poor neighborhoods could help create awareness of the need for preventive care and timely treatment. Community leaders should also educate them regarding economic empowerment to improve their income and reduce the gap between the social classes.
References
Baciu, A., Negussie, Y., Geller, A., Weinstein, J. N., & National Academies of Sciences, Engineering, and Medicine. (2017). The state of health disparities in the United States. In Communities in action: Pathways to health equity. National Academies Press (US).
Barr, D. A. (2014). Health Disparities in the United States: Social Class, Race, Ethnicity, and Health. Baltimore: Johns Hopkins Press.
Part 2: Discussion Questions
Question 1
Structural and intermediary determinants of health have a critical impact on health outcomes for various populations. Structural factors are social and political factors (such as economic policies) that generate distinctions across social classes. At the same time, intermediary determinants include more specific factors that emanate from structural determinants, such as stress, social support, housing, work setting, and nutrition. Lack of physical activity (an intermediary determinant) due to demanding work arrangements (structural determinant) to meet daily living requirements increases the risk of lifestyle diseases, such as cardiovascular conditions. According to data from HHS, African Americans were 30% at a higher risk of dying from heart disease than non-Hispanic whites in 2018 (HHS, 2018). Such disparity emanates from the lack of physical activity and healthy nutrition, as most African Americans are placed in resource-poor conditions by structural arrangements. In Sickness and Wealth illustrates how health inequalities are created by using power to stratify society (Films Media Group, 2008). As a result, the social determinants operate in a health inequality situation, placing the poor at a higher risk.
Question 2
Dr Ichiro Kawachi observes that the ability to avoid smoking and eat a healthy diet depends on access to “income, education, and the social determinants of health.” The statement is valid considering the structural and intermediary determinants that determine the health outcomes of individuals and populations. For instance, society is stratified along with classes with those in the lower and sometimes the middle classes lacking adequate resources to maintain good health (Films Media Group, 2008). They lack financial resources to access a proper diet, and due to stress, they lack the willpower to quit negative behaviors like smoking. People in poor neighborhoods lack resources and power to control their destinies. Conditions in my community hinder health choices. Being in a middle-income community, a majority tend to prefer fast food, which is affordable. As a result, they place themselves at risk of lifestyle conditions, such as diabetes and obesity. Economic policies shape the conditions by creating low-, middle- and high-income communities with access to different levels of socio-economic opportunities. As a result, members of the communities develop health habits that reflect their conditions and affect their health outcomes.
Question 3
What was surprising or disturbing in the film is the number of infants that die before their first birthday in the United States. Being an economically developed nation, such a rate is surprising and, at the same time, alarming. Unfortunately, while no one chooses where they should be born, the infant’s death emanates from the conditions within which they are born, explaining why the rate is higher among African Americans than whites. The disturbing scene in the film is Kim Anderson’s child, who is born weighing weighed less than three pounds, although the mother follows up with her prenatal care and does everything to ensure a healthy pregnancy. The scene shows that socioeconomic status is not the only cause of the problem but the cumulative effect of systematic racism. Regardless of social mobility, African Americans experience other social determinants of health that place them at a disadvantage against whites (Films Media Group, 2008). The scene is disturbing since it shows the real impact of health inequalities in a wealthy country that should be taking care of the needs of all its people. The country should have access to quality maternal and child health care since they have the resources to achieve the objective.
References
Films Media Group (2008). In Sickness and in Wealth: Unnatural Causes
US Department of Health & Human Services (2018). Heart Disease and African Americans. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19
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