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Determinants of Health

Determinants of Health. M6920 September 11, 2001. Health. is a state of complete physical, mental and social well-being and not merely the absence of disease or injury* Includes capacity to function individually and within a social system. World Health Organization. 1997 Deaths*.

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Determinants of Health

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  1. Determinants of Health M6920 September 11, 2001

  2. Health • is a state of complete physical, mental and social well-being and • not merely the absence of disease or injury* • Includes capacity to function individually and within a social system. World Health Organization M6920, Fall, 2001

  3. 1997 Deaths* . *2,314,245 deaths, 445 less than in 1996 M6920, Fall, 2001

  4. Tobacco 400,000 Diet/Activity Patterns 300,000 Alcohol 100,000 Microbial Agents 90,000 Toxic Agents 60,000 Firearms 35,000 Sexual Behavior 30,000 Motor Vehicles 25,000 Drug Use 20,000 Real Causes of Death, 1990 McGinnis & Foege M6920, Fall, 2001

  5. Deaths in New York CityWeek of September 1 Pneumonia & Influenza: 43 M6920, Fall, 2001

  6. A Causal Model of Disease Cause Disease Treatment Cure M6920, Fall, 2001

  7. A beginning complex model Need, Access Disease Health Care Other Factors Cure, Care Evans & Stoddard M6920, Fall, 2001

  8. Growing feedback model Growing care costs Disease Health Care Other Factors Clinical epi Evaluation HS Research Cure, Care Evans & Stoddard M6920, Fall, 2001

  9. Four field model Human Biology Environment Lifestyle Growing care costs Disease Health Care Other Factors Clinical epi Evaluation HS Research Cure, Care Evans & Stoddard M6920, Fall, 2001

  10. Evans & Stoddard M6920, Fall, 2001

  11. Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care Leading Health Indicators, HP2010 M6920, Fall, 2001

  12. Vulnerable Populations • Social groups that have • an increased relative risk or • increased susceptibility to adverse health outcomes • Evidenced by • increased comparative morbidity • premature mortality and • diminished quality of life M6920, Fall, 2001

  13. Fundamental Causes • Low social status • Low economic status • Lack of environmental resources M6920, Fall, 2001

  14. Poor Groups subject to discrimination intolerance subordination stigma Politically marginalized, disenfranchised and denied human rights Groups recognized as vulnerable M6920, Fall, 2001

  15. Women Children Ethnic people of color Immigrants Gay, lesbian, bisexual, transgendered individuals Homeless Elderly Specific Groups M6920, Fall, 2001

  16. Income and health status Adapted from Breeze et al, AJPH 91:2, pg. 280 M6920, Fall, 2001

  17. Household income and health M6920, Fall, 2001

  18. Housing: HOPWA • June 2000 NYC has 43,000 adult/adolescent people/AIDS (up 12,000 in 2 years) • Assistance has shifted from new housing to rental assistance • FY99 City Budget: 199.6 Million • Spent: 141.6 Million M6920, Fall, 2001

  19. Urban waste disposal • Queens generates 3,300 tons of trash EVERY DAY • Fresh Kills landfill • opened in 1948 • capacity to ~2025 • closed April, 2001 • Cost $838.3 million in 2000 M6920, Fall, 2001

  20. Median weekly earnings of women (by educational level) Bureau of Labor Statistics M6920, Fall, 2001

  21. Women’s 1998 median weekly earnings Bureau of Labor Statistics M6920, Fall, 2001

  22. Electricity (per megawatt) Northern California M6920, Fall, 2001

  23. Loss of systems in Russia M6920, Fall, 2001

  24. Loss of systems in Russia US rate: below 1/100,000 M6920, Fall, 2001

  25. Citizenship Rates by Length of Residence % Source: U.S. Bureau of the Census M6920, Fall, 2001

  26. 1988 AIDS Rates(per 100,000 Black Population) 39.8 * * * * 24.7 74.1 * 42.8 * * 187.5 MA 115.8 * 38.3 RI 107.1 17.4 116.6 CT 113.2 27.3 63.2 NJ 153.6 30.8 40.3 54.7 65.5 DE 119.8 71.7 45.9 34.3 MD 124.5 25.8 61.8 41.7 41.0 DC 324.8 43.9 55.2 54.2 31.8 26.0 57.5 Rate per 100,000 66.7 <50 39.9 59.1 37.6 50-99 80.6 100+ 60.5 <5 cases * * 183.5 US rate =86.3 34.6 N=21,515 Includes cases with unknown state of residence † M6920, Fall, 2001

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  29. Infant Mortality in Minnesota • 1978/82 1989/93 • African-American 22.6 16.5 • American Indian 13.9 16.2 • Asian 9.7 6.2 • White 10.2 6.4 M6920, Fall, 2001

  30. Occupational Death, 1999 Hispanic Fatalities Increasing 1993 85 1996 120 1999 200 M6920, Fall, 2001

  31. Children 2-4 years who have ever had tooth decay Family Income (%) M6920, Fall, 2001

  32. Children Age 15 Who Have Untreated Tooth Decay Source: NHANES III, 1988-94 (%) Level of Education (Head of Household) M6920, Fall, 2001

  33. Children with a Preventive Dental Visit* in past year * includes prophylaxis, fluorides, or sealants (%) Source: Medical Expenditure Panel Survey, 1996 M6920, Fall, 2001

  34. Adults age 65+ With Complete Tooth Loss (%) Level of Education M6920, Fall, 2001

  35. Total Tooth Loss, Age 65+, 1995-1998 20% 21-25.9% HP 2000 Objective: 20% 26-34.9% 35% Source: BRFSS 1995-1998 Data unavailable M6920, Fall, 2001

  36. Adults (35+) Who Reported Past Year Dental Visit Source: NHIS 1997 Level of Education M6920, Fall, 2001

  37. Dental Visits in Past Year, Age 35+: 1995-1998 70% 65-69.9% HP 2000 Objective: 70% <65% Data unavailable Source: BRFSS 1995-1998 M6920, Fall, 2001

  38. Minorities Report Difficulty Getting Needed Health Care *Other includes Native American or Alaska native, mixed race, some other race, or not sure. Source: The Commonwealth Fund Survey of Health Care in New York City, 1997 Louis Harris and Associates, Inc. M6920, Fall, 2001

  39. Emergency Rooms Serve Uninsured New Yorkers and the Medicaid Population Adults age 18 or older Source: The Commonwealth Fund Survey of Health Care in New York City, 1997 Louis Harris and Associates, Inc. M6920, Fall, 2001

  40. American Median Income White All Families 1947 Black Female Householder, No Husband In constant 1997 dollars. Source: United States Census Bureau issued in Statistical Abstract of the United States M6920, Fall, 2001

  41. 2000 Poverty Guidelines Income Guideline Size of Family M6920, Fall, 2001

  42. Occupations adding the most jobs Number of jobs expected to be added by 2006 Weekly pay 3 Cashiers 530,000 $247 Systems analyst 520,000 891 General managers 467,000 965 Registered nurses 411,000 697 3 Retail sales 408,000 299 Truck drivers 404,000 481 3 Home health aides 378,000 314 3 Teacher aides 370,000 273 3 Nursing aides 333,000 292 3 Receptionists 318,000 333 The Low-Wage Factor of High-Tech 3 Poverty line for a family of four is $308 a week (1996) Source: Bureau of Labor Statistics M6920, Fall, 2001

  43. Medicare Beneficiaries Reporting Fair or Poor Health Source: Urban Institute analysis of 1995 Medicare Current Beneficiary Survey. M6920, Fall, 2001

  44. Model for research and practice Resource Availability Relative Risk Research Practice Policy Analysis Health Status Flaskerud M6920, Fall, 2001

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