Health Policies

According to the Preston curve, the relationship between income and life expectancy basically disappears at what amount of GDP per capita?

$10,000

in the US, a family of four is considered impoverished if its annual income is at or below....?

$23,550

health inequity

(health disparity) A health inequality that denotes an unjust difference in health Systematic differences in health that could be avoided by reasonable means Unfair distribution of health risks and resources Example: Neighborhood with nice park vs. neighborhood with lots of violence

Measures of social class

- Educational attainment - Inequalities in the distribution of power or wealth - Ownership of assets - Social capital (social network)

Rates of food insecurity are higher than the national average for which groups?

-Households with incomes near or below the federal poverty line -All households with children and particularly households with children headed by a single parent -Women and men living alone -Black and hispanic headed hsouseholds -Households in principal cities and nonmetropolitan area

Wilkinson's Theoretical Synthesis

-Income distribution is a marker of how unequal society is. -The size of income inequalities reflects how hierarchical the society is. -Big differences in income suggest that there is a big difference in education, housing, etc. -Big differences between individuals will diminish social capital, fuel envy, and create political instability. -All of this will work through our biological mechanism.

Preston's curve

Individuals born in richer countries can expect to live longer than those born in poor countries This relationship flattens out a approximately 10,000 GDP per capita

conventional model of health and disease

Internal factors x external factors = disease

3 policies that ensure young children have reliable access to food

1. Increasing SNAP benefits by using alternative calculation method 2. Increasing WIC age-eligibility from age 5 years to 6 years 3. Expanding participation in school meal programs by increasing the Community Eligibility Program (CEP) criteria

Black or african american mothers have what rate of infant mortality?

11%

In the Household Food Security Report (2017), what percentage of households reported to be food insecure?

12

To improve the usability of health information, written communication should use at least what size font?

12

USDA houses __ different food and nutrition assistance programs nationally

15

in 2012, over __% of the US population lived at or below the poverty level

16%

The concept of "health as a human right" was established by the United Nations in what year?

1948

When was lead banned from paint?

1978

People with 6 or more ACES die how much sooner than those without ACES?

20 years earlier on average (60 vs 80 years)

The typical (median) food-secure household spends ______% more for food than the typical food-insecure household of the same size and composition

23%

College graduates can expect to live at least _____ longer than individuals who have not finished high school.

5 years

Approximately what percent of food-insecure households reported that, in the previous month, they had participated in one or more of the 3 largest federal assistance programs?

58%

Studies show that people cannot find the information they are looking for on Websites about _____ percent of the time.

60

On average, households that were food insecure at some time during the year were food insecure for how many months of the year?

7 months

According to the National Assessment of Adult Literacy, nearly ____ out of 10 adults may lack the skills needed to manage their health and prevent disease.

9

Life course perspective

A consideration of health inequalities that acknowledges that one's health status reflects both prior and contemporary condi- tions, including in utero and childhood effects. The life course perspective recognizes the impact of latent, pathway, and cumulative effects on later health. For example, poor nutrition in adolescence, when bones develop, could put individuals at risk for bone fracture in later life, regardless of attempts to slow bone loss in adulthood. Habits that develop early in life may influence the trajectory of one's health choices. Poor exercise habits in childhood may influence the choices that people later make as adults. Although adults can choose to exercise more later in life, childhood habits may serve as predictors of adult choices that continue to impact health. Finally, long-term exposure to conditions over the course of a lifetime also affects health. Earning a low income may have a greater effect on individuals who grew up poor than for those who grew up rich, for example. This prolonged deprivation could amplify the health effects of poverty.

USDA (US Department of Agriculture)

A department of the United States government that manages various programs related to food, agriculture, natural resources, rural development and nutrition.

Feeding America

A national network hunger-relief organization to which the majority of food banks belong.

positive stress

A normal and essential part of healthy development Examples: getting a vaccine, first day of school, new job, getting married

progressive tax

A tax for which the percentage of income paid in taxes increases as income increases (U.S. federal tax system)

According to the Household Food Security Report (2017), rates of food insecurity were higher than the national average for what group?

All households with children - and particularly households with children headed by a single parent

What is an example of health numeracy skills?

Calculating blood sugar levels

What is the problem when looking at the relationship between variables that impact health deciding which one is actually creating the most impact?

Collinearity

Poverty defined in an absolute sense

Comparing a given income to a static benchmark Relies on a fixed monetary threshold called a poverty line, though this threshold in generally specific to year, country, and household size. Those with incomes falling below the threshold are considered impoverished

Poverty defined in an relative sense

Comparing a given income to the overall distribution of incomes in a population. Defined by comparing a given income to the distribution of income in a population. For example, those earning less than 30% of the national per capita income might be considered relatively impoverished, meaning that the poverty definition changes as average income increases.

Relative income hypothesis

Considers subjective measures of wealth and has the advantage of considering psychosocial pathways linking income to health; though testing the hypothesis requires making assumptions about how individuals compare themselves to others. For example, do low-income families feel socially excluded only when other low-income families begin earning more, or do the rising income of celebrities matter as well? It is also possible that relative income matters through other mechanisms as well, with income distribution affecting the ways in which businesses and governments invest in serving the poor

How does the U.S. distribute their spending as a percentage of GDP?

Country with the largest percentage of GDP spent on health care and the smallest percentage spent on social care

When subjects anticipated a stressful situation (performing a speech that would be video recorded), they tended to:

Eat more sweet and fatty foods The effect was only observed among emotional eaters (people who tend to eat as a way to cope with stress)

Food insecurity falls within which of the five key areas of social determinants?

Economic stability

Health as a human right

Enshrined in the United Nations General Assembly's Universal Declaration of Human Rights in 1948 and has since been reflected in national constitutions, treaties and domestic laws, policies, and programs in countries around the world Emphasizes the unique value societies place on health

"space" health inequality

Deals with measures of distance and proximity such that exposure to spatially distributed health risks and protective factors will change according to an individual's precise location. For example, air pollution that exacerbates asthma symptoms would be an example of a health risk that is distributed across space. Proximity to landfills, crime clusters, and health clinics are other examples of spatially patterned health risks and protective factors.

health inequality

Differences in the health of individuals or groups without concern about moral judgment on whether observed differences are fair or just Example: Flint, Michigan state officials knew the consequences of switching water supply, yet switched it anyways

What are the central factors that are indicative of most vulnerable households' inability to be food secure?

trade-offs in paying bills engage in coping strategies foreclosures (tradeoffs in paying bills and coping strategies are better predictors of food insecurity than the standard set of variables- age, household, race, etc.)

T or F: Children born to black mothers have the highest infant mortality rates

true

T or F: Lead based paint exposure can cause symptoms similar to those of ADHD

true

T or F: Those living below the poverty threshold experience food insecurity and hunger at over 3 times the national average.

true

Babies born to mothers who have not finished high school are nearly ____________ to die before their first birthdays as babies born to college graduates.

twice as likely

Households in which the child's portion size was lessened or one or more of the household members did not eat regularly are categorized as having

very low food security

collinearity

which variable is causing the biggest impact when there are multiple factors involved

The largest single ethnic group participating in the Supplemental Nutrition Assistance Program is

whites

Recommendations of ACE study

• Increased attention to primary, secondary, and tertiary prevention strategies needed Primary: Prevention of the occurrence of adverse childhood experiences Secondary: Preventing the adoption of health risk behaviors as responses to adverse childhood experiences during childhood and adolescence Tertiary: Helping change the health risk behaviors and improve the disease burden among adults whose health problems may represent a long-term consequence of adverse childhood experiences

Direct biological effects of stress

•Chronic sympathetic stimulation of the cardiovascular system due to stress leads to sustained increases in blood pressure, which can lead to damaged arteries and plaque formation •Chronic elevation of stress hormones can suppress immunity and promote inflammation by directly affecting cytokine profiles •High cortisol levels also increase insulin resistance and fat accumulation

Interventions outside of the health sector to reduce stress related health disparities

•Early childhood development programs •Career development training •Improving access to affordable medical care •Numerous benefits to low-income working families can buffer some of the stress from economic challenges •Family-friendly workplace and flexible working hours

Social class is measured as a gradient by what measures?

•Educational attainment •Inequalities in the distribution of power or wealth •Ownership of assets •Social capital

What would be a compositional effect on understanding health inequalities?

Persons with cancer moving into the neighborhood of a cancer treatment center

The strategy for making written and oral information easier to understand is called:

Plain language

educational attainment

Years or level of schooling a person has, rather than instruction on specific health topics

absolute poverty

an objective measure of wealth is a useful measure for testing the absolute income hypothesis

Which race/ethnicity has the lowest infant mortality rate?

asian or pacific islander (4%)

Persons with limited health literacy skills are more likely to have:

chronic conditions

The presence of schools, hospitals, and parks would be a considered a __________ effect in the framework for understanding health inequalities?

contextual

literacy

defined as a person's ability to read, write, speak, and compute and solve problems at levels necessary to function on the job and in society, achieve one's goals, and develop one's knowledge and potential

neo-liberalism

drive to make the government's footprint smaller

Food insecurity falls in which SDOH category?

economic stability

ACES childhood exposure least prevalent was:

evidence of criminal behavior in the household (3.4%)

The proportion of income spent on _____ by economically stressed families is used as the basis for the current poverty thresholds.

food

what 4 qualities of a household have a greater risk of experiencing poverty and food insecurity?

headed by single women those with children members of a minority group located in the inner city

threshold model

health outcomes hinge on meeting some benchmark with regard to the social resource

wilkinson's theoretical synthesis

income distribution is a marker of how unequal a society is income inequality measures the differences in social standing or social status -those in lower income bracket will suffer from stress, lack of self-esteem -those with higher income have access to education, better housing

Preston's curve says that individuals born in richer countries can expect to live _________ than those born in poor countries.

longer

high food security

no reported indications of food-access problems or limitations

WIC

nutritional program for women, infants, and children

marginal food security

one or two reported indications—typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake.

What are stratifiers that the WHO highlights to define social groups?

place of residence race/ethnicity occupation gender religion education SES social capital or resources

flat tax

proportional tax on individual income after a specified threshold has been reached

episodes of food insecurity are _____

recurrent (not chronic)

Episodes of food insecurity are usually _______ - not ________.

recurrent; chronic

Stress

refers primarily to the experiences people have when they face challenging events or conditions that they feel exceed their resources for coping

contextual effect

refers to the influence a neighborhood or other type of unit has on people (schools, hospitals)

compositional effect

reflective of the characteristics of individuals that comprise the neighborhood example: a neighborhood with very high rates of cancer due to a cancer center being very close

_______ poverty definition may classify a greater proportion of a population as impoverished, especially in countries with high levels of income inequality

relative

very low food security

reports of multiple indications of disrupted eating patterns and reduced food intake

low food security

reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake

Children whose parents have not finished high school are more than _____ times as likely to be in poor or fair health as children of college graduates.

six times

collective efficacy

social control exerted by cohesive communities and based on mutual trust, including intervention in the supervision of children and maintenance of public order

ACES childhood exposure most prevalent was:

substance abuse in the household (25.6%)

USDA's thrifty food plan

the calculation model that is the lowest cost of 4 food plans developed by the USDA

health literacy

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Most households that had very low food security at some time during a month experienced the associated conditions in how many days of the month?

1-7

What is the term for the measure of several factors that affect a user's experience interacting with a webpage, such as health.gov?

Usability

Less consistent findings related to exposure to stress and health behaviors

-Physical inactivity -Poor sleep

Consistent findings related to exposure to stress and health behaviors

-Smoking -Disordered drinking -Substance abuse -Unhealthy eating habits

effect modifier

A variable that does not lay on the casual pathway between exposure and outcome, but whose presence helps explain when and how an exposure and outcome are related. The relationship between exposure and outcome may vary according to the level of the effect modifier. Example: In many contexts, racial discrimination persists in the workplace. Within such a context, white employees who receive promotions might experience a decrease in blood pressure, perhaps due to increased job control and workplace status. On the other hand, black employees might not reap any health benefit from promotions because discrimination persists at all occu- pational levels, preventing them from feeling a sense of increased status or control at work. In this example, we might observe that better occupations improve blood pressure for white, but not for black, employees. Unlike our first example, in which income had a clear, directional impact on blood pressure, our second example shows how race modifies the relationship between occupation and blood pressure in different ways. This example also reminds us that social groups are not simply of interest as exposures, but may also explain the relationship between other exposures and outcomes.

mediator

A variable that lies on the causal pathway between exposure and outcome, helping to explain the association between them. Example: in a study of occupation and its effects on blood pressure, we might learn that income is the link that explains how a person's job influences their blood pressure. In this example, occupation could determine income, which then might affect blood pressure by influencing whether a person can buy healthy food, receive adequate medical care, or experiences stress over financial matters. When designing policies or programs to influence an outcome like blood pressure, it may be effective to consider ways that income could be used as a policy tool. For example, if income is responsible for the link between occupation and blood pressure, cash transfers or public assistance for low- income workers could improve blood pressure without changing working conditions. However, we might find that, even after increasing income, occupation still has an impact on blood pressure. If this were the case, we would conclude that income only partially mediates the occupation-blood pressure relationship.

Rates of food insecurity were higher than the national average in 2017 for what groups?

All households with children (15.7 percent) Households with children under age 6 (16.4 percent) Households with children headed by a single woman (30.3 percent) or a single man (19.7 percent) and other households with children (18.1 percent) Women living alone (13.9 percent) and men living alone (13.4 percent) Households headed by Black non-Hispanics (21.8 percent) and Hispanics (18.0 percent) Households with incomes below 185 percent of the poverty threshold (30.8 percent).

Cumulative effects

Health effects resulting from long-term exposure to conditions that affect health. Examples include prolonged exposure to environ- mental toxins or long-term poverty.

What country has the most progressive distribution of benefits of public programs and services?

Australia

Distribution of benefits of public programs is most progressive in?

Australia Least progressive in Unites States

Inequality hypothesis

Greater inequality might act to strengthen the effects of socioeconomic status differentiation among outcomes with social gradients.

social gradient

Exists where increasing quantities of social resources such as education, social class, or income correspond with increasing levels of health in a dose-response relationship Example: consider education, which is well known to positively impact health.. The relationship between education and health is such that even at very high and low ends of the education distribution, additional years of school correspond with marginally better health. If instead of a functioning as social gradient, education had a threshold effect on health, we might observe that not having a secondary school education was associated with worse health but that education and health were not linked for those who had completed secondary school or a higher degree. For example, under this threshold model, we would not expect those with a graduate school education to be healthier than those with a college education

toxic stress

Experiencing strong, frequent, and/or prolonged adversity Examples: physical or emotional abuse, exposure to violence

What affects health at evert stage of life?

Family income Education Neighborhood resources Social Capital Sleep Stress

Canada Health Act

Federal Documentation. Ensures everyone has access to health care

In the study by Gundersen at al., the article focuses on a particular group of food insecure households who are using what food network?

Feeding America

The percentage of households with food-insecure children was higher for:

Female-headed households Black, non-Hispanic households Hispanic households Low-income households with incomes below 185 percent of the poverty line Households in principal cities Households in nonmetropolitan areas

Stress pathway

First,our body judges a situation and decides whether or not it is stressful, based on sensory input and processing - and on stored memories. If the situation is judged as being stressful, the hypothalamus (at the base of the brain) is activated that results in the production of glucocorticoids.

overall health distribution concept for operationalizing the study of health inequality

Focus on health differences across individuals For example, describing the range or variance of a given measure across an entire population. This method is agnostic to social groupings, effectively collapsing all people into one distribution. Example: Researchers studying global income inequality have used this approach to highlight the relative wealth of poor individuals in rich countries compared to well-off individuals in poor countries In contrast to focusing on how people from similar backgrounds compare to one another, exploring the income distribution across one global population has yielded important insights into just how un- equally resources are currently distributed, as well as what factors drive these differences.

2017 food security report

Food insecurity and very low food security down from 2016 88.2% food secure 11.8% food insecure Food insecurity in children (7.7%) essentially unchanged from 2016 (8%)

According to the Household Food Security Report (2017), what state had the lowest prevalence of food insecurity?

Hawaii

State with the lowest rate of food insecurity

Hawaii (7.4%)

Very low food security among children was more prevalent in households:

Headed by a single woman And households with incomes below 185 percent of the poverty line.

Latent effects

Health effects caused by prior condi- tions that impact later health, regardless of subse- quent life events. Examples include lack of adequate prenatal care or poor nutrition in childhood.

Pathway effects

Health effects resulting from early life conditions, which continue to impact future behavior. Examples include poor exercise habits in childhood that continue into adulthood. Although these habits can be changed in adulthood, they can be predictors of adult choices that themselves have health effects.

Effects of early childhood interventions are greatest for what children?

For children who are at the greatest social and economic disadvantage, but children in ALL families benefit from early childhood programs

The prevalence of very low food security was significantly higher than the national average (4.5 percent) for what groups?

Households with children headed by a single woman (9.0 percent) Women living alone (7.0 percent) and men living alone (6.5 percent) Black, non-Hispanic households (8.5 percent) and Hispanic households (5.5 percent) Households with incomes below 185 percent of the poverty line (12.6 percent) Households located in principal cities (5.4 percent) and outside metropolitan areas (5.4 percent) Households in the South (5.1 percent).

What is one of the most effective ways for a society to achieve its health potential?

Improving early childhood social circumstances is one of the most effective ways for a society to achieve its health potential

What shows that it is relative income within societies that is important for health in rich countries and suggests that psychosocial mechanisms are relevant?

In rich countries there is no association between average levels of income (e.g. gross national income per capita) and measures of health, such as life expectancy. Yet within rich countries there are strong associations between individual income and life expectancy.

disposable income

Income remaining for a person to spend or save after all taxes have been paid

Life expectancies chart

Japan highest: W= 87, M= 80 U.S. lowest: W= 81, M= 76

Medical care and personal behavior do not occur in a vacuum and are influenced by what upstream determinants?

Living and working conditions in homes and communities Economic and social opportunities and resources

Among household categories, the percentage of households with food-insecure children was lower in:

Married-couple households White, non-Hispanic households Households headed by non-Hispanics of other, or multiple, races Households with incomes above 185 percent of the poverty line Metropolitan households located in suburbs and exurbs outside of principal cities

Gini Coefficient

Most commonly used measure of income inequality within a population, ranging from zero for complete equality, to one if one person has all the income.

Group level differences concept for operationalizing the study of health inequality

Most commonly, we examine differences in health outcomes at the this level to understand social inequalities in health. For example, we might ask how mean body mass index (BMI) of the poor compares to that of the rich. For example, considering the history of slavery and segregation in the United States sheds light on current racial/ethnic health disparities. Similarly, understanding the political and religious history of the caste system in India helps us understand how it affects social status, occupation, education levels, and health outcomes for individuals today. Viewing health disparities through the lens of social groups can help guide interventions, enable surveillance of important equity issues, and advance our understanding of health by helping us make connections that may have not been initially obvious.

State with highest rate of food insecurity

New Mexico (17.9%)

In the study by Gundersen et al., what is NOT a coping strategy that is commonly used in food insecure households?

Paid a medical bill rather than purchase food

absolute income hypothesis

Posits that an individual's health depends only on his own income and not on what others in a population earn By this logic, the health of an individual whose income stays constant should remain unchanged as those around him become wealthier. Similarly, it would predict that earning $50,000 per year had the same effect on health regardless of whether one's neighbors earned an average of $30,000 or $1 million annually. Ignores the fact that as society becomes wealthier, the material goods needed to fully participate in society can change. Goods such as cars, phones, and computers are now more important than ever to accomplish tasks such as getting to work or accessing health care. As a result, those with static incomes in a changing society may fall behind, potentially suffering psychological distress and stress- related health effects from being unable to keep up with average standards of consumption.

The U.S. federal income tax is based on what tax system?

Progressive tax

Who is responsible for improving health literacy?

Public health professionals The government Health care professionals

What population is most likely to experience low health literacy?

Racial and ethnic minorities

"place" health inequality

Refers to membership in political or administrative units, such as school districts, cities, or states. Many government run programs and policies that affect health, such as food assistance programs or tax policies, are specific to administrative units and operate uniformly within their boundaries. As a result, the health impacts of a wide range of programs and policies do not depend on residents' precise physical location, but rather on membership in a given political or administrative unit.

tolerable stress

Response to a more severe stressor; limited in duration Examples: loss of a loved one, a broken bone

What federal food assistance program is also known as "food stamps"?

SNAP

USDA Food Programs

SNAP, Nutritional School Lunch Program, and WIC

What factors are more likely to predict disease?

Social factors are more likely to predict disease rather than medical care

What is an exception to the pattern of the inequality hypothesis?

Suicides seem to stand as an important exception to the general pattern: they tend to be more common in more equal societies despite the evidence that depression is more common in more unequal societies. A possible explanation is that social gradients in suicides are not always consistent internationally. However, another possibility is that there may be some truth in the view that violence can be directed either outwards or inwards against one- self. If suicide is, like homicide, often a response to adversity, we think it likely that greater equality increases a tendency to blame oneself rather than others for what goes wrong.

equity stratifiers

The World Health Organization recommends that health indicators be reported by groups, or 'equity stratifiers' for the purposes of monitoring health inequities

objective measure of wealth

The amount of money in one's bank account

Maximum allotments of SNAP are currently based on what?

The cost of the USDA's Thrifty Food Plan

For many individuals with limited English proficiency (LEP), what is the biggest barrier to accessing health information and services?

The inability to communicate in English

Based on the research study on food bank clients, what was a better predictor of food insecurity over other variables?

Trade-off in paying bills

A lower assessed score on the Food Security Module of the Current Population Survey indicates higher food security. a. true b. false

True

What federal agency is responsible for collecting annual information on food access and adequacy, food spending, and sources of food assistance in the US population?

U.S. Department of Agriculture (USDA)

What country divides people into social groups based on level of schooling achieved?

United Kingdom

subjective measure of wealth

Whether someone feels wealthy or poor in relation to his neighbors

Adverse Childhood Experiences Study (ACES)

•Purpose: to explore the relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction •Methods: Questionnaire mailed to 13,494 adults who completed a standardized medical evaluation at a large HMO (1995-1997) •Conclusion: Strong, graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death Abuse: •Emotional abuse: A parent or other adult in your home ever swore at you, insulted you, or put you down. •Physical abuse: A parent or other adult in your home ever hit, beat, kicked or physically hurt you. •Sexual abuse: An adult or person at least 5 years older ever touched you in a sexual way, or tried to make you touch their body in a sexual way, or attempted to have sex with you. Household dysfunction during childhood •Intimate partner violence: Violent treatment of mother or step mother •Household substance abuse: A household member was a problem drinker or alcoholic or used street drugs or abused prescription medications. •Mental illness: A household member was depressed or mentally ill or a household member attempted suicide. •Criminal behavior in the household: A household member went to prison. Risk factors and disease conditions assessed: Smoking Alcoholism Severe obesity Any drug abuse Physical inactivity Parenteral (intravenous) drug abuse Depressed mood High lifetime number of sexual partners Suicide attempts History of having a sexually transmitted disease More than half of respondents experienced ≥ 1 category of adverse childhood exposure 6.2% reported ≥ 4 exposures

Interventions in the health sector to reduce stress related health disparities

•Supportive counseling in combination with psychoactive medications •Policies designed to remove financial, cultural and geographic barriers to counseling and medication •Increasing people's capacity to manage stress more constructively and avoid health-damaging behaviors -Example: Nurse-Family Partnership for low-income, first-time parents •Integrating social and medical services in medical care settings -Example: Medical-Legal Partnership that provides onsite legal assistance

hypothalamic-pituitary-adrenal (HPA) axis

•The hypothalamus also activates the pituitary which activates the outer portion of the adrenal gland, or cortex •The adrenal cortex releases cortisol (the "stress-hormone") -Higher blood volume, blood pressure and blood sugar levels -Processing of proteins and fat to glucose -Lower production of sexual hormones -Suppression of immune system •The HPA axis also has a negative feedback loop that shuts itself off

•The body's response to stress involves complex interactions between two main physiologic systems:

•The neuroendocrine system (brain and hormonal systems directly activated by the brain) •The immune system (primary role is to defend the body against infection through several mechanisms, including inflammation)