Social Determinants Of Illness Research Articles

Social Determinants of COVID-19 Vaccination Rates: A Time-Constrained Multiple Mediation Analysis.

Objective To estimate the multiple direct/indirect effects of social, environmental, and economic factors on COVID-19 vaccination rates (series complete) in the 3109 continental counties in the United States (U.S.). Study design The dependent variable was the COVID-19 vaccination rates in the U.S. (April 15, 2022). Independent variables were collected from reliable secondary data sources, including the Census and CDC. Independent variables measured at two different time frames were utilized to predict vaccination rates. The number of vaccination sites in a given county was calculated using the geographic information system (GIS) packages as of April 9, 2022. The Internet Archive (Way Back Machine) was used to look up data for historical dates. Methods A chain of temporally-constrained least absolute shrinkage and selection operator (LASSO)regressions was used to identify direct and indirect effects on vaccination rates. The first regression identified direct predictors of vaccination rates. Next, the direct predictors were set as response variables in subsequent regressions and regressed on variables that occurred before them. These regressions identified additional indirect predictors of vaccination. Finally, both direct and indirect variables were included in a network model. Results Fifteen variables directly predicted vaccination rates and explained 43% of the variation in vaccination rates in April 2022. In addition, 11 variables indirectly affected vaccination rates, and their influence on vaccination was mediated by direct factors.For example, children in poverty rate mediated the effect of (a) median household income, (b) children in single-parent homes, and (c) income inequality. For another example, median household income mediated the effect of (a) the percentage of residents under the age of 18, (b) the percentage of residents who are Asian, (c) home ownership, and (d) traffic volume in the prior year. Our findings describe not only the direct but also the indirect effect of variables. Conclusions A diverse set of demographics, social determinants, public health status, and provider characteristics predicted vaccination rates. Vaccination rates change systematically and are affected by the demographic composition and social determinants of illness within the county.One of the merits of our study is thatit shows how the direct predictors of vaccination rates could be mediators of the effects of othervariables.

Putting Action into Population Health Science: Primary Care Interventions to Address Social Determinants of Health.

Concern about health equity and social determinants of illness (e.g., income inequalities, lack of education, food insecurity) figure prominently in many conceptions of population health. In order to illustrate how population health can actively translate science into action, we consider primary care interventions that promote healthy populations by addressing the social determinants of health. In the examples provided in this article, primary care and population health are linked in a way that reinforces each other, and these innovative interventions may lead to improved health outcomes. Population health science provides a variety of methods and approaches for designing and evaluating interventions that aim to link patients with community resources that can address social determinants of health and improve the quality of their lives. Population health can serve as an important bridge between primary care and the public health sector. Population health science has been defined as "the study of the conditions that shape distributions of health within and across populations, and of the mechanisms through which these conditions manifest as the health of individuals" (Keys, K.M. 2016). According to this perspective, population health science elucidates the mechanisms that produce disease and the discipline of public health then applies that information to promote health in populations. Put another way, population health can be seen as the basic science of public health (Galea, S., et al. 2018). Other conceptions of population health have a direct concern with the translation of science into actions, and view science and action as linked and reinforcing each other (Kindig, D., et al. 2003; Diez Roux, A.V, 2016). For example, Kindig & Stoddart (2003) differentiated population health from public health, health promotion, and social epidemiology and argued that "the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two." The thesis of this commentary is that population health science goes beyond studying the mechanisms that shape distributions within and across populations to include actions that promote health of the entire human population. In support of this thesis, examples are provided from the literature on interventions in primary care that promote healthy populations by addressing the social determinants of health.

The scientific basis of medical Generalism

The scientific basis for the various specialties in medicine is strong and is well taught in UK medical schools. This is done by identifying and summarising for medical students the main research which describes and explains the principles of specialist practice. However, ever since 1948, general practice has been the one branch of medical practice which is not taught in this way. Many new doctors qualify believing that general practice is ‘hospital medicine outside hospital’ and ignorant of important research on general practice as a distinct specialty. This article summarises three research studies showing that psychosocial factors affect the body and influence whether patients live or die. They all occur in the home, family or community and are much more likely to be known to family rather than hospital doctors. Generalist doctors can best see the social determinants of illness, to understand why many diseases occur, and to be able to intervene helpfully. Research clarifies the central role of medical generalists. Both the Royal College of General Practitioners and the Health Select Committee of Parliament have called for this material to be taught in medical schools and the sooner it is the better.

Educational Outcomes of the Harvard Medical School–Cambridge Integrated Clerkship

The authors report data from the Harvard Medical School-Cambridge Integrated Clerkship (CIC), a model of medical education in which students' entire third year consists of a longitudinal, integrated curriculum. The authors compare the knowledge, skills, and attitudes of students completing the CIC with those of students completing traditional third-year clerkships. The authors compared 27 students completing the first three years of the CIC (2004-2007) with 45 students completing clerkships at other Harvard teaching hospitals during the same period. At baseline, no significant between-group differences existed (Medical College Admission Test and Step 1 scores, second-year objective structured clinical examination [OSCE] performance, attitudes toward patient-centered care, and plans for future practice) in any year. The authors compared students' National Board of Medical Examiners Subject and Step 2 Clinical Knowledge scores, OSCE performance, perceptions of the learning environment, and attitudes toward patient-centeredness. CIC students performed as well as or better than their traditionally trained peers on measures of content knowledge and clinical skills. CIC students expressed higher satisfaction with the learning environment, more confidence in dealing with numerous domains of patient care, and a stronger sense of patient-centeredness. CIC students are at least as well as and in several ways better prepared than their peers. CIC students also demonstrate richer perspectives on the course of illness, more insight into social determinants of illness and recovery, and increased commitment to patients. These data suggest that longitudinal integrated clerkships offer students important intellectual, professional, and personal benefits.

Poverty as a predisposing factor of illness tendencies in sugar cane workers

This exploratory research based on the Social Ecological Theory aimed to study the health promotion of 39 people working in the harvest of the sugarcane in São Paulo, Brazil. The objectives were to identify the individual, social and environmental factors predisposing the workers to illnesses. The data were collected through direct observation of the labor activity and a questionnaire. The main individual determinant factors were physical effort and hectic work rhythm, and among the environmental factors, intense solar radiation, dust, soot and the presence of venomous animals were highlighted. The conditions of life and work reflect the poverty of these individuals and are the main social determinants of illness. The interaction of these factors can cause respiratory, cutaneous, musculoskeletal problems, occupational accidents. Thus, eradicating poverty and improving work conditions are fundamental for the health promotion of these workers.

Social medicine then and now: lessons from Latin America.

The accomplishments of Latin American social medicine remain little known in the English-speaking world. In Latin America, social medicine differs from public health in its definitions of populations and social institutions, its dialectic vision of "health-illness," and its stance on causal inference. A "golden age" occurred during the 1930s, when Salvador Allende, a pathologist and future president of Chile, played a key role. Later influences included the Cuban revolution, the failed peaceful transition to socialism in Chile, the Nicaraguan revolution, liberation theology, and empowerment strategies in education. Most of the leaders of Latin American social medicine have experienced political repression, partly because they have tried to combine theory and political practice--a combination known as "praxis." Theoretic debates in social medicine take their bearings from historical materialism and recent trends in European philosophy. Methodologically, differing historical, quantitative, and qualitative approaches aim to avoid perceived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social policies on health and health care; the social determinants of illness and death; the relationships between work, reproduction, and the environment; and the impact of violence and trauma.

Social medicine in Latin America: productivity and dangers facing the major national groups

There is little knowledge about Latin American social medicine in the English-speaking world. Social medicine groups exist in Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, and Mexico. Dictatorships have created political and economic conditions which are more adverse in some countries than others; in certain instances, practitioners of social medicine have faced unemployment, arrest, torture, exile, and death. Social medicine groups have focused on the social determinants of illness and early death, the effects of social policies such as privatisation and public sector cutbacks, occupational and environmental causes of illness, critical epidemiology, mental health effects of political trauma, the impact of gender, and collaborations with local communities, labour organisations, and indigenous people. The groups' achievements and financial survival have varied, depending partly on the national context. Active professional associations have developed, both nationally and internationally. Several groups have achieved publication in journals and books, despite financial and technical difficulties that might be lessened through a new initiative sponsored by the US National Library of Medicine. The conceptual orientation and research efforts of these groups have tended to challenge current relations of economic and political power. Despite its dangers, Latin American social medicine has emerged as a productive field of work, whose findings have become pertinent throughout the world.