Category Archives: Social determinants of health

New IOM report on US versus…everyone else

2013-01-09 02.01.45 pmThe Institute of Medicine has released a major new report today on the reasons why the United States seems to have poorer health, despite its greater wealth, as compared to other industrialized countries.

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Do optimists live longer?

In medicine, we focus a lot on preventing, diagnosing and treating diseases. But we also know, at an epidemiological level, that good health doesn’t start in the medical clinic. The major predictors of good health outcomes are economic, as well as social; they have to do with whether people have social support and live in safe neighborhoods, whether they have safety net systems to maintain good nutrition in times of distress, or whether they revert to drugs and alcohol in bad times. These factors seem to predict health outcomes better than access to good medical care or medications. In this week’s post, we talk about a new set of initiatives spearheaded by the Robert Wood Johnson Foundation that attempts to capture these ideas into a new model for healthcare delivery.

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Alcohol use around the globe: new data trends

Along with salt, sugar and tobacco, alcohol stands out as a key “risky commodity” affecting global rates of noncommunicable disease. In this post, we look at new epidemiological surveillance and industry data on alcohol sales and consumption from around the world. We look into what populations are most affected by alcohol abuse, and what policy responses seem to have been successful in reducing morbidity and mortality from risky drinking.

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Occupational health in the electronic age: disease in the new sweatshop

When we say our products are made “in China”, what we really should say it that they’re made in Shenzhen–a city in Guangdong Province, just north of Hong Kong. Shenzhen is one of China’s “special economic zones” (SEZs)–754 square miles of industrial space in which foreign corporations are permitted unique rules and regulations, permitting them to run high-throughput factories that currently use 3.3 million people to make products for the Western consumer market. This is where Xboxes and cell phones come from, produced by Chinese contractors like Foxconn (which makes the new iPhone). There is an unusually high rate of suicide in Shenzhen, and in Foxconn factories in particular; behind these suicides are a broader set of public health issues among electronic workers–from those who make the new gadgets, to those who dismantle them after we throw them away.

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Can we design a heart-healthy home? Disease and the built environment

There is increasing evidence that the quality of our homes and cities is a critical determinant of cardiovascular disease, diabetes and lung conditions. As urbanization and economic change occur globally, whether we live in a house free of dust in a city with open parks and traffic regulations, or in a dusty tenement building next to a major road, seems critically correlated with our likelihood for having shortened life expectancy, poor nutrition, heart disease and lung problems. In this week’s blog post, we look at some of the mechanisms relating the “built environment”—our human-made surroundings of daily living—to the risk of illness. We ask the question: can we do for our hearts and lungs what the Bauhaus movement did for functional design?

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Should doctors make “house calls” again? Preventive hot spotting and early active intervention

In the olden days, doctors would travel from house to house when community members fell ill. Now, we usually expect patients to come to our office-based clinics. The modern model of care is certainly more efficient for us as physicians. But it’s also a barrier for patients to receive medicine; the highest-risk people usually make it to our clinics after being discharged from their first or second hospitalization, well after high blood pressure or diabetes has already taken its toll on their bodies. Our latest research suggests that we can statistically predict which people are most likely to end up having chronic diseases five or ten years from now. We can pinpoint these people right down to which house they live in. Such predictive models present a new opportunity to prevent disease before it becomes costly or deadly. In this week’s post, we look at a new idea for community-based disease prevention in medicine: the geographical mapping of chronic disease risks, and preemptive visits of healthcare workers to households where people are likely to become ill in the future.

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Health effects of financial crisis: omens of a Greek tragedy

Greece has been affected more by the financial turmoil beginning in 2007 than any other European country. Fifteen years of consecutive growth in the Greek economy have reversed. In adults, unemployment has risen from 6.6% in May, 2008, to 16.6% in May, 2011 (youth unemployment rose from 18.6% to 40.1%), as debt grew between 2007 and 2010 from 105.4% to 142.8% of gross domestic product (GDP; €239.4 billion to €328.6 billion) compared with the average change in the EU-15 (the 15 countries that were EU members before May 1, 2004) from 66.2% to 85.1% of GDP in this same period (€6.0 trillion to €7.8 trillion). Greece’s options were limited, since its Government ruled out leaving the Euro, precluding them from one of the most common solutions in such circumstances: devaluation. To finance its debts, Greece had to borrow €110 billion from the International Monetary Fund and Eurozone partners, under strict conditions that included drastic curtailing of government spending. Whereas other countries in Europe (eg, France, Germany) now show signs of economic recovery, the crisis continues to evolve in Greece; industrial production fell by 8% in 2010. Richard Horton has asked whether anyone is looking at the effect of the economic crisis on health and health care in Greece, in light of the adverse health effects of previous recessions. Here, we describe changes in health and health care in Greece on the basis of our analysis of data from the EU Statistics on Income and Living Conditions, which provide comparable cross-sectional and longitudinal information on social and economic characteristics and living conditions throughout the EU.

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