Determinants of Health

If you, like me, follow fitness instructors on social media, you hear a common refrain: Being healthy is a lifestyle, not a trend. In many ways, that is true. Multiple studies prove that dieting does not lead to long-term weight loss. But in some ways, that statement is completely incorrect. Sometimes being healthy has nothing to do with how many servings of fruits and vegetables you consume daily. Nor your ability to stray from vices like smoking and excessive drinking. Just ask the non-smoker who develops lung cancer – about 20 percent of people who die from lung cancer do not smoke or use tobacco products at all. Sometimes your health is determined by factors beyond your control – like your genetics, where you live or even how you look.

These factors are called determinants of health. That’s a technical public health term used to define the range of personal, social, economic, and environmental factors that influence one’s health status.

This podcast is about those factors that we can’t always control and how they impact health – in both positive and negative ways. I’m sure you’re wondering – why even learn about these differences if we can’t control them? Well just because we might not be able to avoid certain illnesses entirely, the information I plan to provide could help start the conversation with your healthcare provider to better understand how our behaviors can limit negative impact.

So a few things before we get this thing going. While I am super smart, I am not a medical professional. The information I provide in this podcast should not be taken as medical advice or opinion. I’m a health writer who has covered health care for several years. I’ve also worked in the healthcare industry as a marketing professional. It was during my time working in healthcare marketing that I began to question why differences in health exist. I thought of ways I could use my talents as a writer to eliminate the disparities. If this sounds like something you’d be interested in learning about, stick around.

So before I really get into explaining the various factors that impact health outcomes, I think it is important to explain some of the public health jargon that is surrounding this topic – like health outcomes, health status, health disparities. The list goes on and on. So as to not completely bore you with a bunch of definitions, I think I should tell you a story.

Back in high school, I had this amazing science teacher. For this story, I’ll call him Dr. Jones. Dr. Jones was a short, stocky, African American man in his 50s who spent half his life teaching earth science in New York City public schools. He loved his job and where he was working. Even after his family relocated to southern New Jersey, Dr. Jones still took the bus and train to get to our school in Brooklyn. Even though he lived so far, he was rarely out. So when he failed to show up to work one day, it was odd. Even odder was that no one knew where he was. He wasn’t answering his cell phone. He didn’t get on the bus to go home. He was just gone.

He was missing for about a week before he reconnected with his family. It turns out he had a stroke while riding the subway. He lost consciousness when he awakened he was unable to speak. At some point, he defecated on himself. He was mistaken for a homeless person, so he was ignored and did not receive the adequate care he needed immediately. After riding the trains for some time, he was taken to a hospital.

Dr. Jones case is incredibly sad, but not altogether uncommon. A study conducted by sociologists at Cornell found only 2.5 percent of people who had a medical emergency in a public place got help from strangers before an emergency medical technician arrived. For African Americans, the odds of getting help from a good Samaritan is even lower. Only 1.8 percent or fewer than 1 in 55 African Americans, received assistance from bystanders. That’s compared to 4.2 percent of Caucasians. This difference in the odds of getting help is a prime example of a health disparity.

The Centers for Disease Control and Prevention define health disparities as preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. These populations are usually defined by factors like race or ethnicity, gender, education, income, disability, geographic location (e.g., rural or urban), or sexual orientation. Combining certain factors might exacerbate the disparities or cancel out the effects of certain advantages an individual might have.

As an African American man, Dr. Jones is considered a part of a socially disadvantaged population. This is despite having advanced degrees, a stable job, and living in a middle income community.

So it is possible because he was an African American man, who was unresponsive, he was not able to get immediate medical attention, which is vital for stroke patients. In the medical profession, the phrase “time is brain” is used a lot because it draws attention to the speed at which nervous tissue is lost as stroke progresses. The quicker a patient gets treatment, the less of the impact the stroke could have on their brain function. The amount of brain function that is lost or saved is an example of a health outcome.

Health outcomes are changes in health status following a medical intervention or a series of interventions. Health status is just the health of a person – good or bad. Dr. Jones, fortunately, survived the stroke, an event that kills 130,000 Americans each year. However, he did have a long road to recovery and retired from teaching.

I’m sure you’re saying to yourself, the fact he suffered this stroke has nothing to do with his race or being a part of any disadvantaged group. You have a point, sort of. Studies have shown that genetics may play a role in stroke risk. Diseases like sickle cell anemia, which occurs more commonly in African Americans, has been associated with stroke, though in younger age groups.

Personal factors like Dr. Jones’ weight probably played a part in his stroke risk. Being overweight or obese can lead to a buildup of plaque in the arteries. If the area of plaque ruptures a blood clot forms. If the clot is close to the brain, it can block the flow of blood and oxygen to the brain, which causes a stroke. Psychological stress, which often occurs with people with long commutes, can also cause stroke.

Other factors that could have played a role in Dr. Jones case, though not likely, is a personal delay in calling for emergency services. A 2011 survey conducted by the American Stroke Association found that only 12 percent of black stroke patients called 9-1-1 immediately. About half delayed contacting 9-1-1 because they thought they would eventually feel better; 75 percent called a family member or friend first; only half of those who suspected they were having a stroke actually arrived at the hospital in an ambulance. Of those that did arrive by ambulance, 35 percent did so because they had no other available transportation.

These are just some of the factors that come into play when we talk about determinants of health.

Special thanks to Marvin Anderson for copy-editing help. Background music courtesy of Casetofoane.