- Describe the 2 reasons Schroeder gives to explain why the US ranks poorly on many health measures in spite of spending more money than other countries on health care. What other single factor would you suggest that might also contribute to this paradox?
- In what ways is the problem of obesity in America like the now decreasing problem of tobacco use? In what ways is it different?
- The pie chart illustrating the 5 proportional categories contributing to premature death in the US are based on total US population mortality. How might these percentages change if the chart were to be redrawn to reflect populations living in poverty in inner cities? People living in poverty in rural areas? Suggest new percentages for each and explain why you think as you do.
- Social determinants of health are relatively new considerations as predictors of premature death, yet a growing body of research indicates their contribution is strong. Name a social determinant and describe a possible role for the Church in ameliorating it.
THE INITIAL POST- should contain 400–500 words and adhere to AMA writing style guidelines.This word limit promotes writing that is thorough yet concise enough to permit your peers to read all the posts. If the Discussion Board Forum prompts you to answer a series of questions, make sure you address all of them thoroughly within the word limit. Do not restate the questions in your post; simply begin a new paragraph for each new thought.
The goal is to have a seamless written argument closed by a brief conclusion tying together your individual responses. Use your best critical reasoning skills, employing the Universal Intellectual Standards as a guide, but not a strict outline. Refer to specific statements of the author(s) whenever appropriate but limit direct quotations to a maximum of 25 words for your entire post. Since this is a personal discussion, you may use first person; however, you should maintain professional decorum at all times.
REPLYS TO CLASSMATE-
Each reply should contain 200–250 words and adhere to AMA writing style guidelines.
Reply to classmate #1-
According to the article provided, the two explanations that Schroeder gives to describe why the US ranks poorly on many health measures in spite of spending more money than other countries on health care are that better individual health does not necessary equal the need for a better health care delivery system and that good health care systems do not necessarily mean that people will be able to receive those services1. I believe that personal behaviors and choices play a large role in individual health status. Even with great resources available, individuals might not want to utilize those resources.
The problem of obesity and tobacco use in America share similarities as well as differences. Both share high prevalence rates, earlier onset (younger population), involve major health complications, and are difficult to treat1. Both obesity and tobacco usage involves stigmas surrounding the issues, are 20th century phenomenons, and are influenced heavily by the promotion industry1. Alternatively, tobacco use is harmful even in smaller percentages, can be harmful to others, contains chemically addictive components, and has a strong evidence history for treatment while obesity does not have these aspects1.
Currently, the pie chart illustrating the 5 proportional categories contributing to premature death in the US are based on total US population mortality show that behavioral patterns rank at 40 percent, genetic predisposition at 30 percent, social circumstances at 15 percent, health care at ten percent, and environmental exposure at five percent1. If these numbers were manipulated to reflect the populations living in poverty in inner cities, I believe, based off of readings from our text book, they would rank differently with behavioral patterns ranked at 45 percent due to lower education levels and income levels, genetic predisposition at 20 percent due to genetic behavioral patterns, social circumstances at 15 percent due to lower education levels and lower incomes, health care at ten percent due to lower income levels and access to services, and environmental exposure at ten percent due to the location of living3. Alternatively, if these numbers were manipulated to reflect the populations living poverty in rural areas, I believe they would rank differently with behavioral patterns ranked at 25 percent, genetic predisposition at 15 percent due to genetic behavioral patterns, social circumstances at 30 percent due to lower access to health care services and lower incomes, health care at 25 percent due to lower income levels and a decreased access to services, and environmental exposure at five percent due to the location of living3.
One social determinate of health is education2. As Christians and health care professionals, we can work towards bettering the level of health education by providing or support public health education efforts as well as better options for those communities such as fresh food stores2. The bible states in Galatians 6:2, “Carry each other’s burdens, and in this way you will fulfill the law of Christ”. Through helping to educate and encourage healthier behaviors, we can help to increase the health of these populations.
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1 Schroeder S. We Can Do Better — Improving the Health of the American People. New England Journal of Medicine. 2007;357(12):1221-1228. doi:10.1056/nejmsa073350
2 Adler N, Glymour M, Fielding J. Addressing Social Determinants of Health and Health Inequalities. Jama. 2016;316(16):1641. doi:10.1001/jama.2016.14058
3 DiClemente R, Salazar L, Crosby R. Health Behavior Theory for Public Health: Principles, Foundations, and Applications. Burlington, MA: Jones & Bartlett Learning; 2019.
REPLY TO CLASSMATE #2-
Schroeder explains there are two reasons the U.S. ranks poorly on many health measures. First, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care.1 I believe another contributing factor to this paradox of why the U.S. spends so much on health care but still ranks poorly on health measures is personal behavior. Unhealthy behaviors contribute to leading causes of early mortality.2
Obesity in America has now become the new tobacco issue. These two have numerous similarities according to Schroeder. Both are highly prevalent, start in childhood or adolescence, were relatively uncommon until the first (smoking) or second (obesity) half of the 20th century, are major risk factors for chronic disease, involve intensively marketed products, are more common in low socioeconomic classes, exhibit major regional variations (with higher rates in southern and poorer states), carry a stigma, are difficult to treat and are less enthusiastically embraced by clinicians than other risk factors for medical conditions.1 Although Obesity and tobacco share many similarities, they do still have their differences. Obesity does not contain any additive chemical components or cause harm to others around you. Eating in moderation is also recommended and not harmful, unlike in smoking.
I believe if a pie chart were drawn for the inner city there would not be much difference from how it currently looks. However, in a rural area I feel there would be a big shift in social circumstances. Social circumstances would be 45%, Health care 5%, Environmental exposure 5%, Behavorial patterns 30% and Genetic predisposition 15%. A lot of health measures depend on people making healthful changes in their lives but that may be hard to do for people who are struggling economically.3 Rural areas are prone to poverty, unequal access to health care, and lack of education.
A social determinant that could be incorporated easily in many churches would be social support. As stated in Proverbs 17:22 “A joyful heart is good medicine, but crushed spirit dries up the bones”.4 Integrating social support groups in churches could help many people cope with behavioral changes. According to the World Health Organization, it defines health as the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.4 Churches could form a weekly mental health group which could aid in a persons’ overall health and well-being.
1 Schroeder S. We Can Do Better – Improving the Health of American People. New England Journal of Medicine. 2007; 357: 1221-8.
2 DiClemente R, Salazar L, Crosby R. Health Behavior Theory for Public Health. Second Edition. Burlington, MA: Jones and Bartlett Learning; 2019
3 Collins P. Local health rankings highlight problems for city, county. Martinsville, VA: Martinsville Bulletin. March 13 2017.
4 World Health Organization. Frequently asked questions. https://www.who.int/about/who-we-are/frequently-asked-questions. Updated 2019. Accessed March 18 2019.
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