Using Social Determinants to Identify Dangers to Health

Over the years I have seen many people question the quantifiable effects of social determinants of health. I used to be one of them. I remember a colleague evangelizing the importance of understanding and considering factors such as income, geographical location and cultural norms in understanding health outcomes. I thought it was “nice to know” but not something we could actually fix. After all, where do you start? How does a health professional begin to understand and account for all the factors that could be impacting a person’s health?

Public health professionals play a significant role in this area. They have the ability to break society into smaller, more manageable bites and delve deeper into what is happening. A great example of this was documented in the a study published in the August 2012 Pediatrics about the increased rate of children admitted to hospitals for child abuse and its link to the housing mortgage crisis.

According to the New York Times report of the study, the rate of hospitalization for children suffering from physical abuse increased an average of 0.79 percent a year from 2000 to 2009. The researchers then linked the data to unemployment rates, mortgage delinquency and foreclosure statistics and found a correlation. For every 1 percent increase in the 90-day mortgage delinquency rate in a metropolitan area, there was a 3.09 percent increase in hospital admission rates for children and a 4.8 percent increase in high-risk brain injuries among children.

Clearly, the economic crisis has increased stress levels across the board. Research by the American Psychological Association (APA) shows work, money and the economy are the most frequently cited sources of stress, the same issues that have topped the list for the past five years.  And while we know that stress has a strong influence on our own health, we may not realize how it is impacting our children. This new research paints a picture. We get stressed. We lose our patience, and we inadvertently take it out on innocent victims in our lives.

As parents, we have all been guilty to some degree of letting stress impact our home lives. What parent has not scolded a child too quickly for doing something wrong simply because we had other things on our mind? If you are worried about how you are going to pay the mortgage next month, you may have less patience for a child who is jumping on the furniture pretending to fly. After all, the noise may be contributing to your headache, and you may worry that he or she may break something you can’t afford to replace.

There are no clear answers on how to fix the problem. But acute awareness is a good first step. Social determinants are the economic and social conditions that influence differences in health. It is most often associated with inequities in health, but – as in this case – it also helps shed a light on potential dangers to a population. Identifying and acknowledging issues like this will help us better address the health of the nation.


Be Careful with Labels in the Fight against Child Obesity

A couple of months ago, Disney quietly launched a new attraction at Epcot’s Innoventions called “Habit Heroes.” The attraction was intended to be an interactive exhibit to combat childhood obesity and encourage healthy habits.

The opening was a soft launch to get feedback before formally launching in early March, and they received quite a bit of criticism. The National Association to Advance Fat Acceptance (NAAFA) felt the attraction stigmatized being overweight because all the villains in the attraction were portly. It criticized the attraction for its negativity and even accused Disney of “taking the side of the bullies.” I read one account by a Canadian blogger who wrote, ”

“So thanks for being so helpful Disney – I mean if your kid’s not overweight or obese, here’s to Disney reinforcing society’s most hateful negative obesity stereotyping, and if they are overweight or obese – what kid doesn’t want to be made to feel like a personal failure while on a Disney family vacation?”

Disney has since closed the exhibit for re-tooling.

I have not seen the exhibit so I can’t speak to its appropriateness. I’m also not familiar with the NAAFA, so I looked at their website. The purpose of the organization is to protect the rights and improve the quality of life for fat people. “NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through advocacy, public education, and support.” I’m not sure I can support an organization for fat acceptance, but they do make a valid point in their criticism of how the attraction can make overweight children feel.

As the nation has tried to tackle childhood obesity, it has created a stigma against being overweight. If you are fat, you are bad. And why not? According to the Centers for Disease Control (CDC), the medical cost of obesity in the U.S. totaled $147 billion in 2008.

The problem is that obesity is not a health issue we can fix with a simple solution. A few years ago, we targeted smokers as the health issue to fix. Health campaigns around the country encouraged smokers to stop cold turkey, and that action removed the negative label. That same standard doesn’t apply to people who are overweight. First of all, we can ask them to stop eating. Food is a necessity. Second, changing your diet does not automatically fix the problem. Weight loss takes time and is often impacted by other social and environmental factors. We eat for more than just sustenance. After all, we have all heard terms like  “comfort food” and “stress eating.” So to address obesity, we need to look at the social and environmental factors impacting weight gain — the “why” people eat.

A few days ago, the New York Times published an op-ed by Frank Bruni where he explored our country’s expanding waistline, the reasons behind it and the toll it takes. He sums up the point well with the following:

“If we’re going to wage a successful war against unhealthy weight gain and obesity, we need to understand all of that. We need to stop vilifying obese people, who aren’t likely to be helped by it.”

This is even more important when we talk about kids. When we target overweight kids, we risk labeling them during a critical period in their development. Studies have shown there is a developmental association between obesity and rates of self-esteem in children and adolescents. Overweight children are at greater risk of lower self-esteem. This can result in social isolation, bullying and other issues.

Bottom line, we have to tackle childhood obesity. It’s critical for the future health of our country. But we have to be careful about labeling overweight kids as bad or deficient in the process. Positive social support has to be part of the equation. So how do we do it?

Eating Healthy — if you can

We all know we need to eat healthy. Just turn on the TV or open a magazine. From the “Eat This, Not That” guy to the glut of health reporters, dietitians and celebrity chefs trying to help us all figure it out, we know healthy eating is important. After all, three-quarters of American adults are overweight or obese. So this should be easy, right?

Not necessarily. Access to food and hunger is a big issue in this country. More than 16 million children in America are at risk of hunger. That’s more than one in five children who are not sure where their next meal is coming from. Child hunger is not just a health issue. It’s a social and developmental issue. Children who are hungry are often more prone to illness, more like to ultimately be obese later in life and more likely to have highly levels of behavioral, emotional and academic problems. How can we expect to raise the next generation of confident, strong, successful Americans when as children, they are not getting their basic food needs during their developmental years?

The Food Network has partnered with Share Our Strength, an organization dedicated to eradicating childhood hunger. On April 14th, the Food Network aired a documentary about childhood hunger in America through the eyes of three families in Texas, Virginia and New York City. If you missed it, you can watch it online. It will air again on the Food Network on April 21st at 6:00 p.m. EDT/5:00 p.m. CDT and April 23rd at 10:00 a.m. EDT/9:00 a.m. CDT.

Eradicating childhood hunger is an investment in our future. Our children need to be strong of mind and body to compete in the global economy. So look at it as a future investment.

But let’s also look at it in more immediate terms. We tend think of food insecurity as an inner city problem or a rural issue. But food insecurity abounds in well-to-do, suburban communities. It can be someone in your child’s classroom. We know the health implications. Children who struggle with hunger are more likely experience headaches, stomachaches, colds, ear infections and fatigue. But the emotional and social impact is much deeper. As the documentary showed, children at risk of hunger feel shame and insecurity. According to Share Our Strength, children who regularly do not get enough nutritious food to eat can be more aggressive and anxious. Teens who regularly do not get enough to eat have difficulty getting along with other kids.

This is a community issue. Let’s look at it from the perspective of one child in one class. Have you ever wondered about the root cause of a child’s behavior? The disruptive child in your son’s class may not be a bad kid. He may be hungry and struggling to concentrate. He may be anxious, reflecting his parents’ anxiety about being unable to provide nutritious food at home. Imagine the positive impact — if this one child could become food secure, he/she could thrive in school, improve social ties and the entire class can benefit. Now replace the word “classroom” for “community” and the possibilities grow exponentially.

Health is a group effort that directly impacts the happiness and productivity of a community. It’s a daunting challenge to tackle. But I’m going to start by picking up some extra food at the supermarket today for my church’s food pantry.