From
StayCurrentMD
#APSA50: Social Determinants of Health
With Dr. Adam Foss · hosted by Dr. Alex Cassar & Dr. Ron Herschel
Part of
Trauma 6 items
Chapter 1 of 10 · Fundamentals
Episode intro
Introduction to Social Determinants of Health at APSA 50
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What the experts said
Racial and socioeconomic disparities in criminal justice and public health have the same root causes.
Mass incarceration removes adults from communities, creating voids children cannot fill, leading to intergenerational cycles where children fall into the same traps as their families.
When prosecutors see domestic violence victims who don't want to press charges, they make judgments without understanding the constraints of poverty (lack of car, childcare, competing priorities) rather than recognizing these as barriers to appointment attendance.
Code for America reduced steps in California's criminal record clearance process and increased completion rates by 44% by removing barriers for people living in poverty.
Patients seeking help experience distrust when they enter a hospital or doctor's office and nobody looks like them, which can ruin the first interaction critical to long-term health outcomes.
There are 2.3 million people in jail and prison in the United States right now, with another 5 million on probation or parole.
Being convicted of a drug crime in the 1990s deprived people of access to housing, employment, education, healthcare, and pro-social activity, increasing rather than decreasing the likelihood of committing another crime.
One in three black men born today will spend some time in jail or prison.
650,000 people are released from prison every year and face 50,000 collateral consequences of felony convictions that impede successful reentry into society.
70 million Americans have a criminal record that will never go away and will impede their reentry into society.
The leading cause of death for young black men aged 18 to 35 in the United States is handgun homicide, which is not true of any other demographic in any other place on the planet.
Handgun homicide accounts for more deaths than the next nine leading causes of death combined for black men aged 18-35.
In Manhattan, black women are 12 times more likely to die during childbirth than white women.
Black women and white women experience breast cancer at almost the exact same rate, but black women are almost twice as likely to die from it.
Black women have a 71% higher chance of dying of cervical cancer.
In Boston, at one intersection on Massachusetts Avenue, life expectancy drops by 25 years depending on which direction you look.
There are more segregated schools in the United States today than there were at the time of Brown v. Board of Education.
There are more black people under correctional control today than there were slaves on the eve of the Civil War.
Over the 400 years of the transatlantic slave trade, researchers estimate 12 million Africans were captured, enslaved, and killed; last year 11 million people went through US jails, recreating slavery every single year.
Children conceived to mothers living in toxic stress inherit that toxic stress epigenetically, changing the way their bones and brains develop and eventually the way they behave, with these changes traceable into prison.
75% of children who were incarcerated in 2015 had an average of 33 interactions with the child welfare system before age 3 for abuse, neglect, and malnutrition.
Children in underperforming schools never learn to read not because they are black, brown, or poor, but because educators don't understand the stress they bring to school and instead blame, shame, and expel them.
In Massachusetts, if an 18-year-old kills another 18-year-old, he receives a life without parole sentence at a cost of $11 million.
Handguns are more accessible than jobs in impoverished communities.
Social determinants of health include economic stability, housing, transportation, physical and psychological safety, zip code, geography, literacy, education, hunger, poverty, community support, discrimination, stress, and provider linguistic and cultural competencies, affecting outcomes like quality of care, mortality, morbidity, life expectancy, and healthcare costs.
Black mothers are dying in childbirth at disproportionate rates compared to other groups in the United States.
In pediatric surgery, black and other diverse children receive fewer pain medications and have their pain taken less seriously, causing them to struggle more during illness and creating distrust in the healthcare system.
Cardiologists give inferior stents to patients they assume will not follow up based on cultural or socioeconomic status, compromising standards of care.