Community health lecture

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Community health lecture

  1. 1. Socio Environment & Health Care
  2. 2. Social Environment <ul><li>Culture one lives in and the people and institutions one interacts with is a social environment </li></ul><ul><li>The environment in which people live, including their social, physical, and economic conditions is a major determinant of their health and safety status </li></ul><ul><ul><li>Where someone lives is essential to how well they live </li></ul></ul><ul><li>Barriers that undermine health and wellness </li></ul><ul><ul><li>Water fluoridation, smoking bans, air quality, immunizations, few places for physical activity, less access to healthy food and health care </li></ul></ul><ul><li>Quality and accessibility of resources can be important factors in strengthening community health and wellness </li></ul>
  3. 3. Access to Health Care <ul><li>Need to look at community factors that help or hinder individuals from obtaining needed medical care </li></ul><ul><li>Disparities in access to health care are of growing concern </li></ul><ul><li>Utilization of health care services varies across communities </li></ul><ul><li>More focus on individual level characteristics </li></ul><ul><li>Race, income, education, insurance status, & disability </li></ul><ul><li>Neighborhood environment affects primary care access </li></ul>
  4. 4. Behavioral Model & Access to Health Care From Dr. Ronald M. Anderson’s Model in the Journal of Health & Social Behavior 1995
  5. 5. Predisposing Characteristics <ul><li>Demographic Characteristics </li></ul><ul><ul><li>Age-old and young likely to need more health care </li></ul></ul><ul><ul><li>Social Structure-education, occupation ethnicity </li></ul></ul><ul><li>Health-Related Beliefs </li></ul><ul><ul><li>attitudes, values, and knowledge that people have about health & health services that might influence their subsequent perceptions of need and use of health services </li></ul></ul>
  6. 6. Enabling/Impeding Factors <ul><li>Personal/Family </li></ul><ul><ul><li>Must have means & know-how to get to care facilities & make use of them </li></ul></ul><ul><ul><ul><li>Health insurance </li></ul></ul></ul><ul><ul><ul><li>Affordability </li></ul></ul></ul><ul><ul><li>Regular Source of Care </li></ul></ul><ul><li>Community </li></ul><ul><ul><li>Health personnel and facilities must be available where people live and work </li></ul></ul><ul><ul><ul><li>Waiting Time </li></ul></ul></ul><ul><ul><li>Provision of municipal services </li></ul></ul><ul><ul><ul><li>Transportation </li></ul></ul></ul><ul><ul><ul><li>Condition of neighborhood </li></ul></ul></ul>
  7. 7. Factors Related to Need for Health Care Use <ul><li>Perceived Health Status </li></ul><ul><li>Evaluated Health Status </li></ul><ul><li>Disability </li></ul><ul><li>Age </li></ul><ul><li>professional judgment about people’s health status and their need for medical care </li></ul>
  8. 8. Socio-economic Disadvantage <ul><li>Suffer more from unhealthy environments </li></ul><ul><ul><li>Quality of air and water, prevalence of toxic waste </li></ul></ul><ul><ul><li>Provision of municipal services might be lacking </li></ul></ul><ul><li>Associated with a variety of health outcomes </li></ul><ul><li>Self-rated health, functional disability, mental health, & mortality </li></ul><ul><li>Churches </li></ul><ul><li>Schools </li></ul><ul><li>Voluntary Organizations </li></ul><ul><li>Neighborhoods with poor physical environments may be less attractive to providers </li></ul><ul><li>Concentrated socio-economic disadvantage may diminish resources necessary to maintain certain organizations </li></ul>
  9. 9. Environments <ul><ul><li>Decreased likelihood of obtaining recommended preventative care </li></ul></ul><ul><li>Not just because disadvantaged neighborhoods are composed of disadvantaged individuals, but because of the neighborhood characteristics </li></ul><ul><li>Neighborhood socioeconomic disadvantage may create physical, service, and social environments that impede the ability to obtain health care </li></ul><ul><li>Decreased likelihood of having usual source of care provider </li></ul><ul><li>Increased likelihood of having an unmet need </li></ul>
  10. 10. <ul><li>Neighborhood Information Networks </li></ul><ul><ul><li>Often seek advice from peers </li></ul></ul>Community Effects on Access <ul><li>Healthcare Resources </li></ul><ul><li>Areas with greater wealth have more healthcare resources </li></ul><ul><li>Inequitable distribution of healthcare resources </li></ul><ul><li>Limits access to healthcare </li></ul><ul><li>Causes poorer long-term health </li></ul><ul><li>Neighborhood Social Capital </li></ul><ul><li>Neighborhood Health Behavior Norms </li></ul><ul><li>Shared attitudes about importance of behaviors differ among neighborhoods </li></ul>
  11. 11. Social Capital/Collective Efficacy <ul><li>May increase individual self esteem & create more positive attitudes toward their life chances </li></ul><ul><li>May increase trust in healthcare institutions </li></ul><ul><li>Found that individuals who felt they were a part of their community had significantly higher physical health outcomes </li></ul><ul><li>affect importance individuals place on health and encourage healthy behaviors </li></ul>
  12. 12. Having Access to Primary Care <ul><li>Prevention can produce significant health care savings </li></ul><ul><li>Investing in prevention has a multiplier effect-multiple saving for multiple conditions </li></ul><ul><li>Having resources available so that people can have their health care needs met </li></ul><ul><li>Focusing prevention investments on communities with the most compromised health status could potentially lead to even greater returns </li></ul>
  13. 13. <ul><li>Policies focusing on changing neighborhood environments may increase primary care access </li></ul><ul><ul><li>Social capital-community empowerment programs </li></ul></ul><ul><li>Policies that aim for more equitable distribution of healthcare resources across neighborhoods may increase primary care access </li></ul>Policy Implications

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