The document discusses studies that have found relationships between socioeconomic factors like education, occupation, income and health outcomes in older age, with manual workers and those with less education or income found to be more likely to experience poorer health and functional ability. It also examines the impact of life course factors and retirement on health, as well as policies aimed at reducing health inequalities among older populations.

1. THE BUILT
ENVIRONMENT
COMHE 303 - Bernicia and Melinda

2. Anne McMunn, Elizabeth Breeze, Alissa
Goodman, James Nazroo, and Zoe Oldfield
Chapter 13: Social Determinants of Health in
Older Age

3. “Successful Aging”
 United States: A response to the traditional
stereotypes of ageing as associated with
inevitable sickness and decline
 Rowe and Kahn: the absence of disease of
disability, the maintenance of cognitive and
physical function, and engagement with life
 United Kingdom: “The Third Age”, potentially a
period of self-fulfillment in which individuals are
freed from the responsibilities of paid work and
child care to plan their lives and pursue those
plans

4. Studies on Aging
 Roos and Havens – found that neither occupation, education, nor
income at baseline predicted successful aging
 Honolulu Heart Program – both education and previous occupation
were associated with successful aging
 Europe and Canada – relationships between health outcomes other
than physical functioning are also associated with educational
attainment among older people
 Swain – being in a manual class household carried a disadvantage
in reporting poor health seven years later regardless of health at
baseline
 Taylor and Ford – did not find class differences in reported
difficulties in functioning, self-esteem, or morale; gender and age
accounted for class differences in reported chronic conditions, acute
symptoms, and self reported poor health

5. Studies on Aging Cont.
 Dahl and Birkelund – men aged 65 and over, whose main job was
manual, were more likely than non-manual workers to have poor
mental health; found no association between class or main
occupation and mental health for women aged 65 and older
 Whitehall – difference aspects of socioeconomic position are
important for pre-retirement mortality than are post-retirement
mortality; occupational grade strongly predicted functioning in older
age
 Arber and Ginn – current household income was inversely
associated with both self-reported poor health and functioning after
adjusting for other socioeconomic factors
 North America – found household income to be positively
associated with functioning in older respondents after adjusting for
numerous factors

6. Life Course Perspective
 Life Course Hypotheses – emphasize the accumulation
of advantage and disadvantages across the entire life
course
 Barker, Marmot, and Wadsworth – describes a latency
effect whereby exposures early in life have later effects
on health
 Marmot et all. – no direct effect on social circumstance
from earlier life on health in later life, but determine the
social and economic position that a person reaches in
later life

7. Retirement as a Transitional
Period
Labor market exit linked with subsequent health
outcomes
 Sweden – those who became unemployed are more
likely to have an subsequent hospitalization and health
at work
 Whitehall – participants had better subsequent health
of those who took voluntary redundancy or voluntary
early retirement (pre-retirement)

8. Health Determinants
 Education, occupation, and income
 Material circumstances, working conditions, social status
or prestige
 Sense of security and control over ones work and life
 Inequalities in healthcare, lack of resources
 Social support
 Disability and mobility; physical and mental health
 Gender imbalances in caring responsibilities

9. Health Behavior
According to Rowe and Kahn, healthy behavior
is the route to successful aging
 Not genetically determined, but by lifestyle
choices
 Influence by social position, culture, and financial
constraints
 Associated with health outcomes

10. Policy in Relation to Health
Inequalities
 Wanless – Funding old age through increased health
services, “full engagement” the public are active in
securing improved health and quick to respond to
healthcare intiatives
 United Kingdom – Help the poorest older people
including minimum income guaranteed
 Camden’s Quality of Life Strategy – Improving
involvement and independence of older people with
outreach to isolated and the minority ethnic groups as
priorities
 Department of Social Security – government
encourages private savings but will provide a “safety
net” for those who cannot save for retirement

11. The New York Academy of Medicine
Toward an Age-friendly New York City: A
Findings Report

12. New York City Elderly
 By 2030, one-fifth of NYC’s population will be
over the age of 60
 older adults will soon outnumber school-aged
children
 Goals
 Create a caring model for modern urban aging
 Focus on the needs of older adults, as defined by
older adults themselves
 Create a process for older adults to voice their
hopes and dreams for a friendlier city

13. Initiatives
 Age-friendly New York City – effort by the World Health
Organization (WHO) to respond to two significant
demographic trends
 Urbanization and Population Aging
 Global Age-friendly Cities – Involves 35 cities around the
world in analyzing their communities and neighborhoods
through the lens of the WHO Active Aging Framework
 WHO Active Aging Framework: shifts city planning away from a
“needs-based” approach toward a “rights-based” approach
 recognizes people should have equal opportunity and treatment as
they grow older
 entails enhancing quality of life by optimizing opportunities for health,
participation, and security as people
 extend the years an individual can live independently and above the
“disability threshold”

14. Determinates of Aging

15. Age-friendly New York City
In July 2007, partnership with the New York City
Mayor’s “A City for All Ages” Initiative and the New
York City Council
 The objective was to assess the city from the
perspective of older residents in order to identify
potential areas for improvement.
 Question: To what extent are the city’s services,
settings, and structures inclusive of and
accessible to older people with varying needs and
capabilities?

16. Methodology
A committee of local policymakers, service providers,
community leaders, researchers, and older residents
 Community forums
 Focus groups
 Interviews
 Constituent feedback forms
 Expert roundtables
 Data mapping
 Request for information
 Self-Assessment of City agencies
 Secondary research
 Website

17. Eight Domains of an Age Friendly
City

18. The City’s Older Population
 The majority of New Yorkers age 65 and
above reside in the boroughs of Queens (30.2
percent) and Brooklyn (29.9 percent)
 Manhattan (20.7 percent), the Bronx (14.6
percent)
 Staten Island (5.5 percent)
 10 several neighborhoods within the city have
high concentrations of residents age 65 or
older

19. The City’s Older Population
 In 2005, 43% of non-institutionalized New Yorkers
age 65+ reported experiencing some form of
disability
 Nearly half of today’s older New Yorkers are
members of racial and ethnic minority groups
 this diversity has significant implications for the
importance of culturally and linguistically appropriate
materials and services for older adults.
 In 2006, the poverty rate among older New
Yorkers (age 65+) was nearly twice the national
average
 18.1 percent vs. 9.9 percent

20. The City’s Older Population
 “I think New York is the greatest place in the
world to be old”
 Health and social disparities among older New
Yorkers linked to issues beyond race and
poverty

21. Where Do We Go From Here?
 Commission for an Age-Friendly City will be
seated
 Supported from the Office of the Mayor and the
City Council
 Guide and oversee the development of
implementation plans that synthesize
commitments from the different sector
 oversee progress on the implementation plans
 promote public policies to institutionalize effective
practices
 guide a process for evaluating the impact of actions taken
 assure continued activity for future years

22. Charles E. Drum, Gloria Krahn, Carla
Culley, and Laura Hammond
Recognizing and Responding to the Health
Disparities of People with Disabilities

23. Health Status
An individuals health status impacts…
 Quality of Life
 Self-Sufficiency
 Participation in Society
Question: What does that mean for the 54 million
Americans with disabilities?

24. Healthy People 2010
Objective:
 Promote the health of people with disabilities
 Prevent secondary conditions
 Eliminate disparities between people with and
without disabilities in the U.S. population.

25. Health and Wellness
Defined as…
Physical, emotional, social, spiritual, and
other factors that enable individuals to
maximize their potential and fully participate in
their community.

26. Disability
U.S. Legislation has 67 definitions for disability.
 Medical Model: Disease, trauma, health impairment, deficits located within the
individual that can be cured or ameliorate through a particular treatment or
intervention.
 Functional Model: Individualistic, medical, physiological, or cognitive impairment; the
inability to perform a number of functional activities regardless of etiology.
 Social Model: The barriers people face when interacting with the environment, a
consequence of social (dis)organization that creates or results in inaccessible
environments.
 American Disability Act: multiple dimensions of disability including
 A physical or mental impairment that substantially limits at least one “major life
activity”
 Has a record of such an impairment
 Regarded as having such an impairment
 Social Security Act: Inability to engage in any substantial gainful activity by reason of
any medically determinable physical or mental impairment which can be expected to
result in death or which has lasted or can be expected to last for a continuous period
of not less than 12 months

27. Public Health
 Traditionally focuses on prevention of disabling
conditions
 Contemporary focus on disability surveillance
and support for research in health promotion

28. Health Disparities
 High rates of oral disease and diabetes
 Difficulty finding, getting to, and paying for healthcare
 Low rate of high school completion, social activities, and
high rate of unemployment
 High rate of obesity, alcohol and tobacco consumption
 Little access to early prevention, transportation, and
comprehensive health information
 More likely to experience early death, chronic
conditions, and preventable secondary conditions
 Secondary conditions: increased risk that people with a primary
disability condition experience that may result in poorer health

29. Addressing Disparities
 Legal and Regulatory Reforms:
 Broader definitions of medical necessity to address habilitation needs
 Simplification of regulations to make maneuvering the health care system easier
 Tax incentives that support persons with disabilities in purchasing equipment or making home modifications to
increase access to the community
 Increased physical accessibility of medical and fitness facilities and equipment (e.g., mammography machines, athletic
equipment)
 Health Plan Benefits:
 Ensure access to needed specialty care, habilitative and rehabilitative services, care coordinated “defragmentation”,
and coverage for prescription medications and durable medical equipment
 Communication Enhancement:
 Interpreter services for non-English speakers, sign language interpreters
 Health information materials in alternative formats (e.g., large print, electronic copies for screen readers)
 Adequate time for medical care appointments
 Use of “plain language” to promote comprehension by all, but particularly people with cognitive disabilities
 Health Promotion Programs:
 Access to generic health promotion programs (e.g., smoking cessation, weight management, drug and alcohol
treatment)
 Complementary and alternative medicine
 Accommodation of facilities and staff to allow equitable participation by people with disabilities

30. http://www.ted.com/talks/aimee_mullins_pro
sthetic_aesthetics.html?quote=453
Aimee Mullins: My 12 Pairs of
Legs