Assignment: effect of the two social conditions on health policy and health care

Assignment: effect of the two social conditions on health policy and health care ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: effect of the two social conditions on health policy and health care I’m studying for my Health & Medical class and don’t understand how to answer this. Can you help me study? Assignment: effect of the two social conditions on health policy and health care Instructions Choose two specific social conditions or determinants. Your essay should address the issues below. Identify any legal and ethical precedents or foundations related to those determinants. Examine the effect of the two social conditions on health policy and health care. What effects do these social conditions create? While writing your essay, a. Differentiate the influence that your two social conditions have on health policy and health care. Your essay may be from a historical perspective and show changes in time, or your essay may be from a current perspective and include recommended changes. Your paper must be at least three pages in length, not including the title and reference pages. It should be organized well and contain an introduction. You must use the textbook and at least two other sources, one of which must be from the CSU Online Library. All sources used, including your textbook, must be cited and referenced in APA style. contentserver.asp.pdf l7o7x9_contentserver.asp.pdf og1mgn_contentserver.asp.pdf qyvgi3_contentserver.asp.pdf Rehabilitation Psychology © 2019 American Psychological Association ISSN: 0090-5550 2020, Vol. 65, No. 1, 11–21 http://dx.doi.org/10.1037/rep0000298 The Social Determinants of Health Index Carli Friedman This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. The Council on Quality and Leadership (CQL), Towson, Maryland Background: Health disparities are avoidable differences that disproportionately impact certain groups. Health equity demands attention to social determinants of health (SDOH), particularly for people with disabilities who often have poorer outcomes and face more health inequities than nondisabled peers. Objective: The aim of this study was to develop a Social Determinants of Health Index for people with disabilities that utilizes personal outcomes. The Index is aimed at helping disability service providers examine the SDOH of those they support, to arm them with more information to provide targeted services and supports. Method: We ran an exploratory factor analysis of Personal Outcome Measures interviews with 1,078 people with disabilities from 2017 to compute composite scores for the factors underlying the model. Results: Findings revealed the Social Determinants of Health Index had 3 underlying factors: choice and engagement; person-centeredness; and health and safety. Choice and engagement are often inextricably linked as choice, self-determination, and empowerment play a key role in the social inclusion of people with disabilities. Services being person-centered are not only a right and requirement of homeand community-based services, but rights should also be person-centered— each person decides which rights are the most important to them. Finally, the third factor recognizes health and safety as foundational parts of health outcomes. Conclusions: The creation of the Social Determinants of Health Index for people with disabilities, which utilizes person-centered outcomes, ultimately aims to reduce health disparities. Attention to SDOH can promote good health for all. Impact and Implications The article introduces a new measure of social determinants of health for people with disabilities. In doing so, service providers can utilize this tool to measure and then improve the social determinants of health of those they support. Health equity demands attention to disparities in social determinants of health of people with disabilities. By targeting the disparities people with disabilities face, we can help facilitate improved quality of life. Keywords: social determinants of health, people with disabilities, health equity, health disparities, personal outcomes develop heart disease than nondisabled counterparts (Altman & Bernstein, 2008; Iezzoni, 2011). However, these health disparities are not necessarily due to people with disabilities’ impairments or their health behaviors alone, but often because of social determinants of health (Emerson et al., 2011; Frier, Barnett, Devine, & Barker, 2018; Iezzoni, 2011). People with disabilities have poorer outcomes and face more health inequities than nondisabled peers, in part because of “increased risk of exposure to socio-economic disadvantage” (Emerson et al., 2011, p. 146). People with disabilities’ health disparities are particularly impacted by disability employment disparities, high instances of poverty among people with disabilities, a lack of affordable and accessible housing, and a lack of accessible transportation (Frier et al., 2018). Assignment: effect of the two social conditions on health policy and health care Health equity—“the absence of avoidable, unfair, or remediable differences among groups of people” (World Health Organization, n.d.)— demands much more than simply controlling or preventing disease; poor health cannot be explained by health services alone (Currie et al., 2009; United States Department of Health & Human Services, 2015). Although medical care is important for health, research suggests medical care itself is only responsible for 10 to 15% of preventable mortality in the United States; in fact, health Introduction Health disparities are avoidable differences that disproportionately impact certain groups—particularly those who have historically faced discrimination or power imbalances, such as people with disabilities, racial/ethnic minorities, women, LGBTQIA people, and so forth— due to characteristics of society and/or differences in health care (Abbott & Elliott, 2017; United States Department of Health & Human Services, 2015). People with disabilities have significantly poorer health and shorter life expectancies than nondisabled people (Altman & Bernstein, 2008; Iezzoni, 2011; Krahn, Walker, & Correa-De-Araujo, 2015). For example, people with disabilities are more likely to be obese and to This article was published Online First November 14, 2019. Thank you to Mary Kay Rizzolo for reviewing this article and providing feedback. The author reports no conflicts of interest. Correspondence concerning this article should be addressed to X Carli Friedman, PhD, The Council on Quality and Leadership (CQL), 100 West Road, Suite 300, Towson, MD 21204. E-mail: [email protected] 11 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 12 FRIEDMAN is largely determined by social and physical environments (Braveman & Gottlieb, 2014; Currie et al., 2009). According to the World Health Organization (2010a) “the roots of most health inequalities and of the bulk of human suffering are social: the social determinants of health” (p. 39). To reduce health disparities and promote health equity, attention must be paid to social determinants of health (SDOH). SDOH are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (United States Office of Disease Prevention and Health Promotion, n.d.). According to decades of research, a large number of social, economic, and environmental factors contribute to health (United States Department of Health & Human Services, 2015). Class, socioeconomic status, and poverty all impact peoples’ health and produce and/or reinforce disparities (Abbott & Elliott, 2017; United States Office of Disease Prevention and Health Promotion, n.d.; World Health Organization, 2010b). Poverty in itself is a social determinant, and poverty is also associated with stressful conditions that impact health (United States Office of Disease Prevention and Health Promotion, n.d.). For example, people’s food insecurity and hunger result in health disparities (Larsson, 2013; World Health Organization, 2010b). As such, income inequality, financial in/security, and economic position all impact peoples’ health (Compton & Shim, 2015; Larsson, 2013; Raphael, 2006). Assignment: effect of the two social conditions on health policy and health care Natural and built environments also serve as SDOH. For example, exposure to toxins and pollution hinder peoples’ health (Compton & Shim, 2015; United States Department of Health & Human Services, 2015; United States Office of Disease Prevention and Health Promotion, n.d.). Ones’ natural environment, including climate change, green space, and community areas, also serve as SDOH (Compton & Shim, 2015; United States Department of Health & Human Services, 2015). The built environment, such as buildings, sidewalks, roads, accessibility, aesthetic elements, and neighborhood deprivation, is impacted by social, political, and economic processes and priorities, which in turn impact SDOH (Compton & Shim, 2015; United States Office of Disease Prevention and Health Promotion, n.d.). Social, political, and cultural institutions and structures also impact the health of people (Kim, Chen, & Spencer, 2012; United States Department of Health & Human Services, 2015). For example, social structures, such as social exclusion, segregation, and social stratification impact health (Larsson, 2013; Raphael, 2006; World Health Organization, 2006, 2010b). Kim et al. (2012) explain, Social stratification emerges as a consequence of persistently biased social and economic policies that favor a majority group holding power. As a result, social stratification puts those with less power and fewer resources at risk for differential exposure and vulnerability to health and mental health problems, as well as the consequences of these problems. (p. 346) Social structures often result in an unequal opportunities; those groups with more advantages (e.g., income, education, social class, etc.) have better health (Compton & Shim, 2015). Race, class, gender, disability, and sexual orientation not only are SDOH in and of themselves, they are also markers of power in/equities that influence health (Raphael, 2006). Discrimination is also a SDOH; racial and ethnic discrimination, sexism, ableism, and other forms of prejudice, even unconscious forms, contribute to health inequities, particularly because they are linked to structures, policies, and attitudes (Braveman & Gottlieb, 2014; Compton & Shim, 2015; Kim et al., 2012; World Health Organization, 2010b). Governance—the ideology of the current government—as well as policies also impact peoples’ lives and, as a result, their health (Raphael, 2006; World Health Organization, 2010b). Macroeconomic policies, public policies, and social policies all have a downstream effect that result in health disparities and, as such, are all SDOH (Compton & Shim, 2015; World Health Organization, 2010b). For example, these policies impact the labor market, housing, education, health care, and many more areas, all of which are SDOH in and of themselves (World Health Organization, 2010b). For example, factors such as the availability of preventative care and access to medicines, both of which depend on policy and funding, impact people’s health and result in health inequities (Kim et al., 2012; United States Department of Health & Human Services, 2015). When there are stronger social protections, there is better population health because social protections serve as safety nets (Raphael, 2006; United States Department of Health & Human Services, 2015). Assignment: effect of the two social conditions on health policy and health care Neoliberalism, the most dominant political ideology of the United States, is also problematic for health disparities as it emphasizes individualism, thereby ignoring structural understandings and determinants of health, and supports unequal resource allocation and the weakening of social structures and protections (Raphael, 2006). Education also plays an important role in health (Abbott & Elliott, 2017; World Health Organization, 2010b). Educational opportunities as well as the quality of education impact peoples’ health (United States Office of Disease Prevention and Health Promotion, n.d.). In fact, the links between education and health may be bidirectional in that people with greater educational opportunities are healthier, and people who are healthier have greater educational opportunities (Braveman & Gottlieb, 2014). The link between education and other social determinants, such as employment, exacerbate health disparities. A number of factors related to employment are also SDOH (Abbott & Elliott, 2017; Frier et al., 2018; World Health Organization, 2010b) and may also be bidirectional. Unemployment can result in health inequities and health inequities also cause unemployment (Compton & Shim, 2015; Raphael, 2006). Job insecurity as well as underemployment both contribute to health outcomes (Compton & Shim, 2015; Raphael, 2006). Once people are employed, the training they receive, the working conditions of their job, the demands of their employment, and their job dis/satisfaction all play a factor in health (World Health Organization, 2006, 2010b). Factors such as work stress, effort–reward imbalance, low control over work, and decision latitude and authority also impact health (Braveman & Gottlieb, 2014; Lauder, Kroll, & Jones, 2007). Unsupportive workplaces, including those without social supports or with poor treatment by supervisors, negatively impact health (Compton & Shim, 2015; Lauder et al., 2007). Finally, both having a living wage, and the prestige of the occupation— how society regards the occupation—impact health (Janßen, Sauter, & Kowalski, 2012). Housing is yet another factor that impacts peoples’ health (Kim et al., 2012; Raphael, 2006; World Health Organization, 2006). Housing stability, insecurity, and homelessness create health dis- This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. SOCIAL DETERMINANTS OF HEALTH INDEX parities (Compton & Shim, 2015; Lauder et al., 2007). The affordability of housing as well as its quality are also SDOH (United States Office of Disease Prevention and Health Promotion, n.d.). Residential segregation produces health inequities (United States Office of Disease Prevention and Health Promotion, n.d.). Moreover, the physical and social neighborhood and communities in which people inhabit are SDOH (Kim et al., 2012; Raphael, 2006).Assignment: effect of the two social conditions on health policy and health care Neighborhood conditions either facilitate or hinder opportunities, mental health, health behaviors, risk behaviors, and physical activity (Currie et al., 2009). While the availability of communitybased resources for community living, and recreational and leisure promote health, exposure to violence and crime in neighborhoods and communities hinders health (Compton & Shim, 2015; United States Office of Disease Prevention and Health Promotion, n.d.). Moreover, community access to healthy food also plays a role in determining health; those that live in food deserts have not only poorer nutrition but also poorer physical activity (Braveman & Gottlieb, 2014). Transportation plays an important role in health, in large part because it is interconnected with other social determinants (Abbott & Elliott, 2017; Compton & Shim, 2015; Frier et al., 2018). A lack of reliable and affordable transportation in one’s neighborhood or community hinders access to education, employment, health care, healthy food, and many more opportunities that promote health. Relationships promote health and reduce health inequities (Lauder et al., 2007; United States Department of Health & Human Services, 2015). For youth, peer relationships can be crucial to development, long-term social skills, and self-efficacy (Currie et al., 2009). While a lack of social support and loneliness hinder health, social capital can facilitate it (Larsson, 2013; Lauder et al., 2007; World Health Organization, 2006, 2010b). Finally, access to technology is a SDOH. Peoples’ access to mass media, information technologies (e.g., cell phones, Internet), and other technologies, such as social media, all impact health (United States Office of Disease Prevention and Health Promotion, n.d.). Social Determinants of Health and People With Disabilities While all of the aforementioned SDOH impact people with disabilities alongside their nondisabled peers, people with disabilities also face a number of social determinants that are specific to their status as people with disabilities. Ableism1 in health care systems, social support, social exclusion and isolation, and living conditions negatively contribute to people with disabilities’ mental and physical health (Emerson et al., 2011). In fact, the ableist focus on preventing and curing disability, and conflating disability with illness can result in broader inequities being ignored (Emerson et al., 2011). Emerson et al. (2011) explain to promote health equity for people with disabilities, systems must: address the drivers of social stratification (e.g., by ensuring that disabled children access effective education, regulate labor markets to ensure that disabled adults can access rewarding and secure employment); address differential exposure to adversity (e.g., social marketing to combat disablist attitudes); address differential vulnerability (e.g., by promoting the resilience of disabled people); and address differential consequences (e.g., by ensuring that all disabled people have equal access to effective health care; p. 146).Assignment: effect of the two social conditions on health policy and health care 13 Purpose According to the United States Department of Health & Human Services (2015), “The availability of high-quality data for all communities is ultimately a health equity issue” (n.p.). For this reason, as well as because people with disabilities face a number of health inequities and disparities, the aim of this study was to develop a Social Determinants of Health Index for people with disabilities that utilizes personal outcomes. To do so, we selected indicators from the Personal Outcome Measures, a person-centered quality-of-life measure for people with disabilities based on literature about SDOH, and then ran an exploratory factor analysis (EFA) of Personal Outcome Measures interviews with 1,078 people with disabilities to compute composite scores for the factors underlying the model. Method Participants As this study involved secondary data, it was exempt from review by our Institutional Review Board (IRB). Our secondary data were originally collected over a 1-year period (January 2017 to December 2017) from organizations that provide human services to people with disabilities. The sample included 1,078 people with disabilities; participant demographics are presented in Table 1. Age, gender, and guardianship status were relatively evenly distributed across the participants. However, the majority of participants (71.0%, n ? 741) had intellectual and developmental disabilities, and were White (78.0%, n ? 743). Most participants lived in provider-owned or -operated homes (50.3%, n ? 462), with fewer living in their own homes or apartments (23.6%, n ? 217), family homes (15.6%, n ? 143), and other settings. The majority of participants (61.6%) received 24/7 around-the-clock supports, with the remaining participants receiving less daily support. Instrument The instrument used in this study was the Personal Outcome Measures (The Council on Quality and Leadership, 2017). The Personal Outcome Measures determines people with disabilities’ quality of life, including self-determination, choice, self-advocacy, and supports, in a person-centered manner. The Personal Outcome Measures includes 21 indicators divided into five factors (see Table 2). Each of the 21 indicators are multidimensional constructs, which contain over 400 probes in total. Over 25 years of administration, the Personal Outcome Measures has been continuously refined via pilot testing, feedback from content experts and advisory groups, a Delphi survey, and validation analyses (The Council on Quality and Leadership, 2017). The Personal Outcome Measures has construct validity; moreover, only data from certified reliable interviewers (those who pass an 85% reliability test) was utilized (Friedman, 2018c). In the first stage of administration, a trained Personal Outcome Measures interviewer has an in-depth conversation(s) with the participant with disabilities about each of the indicators. During 1 Discrimination in favor of the nondisabled. FRIEDMAN 14 Table 1 Demographics This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Characteristics Age range (n ? 948) 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75? Disability Intellectual/developmental disability Mood disorder Seizure disorder/neurological problems Anxiety disorders Behavioral challenges Cerebral pal .. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10