Tuesday, April 06, 2010

Social Determinants of Health and Unequal Access to Care

I realize there is already a recent article surrounding the recently passed health care legislation, but I want to post this article for multiple reasons. Like all the articles here at Triskelos, this one is interactive in that every member can participate in the discussion. But this article is different in that it is a quiz that tests your knowledge and understanding of multiple concepts the legislation attempts to address. Another reason for the post is that I'm currently rotating with the Dean for External and Governmental Affairs at the University of Florida. Her office is tasked with developing outreach projects in concert with local community leaders and activists, obtaining grant money from both private sector donors as well as state and federal grants. And finally, I thought it would be enlightening and entertaining.

Some questions are drawn from texts on social determinants of health, but the vast majority of the questions come from a PBS series called Unnatural Causes and deal with issues such as race relations, poverty, infant and childhood mortality, and the United States Health Care System. Some questions are fairly straight forward and are there for you to cringe at what you already know to be true. Some questions are to make us realize that in spite of our status as "Leader of the Free World" there is much we can learn other countries and systems in the world.

I will post the questions in the article. Please place your answers in the comment section. After 7-10 days I will post the answers. Feel free to contact me sooner if your curiosity is killing you.

1. How does U.S. life expectancy rank compared to other industrialized countries?
A. #1
B. in the top 10
C. 29th place

2. How much does the U.S. spend per person on health care compared to other industrialized countries?

A. Three quarters (75%) of the average
B. The same
C. Four times as much

3. How do U.S. smoking rates compare to those of other wealthy countries?

A. #1 (highest smoking rates)
B. top 5
C. top 10
D. 11-20th place
E. below 25 (lowest smoking rates)

4. Children living in poverty are more likely to have poor health, compared with children living in high-income households. Given this fact, children in New York City’s poorest neighborhoods are how many times more likely to be hospitalized for asthma compared to their counterparts in high income households?

A. 2.5 times
B. 5 times
C. 10 times
D. 20 times

5. African American men in Harlem have a shorter life expectancy from age five than their male counterparts in which of the following countries?
A. Angola
B. Bangladesh
C. The Democratic Republic of Congo
D. None of the above

6. How much does chronic illness cost the U.S. each year in lost work productivity?

A. $105 million
B. $2.2 billion
C. $1.1 trillion

7. On average, how many more supermarkets are there in predominantly white neighborhoods compared to predominantly Black and Latino neighborhoods?

A. half the amount
B. same
C. 4 times as many

8. Generally speaking, which group has the best overall health in the U.S.?

A. Recent Latino immigrants
B. Non-Hispanic whites
C. Native-born Latinos
D. Native-born Asian Americans

9. On average, which of the following is the best predictor of one’s health?

A. whether or not you smoke
B. what you eat
C. whether or not you are wealthy
D. whether or not you have health insurance
E. how often you exercise

10. During the 20th century, U.S. life expectancy increased 30 years. Which of the following was the most important factor behind the increase?

A. Social reforms (like wage and labor laws, housing codes, etc.) and increased prosperity
B. New drugs (like penicillin)
C. The development of the modern hospital system
D. Migration from rural areas to cities
E. More exercise and smoking cessation

11. The top 1% of American families owns more wealth than the bottom:

A. 30% combined
B. 60% combined
C. 90% combined

12. Ireland, Sweden, France, Spain, Portugal and the other western European nations all mandate by law paid holidays and vacations of four to six weeks. How many weeks of paid vacation are mandated by law in the United States?

A. None
B. 1 week
C. 2 weeks
D. 3 weeks

13. True or False: The gap between white and African American infant mortality rates is greater today than it was in 1950.

14. True or False: As of 2004, 7.8 million Americans were classified as “the working poor” in that the wages they earned were insufficient to move them above the poverty line.

15. 82% of known perpetrators of child abuse are parents of the victim. Which of the following best describes the situation in which such abuse occurs?

A. mother acting alone
B. father acting alone
C. mother and father acting together
D. one parent acting with a non family member

16. True or False: Food stamp participation has markedly increased since the establishment as a full fledged assistance program under President Johnson in 1975.

17. The predominantly white neighborhoods in west Los Angeles contain approximately 31.8 acres of park space per 1,000 residents. How many acres of park space exist per 1,000 residents in the predominantly Black and Latino neighborhoods of south central Los Angeles?

A. 28.7 acres
B. 17.2 acres
C. 14.6 acres
D. 5.8 acres
E. 1.7 acres

18. The child poverty rate in Norway is 3.4%, France 7.5%, Hungary 8.8% and Greece 12.4%. What is it in the U.S?

A. 4.1%
B. 8.6%
C. 12.8%
D. 21.9%
E. 32.4%


Damocles Chrysostom said...

I will give my guesses with a few additional questions, thoughts, and caveats:

1. C 29th (Finland, Sweden, Switzerland, et al--homogenous societies all--can they really be compared fairly to the U.S.?)
2. C 4x
3. D 11-20th (Do we still smoke a lot in the US?)
4. C 10x (There are a lot of factors involved here.)
5. D None of the above (Is there chronic civil war in Harlem?)
6. B 2.2 billion (How is this measured?)
7. A half the amount (What is a supermarket?)
8. D Asians It's the rice and soy, baby.
9. C Wealthy, but only because it contains a lot of other factors (education, opportunities for food, exercise, etc)
10. B But this one seems fairly subjective. How would you prove it in exclusion of the other factors?
11. A Is this unnatural? Unavoidable? A crime? Is it so bad for the bottom 30/60/90 that this is true? What if each person on the bottom was still making 30K a year? Would that still be a problem? Compared to a few hundred years ago, however, that is definitely the case, I would argue. Poorer classes on the whole today have much more opportunity, access, and resources than their peasant, serf, and peon counterparts had before the rise of industry, capital, and corporation. Impersonal, yes. But more opportunity for health care (besides the local herbalist and quack)--definitely.
12. A None No, we still allow employers and employees to work these things out.
13. True. The poorer brackets of blacks as a whole are worse off economically, socially, and educationaly than they were before FDR and the omniscient helping hand brought them en masse to the Democratic fold.
14. True. A subjective line doesn't really tell much though. Perhaps a better indicator would be relative spending/earning power based on a person's geography, education, etc.
15. C There are plenty of amoral scumbags out there who are fine graduates of a K-12 school system and culture that teaches them that they are little more than animals. Why not act like them?
16. I guess it depends on what is meant by 'marked increase/decrease.' Is this in absolute numbers or percentage of the population? More people have obviously used the program in the decades that followed whenever that program was put into place (1966?).
17. D 5.8 acres. Again, I wonder how different things were before 1950, when minority populations began moving into previosly white dominated neighborhoods. Did those neighborhoods already have limited parks? Are the majority of the 'white' areas only recent recipients of more park acreage due to design trends of the last few decades? That is fairly color-blind as people have lived wherever they want to since the 1960's.
18. C 12.8 Again, how exactly do you measure child poverty? I suppose it is based on which children belong to which parents. Trends are that either historically poorer groups or new poor immigrants typically have the most children. That probably isn't an American phenomenon, but perhaps most easily seen here as we have the largest non-war-related immigrant population in the world.

Damocles Chrysostom said...

Here are a few final questions:
1. From what data are the results based?
2. Who is responsible for putting together the stats?
3. What is their agenda in giving these facts?

I would say that statistics aren't neutral. We all know how they can be skewed depending on variables, who is doing the counting, etc. I would also say that comparing the U.S. to other 'developed' countries is very much an apple-orange comparison. What other developed country in the world, besides perhaps Great Britain, has the diversity of populations that we do? What other country has already reached approximately 50% of its births (est. 2010 numbers) as being from a non-majority race? I would say that most of these numbers obviously apply to lower income brackets of whites as much as they do to minority groups and have much more to do with economics than race. Do whites in rural Appalachia have better health care access than blacks in urban Chicago? Probably not.

Money follows money and success follows success. For those people of any race who have figured that out and have stopped either waiting for or accepting mere handouts and have sought to make something of themselves, there are plenty of health care options and access to a 'better' life, whatever they believe that to be. For people in developed countries, that often means leaving the 'bucolic' hills and communities of their birth and flocking to the slums and shantytowns that surround the cities of their respective countries. Does that mean that they are all desperate though? I have seen with my own eyes thousands of people dressed in three-piece business suits and women in heels pouring down streets of mud out of the largest slum in Sub-Saharan Africa. These were not dehumanized proles from some Orwellian dystopia. I knew many people from this sort of background, and while their plight was hard and uphill, living in that slum was a step-up from where they had been in their village. Again, no one made them move there. It was not a perfect place, by no means, but it allowed people the opportunity to make some money and hopefully give their children something more economically, socially, and educationally than what they had growing up.

Sounds just a little familiar to our own story here, doesn't it? People didn't crowd our shores because the government told them that they would take care of them. In fact, many left in the 20th century from their respective homelands for that very reason of intrusive governments. All most of our ancestors wanted was to be left alone and be allowed the opportunity to prosper in peace. For most of us, that is the story of our families.

A couple of things that aren't directly related to this article but need to also be raised are certain opinions that are being touted as political dogma. The first is that health care access is at least a Constitutionally-mandated right and perhaps a God-given right to a person simply for being alive. This is both untrue and a disservice to humans as responsible free-agents. That doesn't mean that we shouldn't help each other, but to say that it is the government's job to make sure that every citizen deserves some measure of equality in health care is an exercise of pure statism. (Not coincidentally, this process was instituted by the European fascist regimes of the 1930's).

Second, even if a central government could provide better health care than the private sector(and they can't, statistically speaking), what political and social costs would be the result? Are we willing as a nation to have the government dictate that much more than they already do? Are we willing to be entitled to a particular party or the government as a whole that much more?

Harlequin Heretic said...

1. C
2. C
3. D
4. C
5. D
6. C
7. C
8. D
9. C
10. B
11. B
12. A
13. TRUE
14. TRUE
15. C
16. TRUE
17. D
18. C

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