Please write a 450 word discussion post reply to the following post. Must have 3 scholarly citations in APA format. Sources must be within last 5 years. Please include a biblical integration with a bible verse. Biblical integration is not used as one of the references. Textbook is: Khaliq, A. A. (2020). Managerial epidemiology. (1st ed.). Burlington, MA: Jones & Bartlett Publishers. ISBN: 9781284082173.
Original instructions for post is here: Compare and contrast the determinants of health discussed in the course text. Discuss how data derived from evaluating these determinants of health can inform the health care administrator in effective decision making citing at least one peer-evaluated example of utilization of data in decision making support or policy revision.
Post you will reply to is here: Determinants of Health Defined, Compared and Contrasted
According to the Khaliq text (2020), the term “determinants of health” refers to “extrinsic or intrinsic factors that, in a relatively short or long span of time, can affect the health status of individuals” (p. 19). These determinants are generally attributable to five categories: genetic and biologic factors such as age, gender, race and ethnicity; lifestyle and behavioral factors such as smoking, alcohol use and sexual behavior; socioeconomic characteristics such as education, income and social network; physical environment such as housing, sanitation and air quality, and healthcare access and quality-related factors (Khaliq, 2020). These can be visualized as concentric circles that illustrate how they are related, with the first inner circle representing age, sex and constitutional factors; the second circle representing individual lifestyle factors; the third circle representing social and community networks; the fourth circle represents living and working conditions such as unemployment, sanitation and water, healthcare services, housing, education and agriculture and food production; and the fifth circle represents general socioeconomic, cultural and environmental conditions (Khaliq, 2020).
A high-level contrast of the determinants is that genetic and biologic determinants are intrinsic to an individual, whereas the other determinants are extrinsic to the individual, and the interaction of these determinants is why many diseases and illness have a multifactorial etiology. Also, most genetic diseases are not solely determined by the presence or absence of a single genetic mutation or marker. Rather, research has shown that there are genetic mutations that can exert a protective effect against risk factors in other determinants, such as those present in the environment and lifestyle factors, and there is ample evidence that the occurrence of diseases and severity of their symptoms are strongly influenced by the interaction of social and genetic factors (Khaliq, 2020). In contrast, the mechanisms that link a socioeconomic variable to health outcomes are distinct from those that link other variables such as genetic makeup or quality of care with health outcomes, and the Khaliq text gives the example that disparities in education can be linked to degrees of morbidity and mortality through unhealthy lifestyle choices such as smoking, poor nutrition, and obesity. Studies have shown that individuals with certain psychosocial and behavioral characteristics are more prone to certain diseases or illnesses. Khaliq notes that providing convincing evidence of the health effects of socioeconomic and environmental factors is made difficult for a number of reasons; most notably, the challenge of bridging the realm of biology with the realm of sociology and the fact that data regarding stressful life events and socioeconomic variables are gathered at the population level, whereas diseases occur at the individual level. The determinant of healthcare access and quality can also be compared with the other determinants such as socioeconomic characteristics and environment with respect to race and ethnicity. Research has shown that minority individuals have less access to health care, receive poorer quality care, and have worse health outcomes as compared with the white population, and although some of these disparities are explained by differences in the socioeconomic status of white and minority populations, notable disparities are still present within the same socioeconomic strata in the same geographic districts. Minorities also experience more social isolation, unemployment, and poverty which can result in negative coping strategies such as excessive alcohol use, excessive eating, smoking, and illicit drugs (Khaliq, 2020). However, in contrast Farrell et al. (2022) cautions against using race, which is a social and not a genetic or biological construct, as a proxy to inform clinical protocols that drive healthcare decision-making. Race-adjusted algorithms that use race as a proxy for biological, genetic, or behavioral risk of disease reinforce racial biases and perpetuate health inequities (Farrell et al., 2022).
Determinants and Decision Making
Understanding the role of the various determinants and their interactions are necessary to address disparities in the health status of different populations, and to do this the allostatic load of the population must be understood (Khaliq, 2020). One example that appears in the literature with increasing frequency is the concept of health literacy, which is a midstream determinant of health, and its relevance to health-related decisions and actions. According to Nutbeam and Lloyd (2021), value is placed on achieving higher rates of literacy in a population because it is associated directly and indirectly with a range of health outcomes. Low literacy is associated with established determinants of health, such as employment and income. The authors also state that literacy is not a “fixed asset,” and it can be improved through education and is specific to both content and context. Individuals vary in their ability to learn and will respond in different ways to different forms of communication. As such, health literacy enables individuals to obtain, understand, appraise and use information to make decisions and take actions that influence their health status. Therefore, interventions to improve communications with patients and their caregivers can help them manage clinical challenges such as medication adherence, self-management of chronic conditions, and hospital discharge instructions (Nutbeam & Lloyd, 2021). It is estimated that one-third to one-half of the U.S. adult population has low health literacy, affecting people across the sociodemographic spectrum and disproportionally affecting vulnerable populations, which include older adults, people with disabilities, people with lower socioeconomic status, racial/ethnic minorities, people with limited English proficiency, and people with limited education (Schillinger, 2021). Given these facts coupled with health literacy’s relationship to health outcomes, clinical decision making must take various determinants into account when communicating with patients and their caregivers.
Health literacy interventions can take many forms, such as education and disease management interventions, interventions aiming at improving patient-provider communication, interventions aimed at improving access to health information, and interventions for improving usability of healthcare systems and services (Stormacq, 2020). A 2020 study of 166 diabetic Iranian adults explored health literacy’s role in promoting effective self-care, which is critical to decreasing the risk of diabetic complications and increasing quality of life. The authors studied the effect of a theory-based educational intervention on health literacy and self-care behaviors in these patients, and they found that after their intervention, the number of patients whose health literacy was improved significantly increased, and the results also showed significant improvements in self-care behaviors. They further state that health care experts must be familiar with the concept and strategies of health literacy with respect the clinical decision making, and successfully apply this knowledge when evaluating and educating patients in order to maximize the patient’s understanding of information in the promotion of optimal health outcomes.
Biblical Perspective
We can expect to see in the future even more investment in addressing healthcare access and outcome disparities by addressing determinants of health, because to do so positively affects access to quality, cost-effective healthcare and health outcomes. A classic 2017 study by the National Academy of Medicine estimated that medical care accounts for only 10 to 20 percent of the modifiable contributors to healthy outcomes for a population, so these determinants cannot be ignored (Medical News Today, 2021). It is also the right thing to do according to God’s Word. Proverbs 14:31 says that “whoever oppresses the poor shows contempt for their Maker, but whoever is kind to the needy honors God (NIV, 2011).” In the context of health care, “poor” does not necessarily refer only to those of limited economic means, but to those who might be affected and burdened by determinants and their interactions that prevent them from living their best life as a beloved child of God. Kindness in the healthcare delivery context is not just about how we treat individuals with dignity and respect regardless of the vulnerabilities that they may have due to determinants of health, but about doing what we can to address the root causes of the disparities caused by determinants, no matter how small or big the effort, and praying for our nation’s policymakers and healthcare leaders as they are learning how to do this effectively and efficiently.
References
Farrell, T. W., Hung, W. W., Unroe, K. T., Brown, T. R., Furman, C. D., Jih, J., … & Rhodes, R. L. (2022). Exploring the intersection of structural racism and ageism in healthcare. Journal of the American Geriatrics Society, 70(12), 3366-3377. https://doi.org/10.1111/jgs.18105Links to an external site.
Khaliq, A. (2020). Managerial epidemiology: Principles & applications. Jones & Bartlett Learning.
Medical News Today (2021). What are social determinants of health? https://www.medicalnewstoday.com/articles/social-determinants-of-healthLinks to an external site.
New International Version (2011). Bible Gateway. https://www.biblegateway.com/passage/?search=Proverbs%2014%3A31&version=NIVLinks to an external site.
Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health, 42(1), 159-173. https://doi.org/10.1146/annurev-publhealth-090419-102529Links to an external site.
Schillinger, D. (2021). Social determinants, health literacy, and disparities: Intersections and controversies. HLRP: Health Literacy Research and Practice, 5(3), e234-e243. https://doi.org/10.3928/24748307-20210712-01Links to an external site.
Stormacq, C., Wosinski, J., Boillat, E., & Van den Broucke, S. (2020). Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: A systematic review. JBI Evidence Synthesis, 18(7), 1389-1469. https://doi.org/10.11124/JBISRIR-D-18-00023Links to an external site.
Zeidi, I. M., Morshedi, H., & Otaghvar, H. A. (2020). A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients. Journal of Preventive Medicine and Hygiene, 61(4), E601. https://doi.org/10.15167%2F2421-4248%2Fjpmh2020.61.4.1504Links to an external site.