Social Determinants of Health and Development

Question: Write an essay on social determinants of health and development. Answer: In this report, the author will discuss social determinants of health and development. The essay will specifically focus on early life influences on the health of Native Americans. The author will present public health framework to critically evaluate the impact of social, economic, cultural and political factors on the population and develop strategies to address these factors. According to Alastalo et al., (2013) the conditions, environment in which people live, and resources such as food supply, transportation, education, social relationships that enhance the quality of life constitutes social determinants of health. This is a contemporary approach for action on health inequalities. Different social determinants include race, gender, socioeconomic status, early life experiences and place of residence. In this report, the author will mainly highlight early life influences as a social determinant and its impact on midstream and downstream determinants of health. In this report, the impact of this social health determinant on Native Americans will be demonstrated. Further, the author will discuss how to address the influence of this determinant. A thorough literature review will be performed to support the ideas and theories used in the study. Several researchers have worked on the subject of social determinants and explained the three factors associated with it. (Jensen et al., 2013) identified these factors to be income inequality, social connectedness and sense of personal or collective efficacy. (Braveman Gottlieb, 2014) believes that the unequal distributions of health and well-being of the nations relate to the uneven distribution of economic and social factors. Health disparities occur in the population with poor living conditions, race, with Native Americans suffering from less than optimal health outcomes. People with low economic levels have the limited connectedness with their family, friends, social groups and communities. They are less able to control their lives and circumstances. These people are more likely to suffer health problems. Hence, it is not always that biology is responsible for all the individuals health outcomes. According to Currie et al., (2012) due to the current development of effective med ication and treatment and rising political focus, these determinants are not in the forefront to influence and enhance health Why EARLY LIFE INFLUENCE' is a social determinant of health Early life influences mainly refer to experiences in childhood and its impact on later life. These early experiences leave their impact for years and substantially show the outcome in adulthood. According to Currie et al., (2012), behavior related to health such as sedentary lifestyle, smoking, low educational attainment increases health degradation in later life. However, this decline in health is not only manifested by environmental and biological factors but due to historical experiences as well. According to Kendall-Tackett, (2014) early childhood lays the foundation of the adult health. Jensen et al., (2013) reports that slow growth with toxic stress during early life are biologically incorporated during the development process. Eventually, it leads to poor emotional health and significantly reduces cognitive skills in addition to a decrease of emotional and physical functions during adulthood. Sachser et al., (2013) identified that poor development of fetus results from illicit drug use, malnutrition, excessive smoking, and lack of appropriate prenatal care during pregnancy. It is reflected in adverse health issues in later life. A study by Doucet Rovers, (2010) shows that experiences in childhood such as child abuse, maltreatment, a death of near one's parental separation, are termed as traumatic experiences and are factors for Early Life Stress (ELS). Throughout the life, these serve as a template for health decline. Several types of research have shown that the low socioeconomic situations in early life also hamper the physical function and general health in later life. According to Jensen, et al., (2013), it is due to sensitive periods of growth and development in early life that the mental and physical health in adulthood and at old age is detoriated. The Australian researchers working on public health has developed the framework of socioeconomic health determinants. It is based on researched evidence and classifies the determinants as upstream, midstream and downstream factors. From left to right the framework depicts the effect of macro factors on the intermediate factors and the combined impact of th e micro factors (Figure 1). In this public health framework, the upstream determinants identify the physical, economic, social and environmental factors as key determinants of socioeconomic variability in health. The factors such as housing, income, employment, domestic and international policies constitute the upstream determinants. On the other hand, the psychosocial processes and health behaviors are outlined by the midstream factors which are known to result from the upstream factors. Finally, the downstream factor reflects the overall impact of the above two factors. It refers to the biological health model that is it shows the illnesses and diseases. These ultimately create disparities in life expectancy, mortality, and morbidity. To solve a problem permanently one has to address the root causes for long term benefits. Understanding the concept of the early life influences may help develop strategies to prevent or develop measures to resolve the issue. It will also assist in answering the myriad questionsassociated with it. Such studies allow researchers in clinical and academic medicine towards the challenge of developing "interventions to mitigate" the health effects related to traumatic life experiences. Early life influences of Native Americans (Goodkind et al., 2012) asserts that due to the violent colonization of the indigenous Americans, psychological risks have increased as it damaged the protective factors that are culture based, disrupted the community system as well as the knowledge of parenting. It is the major contributing factor of the health disparities in this group of people. Doucet Rovers, (2010) Contends that the link between early life influences and its effect in later life can be established only if it complies with three theories based perspectives, which includes: psychosocial, economic theory and ecological systems theory. The impact of European activities on the aboriginals of America includes infliction with various infections, loss of lives and violent experiences termed as American Indian Holocaust. Dickerson Johnson, (2012) argues that explicit policies intended to assimilate indigenous people forcefully and suppress of culture lead to cultural genocide. The majority of the Native Americans underwent loss of lands and was devoid of agricultural activities. According to Alastalo et al., (2013) they were forced to relocate to urban areas thereby leading to poor socioeconomic conditions. Barnes et al., (2010) observed and applied the theory of attachment to describe the existence of insecure attachment in children of Holocaust survivors". Currie et al., (2012) supported the concept of Barnes et al., (2010) while researching on this group of individuals and his findings show the predisposition of stress-related disorders. These studies proved that such traumatic experiences leave a permanent impact on the health of Native Americans as well as on the well-being of other communities. Bonanno, (2004) in his article Stress, trauma, and coronary heart disease among Native Americans highlighted the fact that disproportional amount of trauma is the contributing factor of accelerated cardiovascular diseases and death. In the comparative study conducted by Dickerson Johnson, (2012) adverse childhood experiences of 7 American tribes and compared to that of the study of Shonkoff et al., (2012) on Adverse Childhood Experiences (ACE). The results showed that the majority of the selected subjects were exposed to trauma, and the experiences were of more than four categories. Epigenetic studies by (Shalev Belsky, 2016) reveal, genes have the ability to store memories of trauma experienced by our ancestors. He also says it can impac how we react to stress and trauma. It explains further that the early traumatic experiences influence the gene structure, which becomes more prone to activating negative responses to toxic stress. The studies are considered to be scientific proof of intergenerational trauma being real. Therefore, historical trauma is the contributing factor of diabetes and depression. According to Gray et al., (2012) increased addiction, sexual abuse, suicide and mental illness and other similar vices among Native Americans might be an influence of historical trauma. Goodkind et al., (2012), reported that the epigenetic studies helped track present help disparities to the colonial health deficits which have resulted from the consequences of colonization. The same was reported by American Indian and Alaska Native Genetics Research Guide created by "National Congress of American Indians." Which midstream and downstream determinants do it influence and how? In this section, the author will discuss the midstream and downstream determinants are influenced by early life stress. According to May Previte, (2016) early life influences affect the downstream factors. Traumatic stress leads to damage of physiological functioning. Sachseret al., 2013) Recognized this determinant as post-traumatic stress disorder because of European conquest. Adverse experiences in early life result in damaged homeostasis. Shonkoff et al., (2012) recognized that such people suffer from severe gastrointestinal disorders, cardiovascular problems and diabetes. (Shalev Belsky, 2016) believes that these ultimately create disparities in life expectancy, mortality and morbidity. These relate to downstream factors. According to Lovallo, (2015) adolescents of Native America were found with compromised immune system and hypertension. Stress in early life influenced their body mass index which falls under the category of downstream determinants. A survey conducted by Currie et al., (2012) on 76 school teenagers in Washington of age range 15-16 years. Results showed 14 children with the high rate of absenteeism in schools, poor academic performance, and lack of friends, low self-esteem, and negative perceptions. Four of the children left school. Further studies by Lovallo, (2015) traced back these factors to toxic stress in early life and poor socioeconomic conditions. According to Gray Montgomery, (2012) Native Americans of any ethnic group showed highest alcohol consumption per week. Dickerson Johnson, (2012) adds that they rank high on the list of binge drinking, and illicit druguse. National Survey on Drug Use and Health, 2010, further confirms these reports. These details are in line with the midstream factors. Doucet Rovers, (2010) confirmed that alcohol consumption correlates with lack of positive role models, loss of cultural identity, history of neglect, low self-esteem, self-medication due to hopelessness, and lo ss of connections with family and tribal. Capezza et al., (2012) identified that trauma is associated with the damage of endocrine and sympathetic nervous system. During stress, the body consumes oxygen and glucose, and a brain is stimulated to activate adrenal glands for a release of epinephrine. It further results in increased blood pressure, heart rate, cortical released from pituitary gland. Cortical and epinephrine are increased at the higher rate at the time of stress. These determinants fall under the category of midstream factors. Statistical reports reveal that the Native Americans have high suicide rate even three folds greater than the national average (Centers for Disease Control and Prevention, 2010). It was stated in reports of Currie et al., (2012) that the Native American suicide rates were found to be 33 per 100,000, when compared to Black (7.4), Hispanic (9.9), non-Hispanic White (14.2), and Asian or Pacific Islander (8.5). Sachser et al., (2013) analysis confirms the absence of the link to the cultural past and inability to relate to the present circumstances is the contributing factor of suicides. This gives the evidence of how early life influenced the midstream and downstream determinants. How does this determinant interact with other determinants in this culture to impact health? In this section, the author will discuss the other determinants influenced by early life influences. According to Carlson Everett, (2013) in Native Americans domestic violence, sexual abuse is three-fold higher than the average. Braveman Gottlieb, (2014) reports that there is a high rate of childhood abuse and assault due to their forced removal from native American families making them vulnerable to adverse experiences. According to Capezza et al., (2012), these children are highly represented in child protective services. In his reports Braveman Gottlieb, (2014) showed that a very smaller group of individuals has high education attainment in Native American community which is 10% out of 23% of the total population. Around 26% of the total population live in poverty and have two fold more unemployment rate and low income. They are subjected to high taxation. Consequently, they were forced to live in poor housing conditions with inadequate sanitation and drinking facilities. These are the upstream determinants influenced by the early life experiences. According to Goodkind et al., (2012) parents who are the victims of historical trauma are less attached to their children due to lack of trust and intimacy. In some cases, parents adapt violent nature in dealing with their children. Currie et al., (2012) identified that breakdown of families due to the removal of children by force is the other primary factor for detachment. As parents entered this cycle of violence, they lost social connection. They are isolated from their neighbors and mainly stay on the outskirts of the city with compromised transportation system. It consequently deprives them of medical facilities and affects their general health. These upstream factors together with midstream factors have a cumulative effect on the downstream determinants. The same is clearly depicted in figure 1. What can be done to address this determinant in this culture? In this assignment, the author discusses the ways to address the selected social determinant in this culture. Hartmann et al., (2012) suggested that the mental health interventions should include both the motivational and the intervention phases. The former phase deals with the historical perspective related to present health issues and the later deals with the use of evidence-based practices and patient centered approach. Rehabilitation programs should be more efficient and oriented towards decrease of readmissions of patients. Lovallo, (2015) said that intervention for the clinicians is the necessary step to validate the existence initial historical losses that happened along with the continued discrimination which impacted the Native American people. A collaborative effort is necessary from researchers, clinicians, psychologists, nurses, to develop innovative, methods to address this issue. Some legislation already in use includes Mental Health America. It collaborates with the managers and leaders of the hospitals for recommendation of policies related to improvement of quality and safet y of mental health services. It aims to decrease the overrepresentation of children in mental care hospitals. Gray et al., (2012) suggested that palliative care should be provided to this community to assist in reaching the medical facilities; to aware, them of stress-associated diseases and preventive measures. I personally believe the government must frame policies and regulations to safeguard the health of children and adults suffering from early life influences. There must be regular programs for people to educate them of adverse health consequences of stress. Yoga, meditation and spiritual programs must be mandatory across the nation. Hartmann et al., (2012) believes that these activities have immense health benefits and are evident through bout of literature available. Shonkoff et al., (2012) suggests the use of tribal healing for addressing this issue. In other countries such as Australia, this approach was successful in some communities. Community healing decreased alcohol consumption and adolescent addiction of drugs. It includes the involvement of parents and relatives, which is highly preferred by indigenous people compared to strange hospital environment. The other advantage it offers is that patients do not have to travel distant and expensive hospitals. Tribal healing is cost effective and strictly maintains its traditions. People included for healing must comply with the rules and are punished if failed. It disallows substance abuse being in a community and considered sin. Therefore, it helps people recover easily. Further researches in this area are needed, as it is evident from the literature research that there is underrepresentation of Native Americans in mental health services. Doucet Rovers, (2010) found the same in his literature review on Native Americans' mental treatment conditions that six nonrandomized outcome studies, three randomized studies, seven clinical case studies, 16 studies related to intervention descriptions, and 24 intervention approaches. However, the article did not show the validity of the treatment process or any empirical treatment modalities to address mental health requirements of the Native Americans. The health disparities will continue without the required interventions and provision of evidence-based care and patient centered approaches. Conclusion The social determinants of health and development are the agents influencing the issues. These mainly fall into three categories of social connectedness, economic inequality, and sense of efficacy. Addressing these issues is advantageous in eliminating the root causes. A participatory approach is useful to assess and address the social determinants of health and development issues. It is easy to get a clear concept on the subject by being inclusive of peoples ideas, perspectives, their knowledge of history and context of the issues and analyzing the data. Based on the above discussion it can be concluded that early life influences indeed have psychological, physiological, behavioral effects in later life. A Large number of individuals from Native American population continue to experience social, economic, environmental and physical distress. The public health framework provides an opportunity to understand the causes of the current mental health issues of Native Americans. It showed the interrelatedness between the upstream and midstream and its cumulative effect on the downstream determinants. The report depicts how adverse experiences of early life and that of ancestors affect the adulthood and subsequent generations. The health disparities will continue without the required interventions and provision of evidence-based care services. Also, tribal healing, community participation, counseling sessions are the approaches needed to validate depression related to historical trauma. 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