Obesity in Urban America
1.Country of choice (5 points)
During the past three decades the United States has witnessed a dramatic increase in the prevalence of obesity which has become a public health crisis (US Department of Health and Human Services Public Health Service 2001 Ogden Carroll Curtin et al. 1999 2004).
Obese persons have an increased risk for diabetes (Marmot 2005) cardiovascular disease (Kim Millen Gershamn Irwin 2000) cancer (Tarlov 1996) and mortality (WHO 2007 Summary of proceedings 2006). Obesity and overweight rates are increasing rapidly in the United States (Berkman Kawachi 2003 Kawachi Berkman 2003). In 2000 approximately 20.1% of the adult population was obese and 36.7% was overweight. Similarly the current National Health and Nutrition Examination Survey (1999present) found that the percentage of obese adults increased from 22.9% between 1988 and 1994 to 30.5% between 1999 and 2000 (McCarthy 2000). Childhood obesity rates also increased between 1988 to 1994 and 1999 to 2000 from 7.2% to 10.4% among children aged 2 to 5 years (Marmot Wilkinson 2006).
The southern states were the first to have more than 20% of their adult populations obese higher rates of obese and overweight adults have spread to all areas of the country (Davis 2006 Edelman Mitra 2006). Many of the metropolitan areas that have the highest levels of urban sprawl are located in the South.
This suggest the first links between levels of urban sprawl and the risk for being obese or overweight.
Urban sprawl: is often loosely defined and complicating these definitions is confusion among causes consequences and attributes of urban sprawl. Urban sprawl is idefined as an overall pattern of development across a metropolitan area where large percentages of the population live in lower-density residential areas. The causes of urban sprawl are not well identified but include affluence that enables households to purchase larger houses on larger lots cultural values that reject urban living and emphasize automobile use inexpensive land values that support urban sprawldependent lifestyles and government policies that promote urban sprawl (McLafferty Grady 2005 Last 2001 Collins 2004).
Overweight and Obesity: Obese or overweight status is usually determined by the body mass index (BMI) formula (weight in kilograms divided by height in meters squared); adults are considered overweight when their BMI is greater than 25 and obese when their BMI is greater than 30 (National Institutes of Health (NIH) 1998 Willett W Dietz W Colditz G 1999). BMI was calculated with respondents self-reported heights and weights.
ll- Public health inequity (5 points)
Creating health equity is a guiding priority and core value of American Public Health Association (APHA). By health equity we mean everyone has the opportunity to attain their highest level of health. How do we achieve health equity? We address the conditions in which people are born grow live work learn and age. These social determinants of health are shaped by the distribution of money power and resources that include employment housing education health care public safety and food access (Braveman 2011). Inequities are created when barriers prevent individuals and communities from accessing these conditions and reaching their full potential. Inequities differ from health disparities which are differences in health status between people that are related to social or demographic factors such as race gender income or geographic region. Health disparities are one way we can measure our progress toward achieving health equity.
lll- Relationship between Country and Public Health Inequity (10 points)
Health inequalities in the United States as a nation are the worst of all wealthy developed countries: Americans die younger and suffer worse health than people in over 30 other nations. The situation is not improving despite enormous expenditures on medical services with the US paying close to half of the worlds health care bill. The reasons for these health inequalities relate to the political economy of the nation rooted in its founding history and overlaid with recent changes wrought by neo-liberalism. Sixty years ago the nation was one of the worlds healthiest but as a consequence of political choices that have increased the wealth of a few everyones health has suffered. The US provides many lessons for other countries that want to avoid this health catastrophe.
lV Description of Social Determinants of Health in the country
(list at least four social determinants of health in that country you selected. Please be very specific (10 pt.);
The complex integrated and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment physical environment health services and structural and societal factors. Social determinants of health are shaped by the distribution of money power and resources throughout local communities nations and the world (Commission on Social Determinants of Health 2008).
Determinants of Health
The social determinants of health as well as race and ethnicity sex sexual orientation age and disability all influence health. Identification and awareness of the differences among populations regarding health outcomes and health determinants are essential steps towards reducing disparities in communities at greatest risk.
Factors that contribute to a persons current state of health. These factors may be biological socioeconomic psychosocial behavioral or social in nature. Scientists generally recognize five determinants of health of a population:
Physical environment. Examples: where a person lives and crowding conditions
Social environment. Examples: discrimination income and gender
Biology and genetics: Examples: sex and age
Health services. Examples: Access to quality health care and having or not having health insurance
(Preamble to the Constitution of the World Health Organization U.S. Department of Health and Human Services 2009).
V- Explanation of Specific Health Determinants (40 points)
A full understanding of the role of the urban environment in shaping the health of populations requires consideration of different features of the urban environment that may influence population health. The study of the social determinants of health (SDH) is embedded in the recognition that the solutions to poor health material deprivation lack of access to health care clean water sanitation and the like are not simply alleviated with the provision of resources or technical assistance (Marmot 2005) Rather it is the understanding that when available access to resources and technical assistance is often socially determined (Kim Millen Gershman Irwin 2000).
The focus of this paper will be SDH in urban settings. In simplest terms social determinants are the social characteristics in which living takes place (Tarlov 1996). The determinants include unemployment unsafe workplaces urban slums globalization and lack of access to health systems (WHO 2005) SDH also include social factors such as place of residence race and ethnicity gender and socioeconomic status (Summary of proceedings 2006).
1-Social determinant 1 and health inequity: Physical environment
Place of residence and an individuals status within the place are important determinants of health in urban settings. Industrial activity can have significant impact on cities with respect to pollution and less expensive housing is often found in areas with less desirable physical environments. Natural and manmade disasters have also affected health in neighborhoods (e.g. environmental pollutants in lower Manhattan after 9/11) cities (e.g. methyl isocyanate gas in Bhopal India) and regions (e.g. 2004 Indian Ocean tsunami Hurricane Katrina).
It is important to recognize that the place of residence is situated within a particular social milieu that can have substantial impacts on health in terms of exposure and access to care. Slum dwellers are often a particularly vulnerable group for a variety of reasons including precarious or nonexistent land tenure (Davis 2006) lack of urban resource infrastructure (Edelman Mitra 2006) and tenuous relationships with governments and law enforcement (Davis 2006). Immigrants living in ethnic enclaves within cities may have different experiences than immigrants living in areas in which they are among the minority or there is no majority. For example a study of immigrant mothers in New York City (USA) noted substantial differences in geographical access to prenatal clinics by country of origin.
2-Social determinant 1 and health inequity: Social Environment
Race and ethnicity are constructs that classify population groups based upon economic social cultural behavioral and biologic factors (Last 2001) there are no generally agreed upon definitions (Collins 2004) and the terms are often used interchangeably ( National 2005). The associations between race/ethnicity and health are complex and often multifactorial. Some population groups are more likely to have specific diseases because of allelic inheritance (e.g. Tay Sacks disease among Ashkenazi Jews). In other cases differences in rates of disease among groups are related to differences in likelihood of exposure or access to care.
Racism is discrimination based on race or ethnicity. Racism can affect heath by restricting access to material resources; educational economic and occupational opportunities; and health and social services (Williams 2003). It has also been hypothesized that stress resulting from experiencing racism is associated with health outcomes (Williams Neighbors HW Jackson 2003 Tull Sheu Butler Cornelious 2005).
3-Social Determinant 1 and health inequity: Biology and genetics
The examination of gender as an SDH is not simply the comparison of disease and exposure for women vs men. Gender moves beyond the biology of being male and female and focuses on…
Obesity in Urban America