Social Determinates of Health Essay

Refer back to the interview and evaluation you conducted in the Topic 2 Family Health

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Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.
Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.Social Determinates of Health Essay

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The social determinants of health are responsible for health inequalities. For reducing health inequalities and improving health status of people, it is important to recognize main factors which are affecting health, that is, determinants of heath. Maori has the poorest health status in New Zealand. Economic factors have major role in contributing better health. People with low income are more vulnerable to diseases and disabilities. This essay will discuss about relation between economic factors related to heath and current nursing practice and identifying New Zealand government strategies to reduce this disparity. Moreover, discussing about psychological factors associated with smoking and crises due to this risk taking behaviour.Social Determinates of Health Essay

The social determinants of health consists of various factors that determine health and wellbeing, for instance, socio-economic factors, genders, cultures and education (McMurray, 2010). Some groups of people are healthier than others. There is a relation between income and health, as well as they are strong predictors of health. People with low economic status have poor education, unemployment, job insecurity bad working conditions and lower class jobs (Marmot, Foege, Mocumbi & Satcher, 2008). It affects the access of healthy environments and appropriate medical care facilities (Dew & Matheson, 2008). In New Zealand, there is a significant disparity in health between the Maori and non-Maori people of Aotearoa New Zealand. Maori people and pacific people are highly vulnerable to ill health and disabilities. Maori mortality rates are approximately double as compared with European New Zealanders rate (Dew &Davis, 2005). However, many surveys found that Maori have similar or lower rates of hospitalization than other New Zealanders in spite of their higher demand of treatment. This shows that financial conditions affect not only production but also consumption of health care. (Ministry of Health, 2002). The poor health status of Maori may due to poor economic circumstances. Maori people aged between 45 years and 64 years are more likely to die than others in this same age in New Zealand (Dew & Matheson, 2008). Inequality in life expectancy and the risk of death rate are significant health inequality. The gap in life expectancy between Maori and non-Maori increased to 10 years. The early death rate in Maori population is mainly related to occupational class. More Maori people are doing unskilled works than others and it can cause higher risk of early death (Dew & Matheson, 2008).Social Determinates of Health Essay

Nursing services should be organised according to demands of whanau rather than the needs of providers. Nurses must recognise, understand and remove financial, cultural, geographical, physical barriers for reducing inequalities in health. Economic barriers are unsafe working conditions with little jobs, unemployment, inadequate housing, crime, high disparities in income and wealth. Participation and encouraging them with proper support at all levels of the health and disability sector can improve their status. Maori participation should be ensured in planning, development and delivery of health and disability services (King & Turia, 2002). Therefore, they must get appropriate and effective nursing care. Moreover, Maori should be ensured with development and workforce enhancement. Nursing services should be culturally appropriate. Maori health models should be used for caring Maori. Build and recognize values of Maori models of health and traditional healing, for example, massage, herbal remedies and spiritual care. They want services that reflect Maori cultural values. Nurses must provide workplace education, health promotion and clinical services to keep the work place and its employers safe and healthy. They need high levels of communication skills, understanding of interpersonal and government standards and legislation. Plunket nurses provide family parenting support in community (McMurry, 2010). Treaty of Waitangi protects the rights of responsibilities of Maori. Therefore, it reduces in equalities in health in New Zealand ( McMurray, 2010).Social Determinates of Health Essay

The government introduces strategies to decrease inequality in health status. They are New Zealand Health Strategy as well as Health and Disability Strategy. This strategy makes sure accessible and appropriate care services for people from lower socio- economic group including Maori. It helps to identify and provide care according to their health needs. The Ministry of Health provides nutritional guidelines and policies for New Zealanders to address nutritional needs. Maori and Pacific people are the groups, who have the poorest health status in New Zealand. Improving the quality of health education programs focused at Maori can improve their status. Encourage the Maori health providers to participate in health section and organization of smoking cessation programs. Increase mental health services for Maori. People with poor health often find to get a good job. Health status determines socio-economic position. The main disability services are income support, disability allowance, accidental compensation, antidiscrimination legislation as well as education and support services for people with disabilities, chronic illness and mental health illness living in the community (King & Turia 2002).The government and the Ministry of Health provide key priority to reduce health disparity among Maori. Encourage Maori health providers to build Maori models of health. The New Zealand Disability Strategy pointed out the demand to remove the barriers like discrimination among Maori with disabilities. Improve the number of trained Maori clinicians, health professionals, managers, community and voluntary worker and researchers in order to strengthen the health and disability sector. Improving the skills of the Maori health and disability workforce can reduce inequality in health. Publicly funded hospitals and primary health care organisations have started to identify and meet the needs of Maori. Now many hospitals have Maori and whanau units, as a result they get better care and culturally safe treatment. District health boards are working with primary health care and it plays a significant role in reducing health inequalities (King, 2002).Social Determinates of Health Essay

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Smoking is significantly prevalent among Maori in New Zealand. Many Maori women die early due to smoking related to illness at greater than others. There is no decrease in the smoking percentage among Maori for the last five years. There are many psychological factors that are associated with smoking. Depression and anxiety are closely related with smoking. Depression can cause smoking, whereas, addiction of smoking can lead to depression. Parental influence is another causative factor for smoking. If parents are smokers, children will be more vulnerable to smoking. Researchers found that, these children have four fold risks than other children. Suicidal tendencies, low self esteem, poor body image, low socio-economic status, and lack of academic performance at school as well as poor quality of life are also influencing factors for smoking. The psycho-social conditions of adolescents and their behaviour decisions can cause depression and risk taking behaviours (McMurry, 2010). In New Zealand, 42% smokers are Maori. These indigenous people with low levels of education, employment and home ownership are more vulnerable to smoking. People who have prolonged mental stress are also having a high risk of smoking. Many youngsters start to smoke as an experiment. Finally they gets addicted to these substances. Smoking can cause severe health problems like lung cancer, chronic obstructive pulmonary diseases, pneumonia and asthma. Passive smokers are also more vulnerable to lung cancer. When women smoke during pregnancy, it can lead to intra uterine death and deliver a baby with low birth weight (MOH, 2008).Social Determinates of Health Essay

In conclusion, Maori have poorest health status in New Zealand. The socio- economic determinants of health are responsible for health equalities. Home ownership and property ownership are low in Maori than others. Therefore, salary is the main source of income for them. Labour market is a significant income for them. The low income negatively influences their health. The government introduced New Zealand Health Strategy to reduce inequality. This essay discussed about current nursing practice taking initiation to reduce this disparity. Moreover, Risk taking behaviour such as smoking causes many problems and psychological factors related with smoking.

The establishment of the 2010 Patient Protection and Affordable Care Act (ACA)
was developed, in part, as a solution to concerns over availability of insurance coverage
and access to care. At the same time, the ACA spearheaded a national movement toward
zero-cost preventive care. While the validity of the ACA is hotly debated, the ACA’s
access and preventive care intentions have largely avoided open political conflict. The
surprising unity of purpose inherent in this fact demonstrates a national health policy
commitment to principles laid down in Social Determinates of Health (SDH) research.
Siding decisively on the socio-economic status causes health side of the economic debate
that has raged for almost half a century, our national policy perspective implies that
preventive care improves health. It is unclear today whether the benefits of embracing
SDH priorities outweigh the costs.
Continued debate around the legitimacy of the ACA, problematic program design,
and a long history of attacks which target risk-sharing transfers and subsidization
continue to increase carrier level uncertainty. Increasing uncertainty has sparked a period
of increasing premium inflation and volatility, increased cost-sharing, and rapidly
increasing deductibles. So, while preventive care has become a permanent part of our
national health conscience, so too has increasing levels of financial strain and uncertainty
around the “shock” burden of adverse health events. A compounding feature of the
American economic landscape is the trend toward precarious employment that
undermines income stability and increases both the frequency of job changes and
associated search costs. This dissertation emerged as a natural curiosity around the
question, “are increasing tendencies to live financially strained and decreasing
opportunity for long-term stable employment reducing individual health stocks?” The
impetus of Chapter 2 is to answer this question.
There is a great deal of economic history underpinning the well accepted


socioeconomic status health gradient (Halliday, 2007). In Chapter 2, we use this
historical work as a stepping off point to inform on two potential SDH transmittal
pathways running from SES to health. To do so, this research uses an unbalanced panel
consisting of eight waves of the Panel Study of Income Dynamics PSID from 1999
through 2013. Theoretical motivation for this work is drawn from Muurinen (1982) who
posits that health outcomes are likely driven by an individual health depreciation factor
which is, “endogenously related to choices made by the individual.” The theoretic model
is developed from the perspective that the efficiency of converting human capital into
income is not costless, that this cost varies across individuals, and that it is observable in
health outcomes. In this way, this research is built on the standard assumption that the
process of income generation is a function of human capital (Becker, 1967; Becker,
1994) which is stitched into Grossman’s, 1972 health investment model. Emergent
hypotheses are that both financial strain and job-switching frequency cause negative
health consequences. Estimation proceeds with the dynamic panel random effects
ordered probit specification with correlated random errors, and corrections for the initial
conditions problem. This work differs from historical research across two important
dimensions. First, following the course set by (Contoyannis et al., 2004), this study uses a
small T large N dynamic longitudinal survey and differs from prior research on financial Social Determinates of Health Essay
strain in this respect. Second, we develop and test the theoretical relationship between
job switching frequency as a causal mechanism in the relationship between SES and
health. We find that both variables are negatively related to self-assessed health status
SAHS, however they effect the individual in different ways. Financial strain “shock” is
negative but has no permanent effect which we attribute to consumption smoothing, and
job-switching frequency exhibits a long-term effect but no meaningful short-term effect.
Of course, policy implications run counter to the national trends of increasing financial
strain and increasing transience in employment, and are thus so broad in declaration as to
be essentially meaningless. As a result, we take two approaches to narrowing the scope
of policy recommendations. Taken in order, Chapter 3 develops a pragmatic policy
evaluation method to assist policy makers in reducing individual level cash-flow shocks
which emerge as a result of imprecise health and health insurance policy.
The development of our policy analysis tool is predicated on a recent trend toward
state management and modification of ACA related policy directives. Although states
have the option of applying for a 1332 waiver to waive or modify elements of the ACA,
few states have the internal capacity to accurately define appropriate values for health
and health insurance policy measures often deferring to the federal benchmarks which
poorly characterize state needs. To further complicate matters, decisions which effect
many are often made on the backs of allegory and hyperbole during rushed sessions and
through analysis periods crammed into overnight hours. Having firsthand experience
with this world, it became clear that an actionable path to reducing financial strain shocks
was to formalize and operationalize the decision making process around a simple to
implement quantitative low overhead model of policy change. We develop our model
around reinsurance program design although the methodology is applicable to many
program design efforts.
The overwhelming majority of 1332 waiver applications relate to establishment of
state run reinsurance programs. Access to requisite state level information is made
publically available through the transparent waiver process. Leveraging this information
resource, our research develops a generalizable quantitative health policy evaluation
algorithm. Using simulation and sensitivity modeling, the model is adapted to two policy
changes which took place in Alaska: the expansion of their Medicaid program, and then
the implementation of a state funded conditions based reinsurance program. As a third
validation test of the model’s predictive power we test against the actuarial analysis
generated for the State of Washington’s proposed attachment point reinsurance model. In
the case of Washington State, the model predicted extensive unanticipated liability which
was sufficiently compelling to motivate a change in program parameters. Across
validations, the model predicted results were both statistically credible and reduced year
over year premium volatility relative to the comparable actuarial approaches taken.
Because the population of insured act as an intra-liminal shock absorber for state and
carrier error terms, adoption of such an evaluative method is supportive of reducing
individual level expense volatility. Reduced volatility in expected health and health
services cost directly effects a reduction in financial strain and the rate of consumption of
individual health stock. In chapter 4, we turn our analytical lens to adolescent
circumstances and experiences in order to inform policy makers on youth programs
which are predictive of adult financial strain.
Chapter 4 presents a case study of Caucasian adolescent conditions, behaviors,
and experiences and their effects on the probability of adult financial strain. Our research
thus fully embraces SDH preventive aims. SDH theoretical categorization of relevant
factors is broad. SDH factors thought to influence health run the gamut leaving few
stones unturned: poverty, hunger, occupational exposure to hazards and relations at work,
social and economic effects ranging from illness to the experiences of gender relations
and racism, home circumstances, self-efficacy, dietary intake, habitual tendencies,
accumulated deficits of ones’ past, schooling, marital status, socioeconomic status, and
position in the life-course (Lee and Sadana, 2011). Such a broad spectrum of
interlinked influences necessarily cuts across variables of class, housing stock, the
education system, and the operation of markets in goods and labor (Solar & Irwin, 2007).
SDH research is thus both wide with opportunity and fraught with pitfalls. In this study,
we employ both conventional statistical modeling and machine learning approaches to
evaluate a battery of retrospective childhood circumstances on adult tendencies toward
financial strain. This research uses eight waves of the PSID (1999 – 2013) and integrates
the Childhood Retrospective Circumstances Survey which queries 2013 participants in
the PSID on childhood and adolescent events, situations, and behaviors. With greater
than one hundred twenty variables focusing on disparate domains including: health,
education, social, neighborhood, and family influences coupled with SAH theories that
imply a multitude of interconnections, this research uses Principle Component Analysis
to reduce the variable count into orthogonal components which group correlated variables
without a-priori assumptions. We use both individual and ensemble techniques (decision
tree and random forest) machine learning algorithms to evaluate component sensitivity Social Determinates of Health Essay
effects with respect to accurate prediction of adult financial strain. After normalization of
results, we use combination forecasting ((Bates and Granger, 1969; Bohara, McNown &
Batts, 1987) to weight model sensitivities for aggregation. Coefficient directional effects
and significance are recovered from bootstrapped training session for our preferred
random forest model. These results are validated against a variety of logit specifications
which are qualitatively similiar. Results are consistent with the perception that students
that enjoy school, tend to be more financially stable in adulthood. Additionally, fathers’
work habits are a robust role modeling tool. We also find a pair of counter intuitive
findings: first, mother’s work habit is positively correlated with offspring tending toward
financial strain in adulthood, and second, that close affectionate maternal relationships
seem to coincide with higher levels of adult financial strain in later life. Past research
(Reed et. al. 2016; Swartz et. al. 2011; Fingerman et. al. 2012; Kirkpatrick, 2013; West
et. al. 2012; Suitor et. al. 2017) is consistent with the second finding; that easy to
approach, forgiving and attentive parents may provide more robust safety nets thus
inhibiting the development of sound financial behavior in offspring. In combination with
mom’s employment characteristics, we posit a direction for future research; that is, the
role of mom’s employment history and mother/adolescent social relationships that
emerge in this research seem to suggest that it is more beneficial to have a strict, and
present mom within the household and less beneficial to have an absent but
easy/forgiving mom in terms of adult tendencies toward adult financial strain. We find
this vein for future research compelling in the context of: increasingly fully employed
mothers, helicopter parenting, youth contending with increasingly precarious
employment, and rising compulsory health insurance expenditures. Social Determinates of Health Essay

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