From
StayCurrentMD
#APSA50: Social Determinants of Health
With Dr. Adam Foss · hosted by Dr. Alex Cassar & Dr. Ron Herschel
Part of
Trauma 10 items
Chapter 1 of 15 · Fundamentals
Episode intro
Introduction to Social Determinants of Health at APSA 50
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What the experts said
Racial and socioeconomic disparities in criminal justice and public health have the same underlying causes.
Children in the US are disadvantaged by racism, classism, homophobia, and xenophobia, which marginalizes people not fitting the dominant narrative in every aspect of life including culturally, economically, health metrics, and the criminal justice system.
When adults are removed from communities, the economy, and healthcare through incarceration, children are forced to breach the void and fall into the same traps, creating intergenerational and sometimes intractable cycles.
Professional education fails to prepare practitioners for working with marginalized populations: law school does not teach about trauma or poverty despite public interest lawyers working in trauma-dictated communities, and medical school likely does not teach the history of racial bias in the United States.
When procedural steps are placed in the way of people living in poverty, the likelihood they complete the process decreases exponentially.
Code for America reduced steps in California's record clearance process and increased completion likelihood by 44%.
Workforce diversity is important for inclusivity, but what is most important is building pipelines for people who are impacted by the issues to reach professional positions, not just demographic representation.
Patients experience distrust when they enter a hospital or doctor's office and nobody looks like them, which ruins the first interaction and is critical to long-term health outcomes.
In 1.5 million miles of air travel, Adam Foss sat next to two black people on an airplane for the first time, and he has never sat next to a black person in first class except celebrities from television or sports.
In Fortune 100 C-suite offices (Amazon, Airbnb, Google, etc.), the only black people present are those bringing in and out the coffee.
Of approximately 90 colleges, graduations, and law schools visited, none had an African American population over 5%.
2.3 million people are in jail and prison right now, with another 5 million on probation or parole.
1 in 3 black men born today will spend some time in jail or prison.
650,000 people come out of prison every year and face 50,000 collateral consequences of felony convictions that impede successful re-entry.
70 million Americans have a criminal record that will never go away and will impede their re-entry into society.
The leading cause of death for young black men aged 18-35 in the United States is handgun homicide, which is not true of any other demographic in any other place on the planet.
Handgun homicide accounts for more deaths than the next 9 leading causes of death combined for black men aged 18-35.
In Manhattan, black women are 12 times more likely to die during childbirth than white women.
Black women and white women experience breast cancer at almost the exact same rate, but black women are almost twice as likely to die from it.
Black women have a 71% higher chance of dying of cervical cancer.
In Boston, at one intersection on Mass Ave, life expectancy drops by 25 years depending on which direction you look.
There are more segregated schools in the United States today than on the eve of Brown v. Board of Education.
There are more black people under correctional control today than there were slaves on the eve of the Civil War.
Over 400 years of the transatlantic slave trade, 12 million Africans were captured, enslaved, and killed; last year 11 million people went through US jails, recreating slavery's scale every year.
At age 19, Adam Foss was caught drug trafficking (a federal offense with a 10-year minimum mandatory sentence), but the arresting officer was his adoptive white father who took him home and loved him instead of prosecuting him.
Being convicted of a drug crime in the 1990s would have resulted in the label 'convicted drug felon' and deprivation of access to housing, employment, education, healthcare, and pro-social activity, which increases the likelihood of committing another crime rather than decreasing it.
Stanley emigrated from the Dominican Republic at age 9 with his two older brothers to get a better education in Boston, but witnessed more violence, poverty, and trauma in the Fidelis projects than he had in a developing nation.
Stanley's two brothers went to prison and his father ran away due to fear of deportation after problems with law enforcement, leaving Stanley and his mother alone.
Stanley told Adam Foss that when robbing people, the thought of prison never entered his mind because he was worried about his mother dying, and that young people carry handguns to high school not thinking about 18 months in jail but worried about what happens if they are caught without one.
Children conceived to mothers living in toxic stress inherit that stress epigenetically, which changes the way their bones and brains develop and eventually the way they behave, and these changes can be traced into prison.
75% of children locked up in 2015 had on average 33 interactions with the child welfare system before age 3 for abuse, neglect, and malnutrition.
Children from impoverished communities do not learn to read in underperforming schools not because they are black, brown, or poor, but because educators do not understand the stress they bring to school and blame, shame, and expel them instead.
If an 18-year-old boy in Massachusetts kills another 18-year-old boy, he receives a life without parole sentence at a cost of $11 million.
Stanley became the first freshman in his college's history to pitch in the national championship game (11 innings, 8 strikeouts, 2 hits), made the Dean's list for the first time, and is now a junior majoring in criminal justice applying to law school to become a prosecutor.
Social determinants of health include economic stability, housing, transportation, physical and psychological safety, zip code, geography, literacy, education, hunger, poverty, community support, discrimination, stress, and provider cultural competencies, and these affect healthcare outcomes like quality of care, mortality, morbidity, life expectancy, and costs.
Black mothers are dying in childbirth at rates that are ridiculous compared to other groups.
In pediatric surgery, black and other diverse children's pain is not taken seriously—they receive fewer pain medications or are ignored when they reach out to nurses for pain.
Cardiologists sometimes give patients inferior stents (not the best available) based on assumptions about their cultural or socioeconomic status and likelihood of follow-up, compromising standards of care.