required 1. Alma-Ata Declaration. WHO, 1978.
2. Ottawa Charter for Health Promotion. WHO, 1986.
3. Rio Political Declaration on Social Determinants of Health. WHO, 2011.
4. U.S. Department of Health and Human Services. Healthy People 2020: Social Determinants of Health.
There are a variety of health, economic, and social indicators on Gapminder. (http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=5.59290322580644;ti=2013$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=phAwcNAVuyj2tPLxKvvnNPA;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0TAlJeCEzcGQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=lin;dataMin=142;dataMax=182700$map_y;scale=lin;dataMin=1;dataMax=84$map_s;sma=50;smi=2$cd;bd=0$inds=)
In this activity we will explore some of the potential social and economic determinants of the health indicators and how they change over time. To do this, choose one health indicator and one social indicator from the Gapminder database. You can do this for all countries with available data or focus on one country.
Take a screenshot of your graph (or a video of the graph changing over time if you can figure out how to do that) and post it in the forum with a description of the figure and why you think it’s interesting. Comment on the direction of the relationship between the health and social indicator and how that relationship changes (or stays the same) over time. It there are anomalies (e.g., a sudden increase in mortality during particular time), try to uncover possible explanations by searching the internet for scientific or news articles.
Post your description and graph to the paper. Please make it editable so that I can copy and paste. You title should include the health indicator, the social indicator, and the geographic region of interest (e.g., “Life expectancy and GDP in Estonia”). Your description should be 300 words in length. Be sure to provide references if you refer to other sources.
Conference 2: Analyzing Contextual SES (200 Words, 2 references)
The following readings are required for this lesson:
1. Marmot & Wilkinson, Chapter 10: Poverty, social exclusion and minorities
2. El-Sayed AM, Galea S. Temporal changes in socioeconomic influences on health: maternal education and preterm birth. Am J Public Health. 2012 Sep;102(9):1715-21.
3. Link B, Phelan J. McKeown and the idea that social conditions are fundamental causes of disease. Am J Public Health. 2002;92(5):730-2.
Before we look at health and neighborhood context in lesson 3.5, let us explore that context a bit. You can use this map (https://project.wnyc.org/median-income-nation/#4/38.63/-95.89) from WNYC to look at median incomes across the United States. We use maps like these quite a bit in public health to look at the geographic distribution of social determinants of health, morbidity, and mortality. You should become comfortable with reading and interpreting these maps.
For this exercise, each student will select a state. You will then answer the following questions in the discussion forum:
• What areas tend to have the highest median incomes? The lowest?
• Do you think your state is equitable with respect to income distribution?
Title your forum post with your name and state. Answer the four questions above in the body of your post with no more than 200 words.
Conference 3: Race and Ethnicity (200 Words, 2 references)
The following readings are required for this lesson:
1. Marmot & Wilkinson, Chapter 12: The social determination of ethnic/racial inequalities in health
2. Geronimus, A. The weathering hypothesis and the health of African American women and infants: Evidence & speculation. Ethnicity & Disease. 1992. Vol 2; pg 207-221.
3. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Reports. 2001;116(5):404-16.
In the following forum discussion please do the following:
1. Define race and ethnicity
2. Provide an example of race as a social determinant of health (separate from ethnicity)
3. Provide an example of ethnicity as a social determinant of health (separate from race)
Your answer should be no more than 200 words
Paper 1: Fish Bone Diagram Assignment (1 page, 2 references)
For the fishbone diagram assignment, you need to construct a fishbone based on one of our readings.
Please refer to the attached power point on how to complete a fish bone diagram
Assignment details:
1. The main outcome of the paper should be the fish’s head.
2. You need to first draw the immediate causes of the outcome.
o These may or may not be mentioned in the paper.
o If the main immediate causes are not mentioned in the paper, you can list the ones you may already know.
o You may also have to look up what the main causes of the health outcome are.
3. Next draw the causes of the causes until you reach the social determinant(s) of the main outcome.
o Again, not all of the causes linking the immediate causes to the social determinant(s) will be addressed in the paper. That is okay. Use logic and the knowledge you already have to fill in the diagram to the best of your ability.
4. Thought bubbles for possible solutions are optional.
5. Make sure to include all key variables that are included in the paper you are diagramming.
6. All bones that are derived from the paper should be highlighted in some way. I used yellow highlighting in the ppt, but you can use red text, italic text, etc.
7. Keep in mind that social determinants can have negative and positive impacts on outcomes.
8. I will accept the following file types: pdf, ppt, pptx, doc, docx. Your fishbone diagrams can be either hand written (legibly and as a pdf) or typed (as a ppt, pptx, doc, or docx file).
9. Make sure to put your name and the paper you are using on the diagram somewhere.
10. I have provided a ppt file with the fishbone diagram to make things a little easier for you.
The following articles are the ones that are eligible for review:
• Bennett GG, Wolin KY, Robinson EL, Fowler S, Edwards CL. Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health. 2005 Feb;95(2):238-40.
• Herrick AL et al. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS and Behavior 2013;17 (4):1423-30.
• Malmusi D, Borrell C, Benach J. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010 Nov;71(9):1610-9.
• Mansdotter A, Lindholm L, Lundberg M, Winkvist A, and Ohman A. Parental share in public and domestic spheres: A population study on gender equality, death and sickness. J Epidemiol Comm Health. 2006;60:616-620.
Caution: If you choose Article 1 for example, the outcome should be tobacco use among African American’s (something close to this). Second, the assignment did not call for written texts so please don’t write a text. Third, you should have more than 6 overall causes of the main causes. Also make sure that you follow your causes back to the SDH’s.
Paper 2: FINAL PAPER INSTRUCTIONS (11 PAGES TOTAL: 10 PAGES TEXT+ 1 PAGE FISH BONE DIAGRAM, 10 REFERENCES)
Each student must write a final paper for this class, either on (1) the social determinant of a health outcome or (2) at least three theory-based interventions for a health outcome. Paper topics must be approved by the instructor. Each student will be required to read and comment on a draft of another student’s paper; this will count towards your participation grade. Specific directions for each choice are below.
Format guidelines for the final paper assignment
The final paper should use the following format:
• 1.5 spacing
• 1 inch margins
• Arial 11 point font
• Citations should use the American Journal of Epidemiology reference style or the American Psychological Association reference style. References should be on a separate page. See the instructions for authors for details.
o I highly encourage you to use a reference citation manager software such as Endnote (available for free through NYU here), Zotero, etc.
o Do not use the endnote or footnote function in MS Word.
• Only doc or docx files are accepted, except for fishbone diagrams, which may be emailed to me ([email protected]) separately as doc, docx, jpg, pdf, or ppt files.
Your papers must not plagiarize. See: www.indiana.edu/~wts/wts/plagiarism.html. These papers will be submitted to Turnitin. See also the NYU GIPH Statement of Academic Integrity.
Final Paper Choice 1
Review and synthesize the research literature on a particular social determinant of a particular health condition. You must select one health problem or condition that interests you and one of its social determinants. You must develop a fishbone diagram connecting your health outcome to your SDH.
Word limit: 2500-3500 words
Word limits do not include the fishbone diagram, bibliography, or the table summarizing each article. Appendices, if necessary, should be kept to a minimum and are not included in the page limits. It is expected that a minimum of at least 10 references will be included in the analysis (further references are likely to be necessary).
Final papers will be evaluated according to the following criteria:
1. Introduction: Description of the health outcome and its epidemiology. Description of the social determinant being investigated. Discussion of the research question (2.5 pts).
2. Methods and Results: Review and synthesis of literature/findings (i.e. description of search criteria and selection process, evaluation of article results, relevance of literature selected, presentation of results). You must report at least 5 measures of association (i.e., odds ratio, rate ratio, hazard ratio, difference between means, etc.) from among the 10 papers and their 95% confidence intervals. (7.5 pts).
3. Discussion: Discussion and analysis of findings (i.e. how well does the literature answer the research question, limitations). As discussed in class, Margaret Whitehead developed a typology of four actions we can take to address health inequalities: strengthen individuals; strengthen communities; improve living and working conditions; and promote healthy macro-policies. Think about the social determinant and health outcome for this paper. Based on Whitehead’s typology, at least one paragraph of your discussion should describe one approach for each action category that could address disparities in your health outcome caused by your social determinant of health. You can describe actions you have read about this semester (if so, provide a reference) or you can offer your own ideas. (5 pts).
4. Fishbone diagram: Illustrate the social determinants of the health condition of interest using a fishbone diagram. The fishbone should be on a separate page; you can insert the fishbone as an image (2.5 pts).
5. Table summarizing articles: At a minimum, list author, publication year, setting, population, results (2.5 pts).
6. Writing: Clarity, appropriate language, absence of jargon, organization of paper, grammar, spelling, etc. (5 pts).
Papers that review fewer than 10 papers will lose points. Do not review a review article (including systematic reviews or meta-analyses) or an editorial; however, review articles can be used as background references for the introduction and discussion sections. If you are unsure if a particular article is acceptable, email the instructor.
________________________________________
Final Paper Choice 2
Review and analyze three theoretically-driven interventions designed to improve a health outcome of your choosing. At least two different theories must be represented among your interventions. Intervention components for each intervention must be mapped to theories underpinning each intervention in a table. Each intervention has to have been evaluated, either quantitatively (i.e., through some sort of trial) or qualitatively. Only one of the interventions can be evaluated with qualitative methods.
Word limit: 2500-3500 words
Word limits do not include the tables or bibliography. Appendices, if necessary, should be kept to a minimum and are not included in the page limits. It is expected that a minimum of at least 10 references will be included, at least three of which should be the interventions that are being analyzed. Papers that include fewer than 10 papers will lose points.
Final papers will be evaluated according to the following criteria:
1. Introduction: Description of the health outcome and its epidemiology. (2.5 pts)
2. Description of interventions: Description of the intervention’s theoretical underpinnings, including a description of the theory. (5 pts)
3. One table for each intervention that maps the intervention components to the underlying theoretical constructs. (3.75 pts)
4. Efficacy or effectiveness of the interventions: How were the intervention outcomes determined? Did the interventions improve health? You must report the main outcome’s measure of association (i.e., odds ratio, rate ratio, hazard ratio, difference between means, etc.) for each intervention that is quantitatively evaluated. In other words, report the measure of association that demonstrates if the intervention worked or not. (3.75 pts).
5. Discussion: Discussion and analysis of interventions and their outcomes (e.g., how well was the intervention designed; how well did it perform; if it did not work, why not?; if it did work, why?) (5 pts)
6. Writing: Clarity, appropriate language, absence of jargon, organization of paper, grammar, spelling, etc. (5 pts)
Criteria (as outlined in the paper description) Other Notes to be included
Introduction: Description of the health outcome and its epidemiology. Description of the social determinant being investigated. Discussion of the research question Make sure the epidemiology of the topic is present in addition to the criteria discussed
Methods and Results: Review and synthesis of literature/findings (i.e. description of search criteria and selection process, evaluation of article results, relevance of literature selected, presentation of results). You must report at least 5 measures of association (i.e., odds ratio, rate ratio, hazard ratio, difference between means, etc.) from among the 10 papers and their 95% confidence intervals. This has to be done properly and all elements covered
Discussion: Discussion and analysis of findings (i.e. how well does the literature answer the research question, limitations). As discussed in class, Margaret Whitehead developed a typology of four actions we can take to address health inequalities: strengthen individuals; strengthen communities; improve living and working conditions; and promote healthy macro-policies. Think about the social determinant and health outcome for this paper. Based on Whitehead’s typology, at least one paragraph of your discussion should describe one approach for each action category that could address disparities in your health outcome caused by your social determinant of health. You can describe actions you have read about this semester (if so, provide a reference) or you can offer your own ideas. Please address all element and ensure that there is discussion of the Whitehead Typologies
Fishbone diagram: Illustrate the social determinants of the health condition of interest using a fishbone diagram. The fishbone should be on a separate page; you can insert the fishbone as an image. Make sure the diagram is not thin and should lead back to SDH
Table summarizing articles: At a minimum, list author, publication year, setting, population, results You must include a table summarizing the articles as stipulated
Writing: Clarity, appropriate language, absence of jargon, organization of paper, grammar, spelling, etc. Please proof read and edit the paper
Paper 3: Group Project- NEIGHBORHOOD PROJECT ASSIGNMENTS (6 pages (but please make it 3 single space 10 references)
The neighborhood project is designed to help you observe the social determinants of health in NYC neighborhoods. The learning objectives of the assignment include:
• Learning how to access and present demographic and health data retrieved from local and national web-based data sources
• Assess how neighborhood conditions might affect specific health outcomes
• Describe the potential pathways of influence between health outcomes, proximal risk factors and root causes
• Begin to consider social, psychological and biological mechanisms that connect these factors
• Improve ability to synthesize health data and conceptual maps of relations
• Practice delivering a concise presentation on a complex health issue
DIRECTIONS
Students will be randomly assigned to one of the UHF neighborhoods in class. Within each neighborhood group, each student should pick a different health outcome from one of these choices: (LET ME KNOW IMMEDIATELY WHAT YOU SELECTED SO THAT I CAN INFORM MY TEAM MATES)
• Self-reported health
• Depression
• Access to Health Care
• Influenza vaccination
• Colon cancer screening
• Breast cancer screening
• Asthma
• High blood pressure
• High cholesterol
• Smoking
• Alcohol consumption
• Physical activity
• Diet/Nutrition
• HIV
• Sexual behavior
• Emergency preparedness (2012 NYC CHS)
• Environmental health (2012 NYC CHS)
You may not choose a health outcome that is not on this list. You will be able to find neighborhood-level data for these outcomes in the 2012 and 2014 NYC Department of Health and Mental Hygiene Community Health Survey datasets.
There are two components to the neighborhood project. (1) Each student will submit a 3-page summary of the social determinants of a health outcome in your assigned neighborhood. (
Analysis and synthesis of secondary data
First, you will use available health department and census data to describe the target neighborhood. You do not need to download and analyze datasets. Data for NYC are readily available online through the NYC Department of Health and Mental Hygiene as well as the NYC Departments of Planning and Sanitation in reports and online databases that will give you estimates. The following websites will get you started.
Health data:
Check the NYC health department website (various sources), for example: http://www.nyc.gov/html/doh/html/community/community.shtml
Epiquery (https://a816-healthpsi.nyc.gov/epiquery/) will likely be very helpful.
Demographic data:
Use Info Share or data from the health department or Department Of City Planning website; it is important that your health outcome data match your neighborhood unit/area. You can access neighborhood data using InfoShare: http://www.infoshare.org.
You can also use American Fact Finder – a US Census website. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml
There are so many different types of neighborhood units. What are we using and how does it relate to the other units?
You should use United Hospital Fund (UHF) neighborhoods because that is the level at which you can easily get health data. Think about the problems you will encounter using a neighborhood unit this large. Pay particular attention to what neighborhood unit you are using. Try to consistently use the same one for this exercise because each different type of unit may not necessarily map neatly on to another. Here are four common neighborhood unit types that are used for health analyses in NYC:
• UHF Neighborhoods are defined by the United Hospital Fund for its Health Atlas and other purposes. UHF Neighborhoods consist of between three and six zip codes. There are between 33 and 42 UHF Neighborhoods in New York City, depending on who is defining them and for what purpose.
NB: The assigned neighborhoods are UHF neighborhoods.
• Zip Codes are United States Postal Service designations used to deliver postal mail. There are 1,672 in New York State and 185 in New York City. Zip codes change periodically as the population pattern changes and the Postal Service reorganizes its delivery services.
• Community Districts (CDs) were established by the New York City Charter in 1969 to facilitate delivery and accountability of city services. The New York City Department of City Planning issues maps of the fifty-nine Community Districts that make up the five boroughs. Each Community District is referred to by a borough and sequence number (e.g. BX-1 = Bronx Community District 1). Each borough has between three (Staten Island) and eighteen (Brooklyn) Community Districts.
• A census tract is an area defined by the Bureau of the Census as part of their counting districts. It has an average population of 4,000 people, ranging from 1,500 to 8,000, and varies in size according to the population density of an area. Areas with denser populations will have smaller sized census tracts (as small as a few blocks), and areas with sparser populations will have larger sized census tracts. There are 2,281 Census Tracts in New York City and 5,514 in New York State.
• As a resource, you might want to look at Chapter 19 in Macrosocial Determinants of Health, which is available through NYU libraries as an e-book.
Fishbone diagram
Draw a Fishbone Diagram to flesh out the proximal risk factors, secondary and ultimately “root” or “fundamental” causes of the health outcomes in question.
DELIVERABLES
Neighborhood project summary (25)
In this assignment, students will explore the social, physical, and service environment of an NYC neighborhood using existing data and research. Students will choose one disease or health behavior that represents a significant burden to your target community and analyze the social determinants of that health outcome with a fishbone diagram. Products will include the fishbone diagram and a 3-page summary of your findings.
The summary should include the following elements:
• Description of the health outcome (5 pts)
o One to two sentences describing the health outcome general with respect to morbidity and/or mortality and risk factors.
o Proportion of the community with the health outcome.
o Proportion of the community with the risk factors for the health outcome.
• Description of the neighborhood boundaries and elements of the community relevant to your health outcome (5 pts)
o Population characteristics (e.g., gender, race/ethnicity, age, income, poverty, etc.)
o Physical environment (e.g., housing type and condition, types of businesses, transportation access, schools, etc.)
o Social environment (e.g., faith communities, signs of social cohesion or social capital, etc.).
o Community resource infrastructure (e.g., hospitals, schools, drug treatment programs, etc.)
• Description of major social determinants of your health outcome in the target community, based upon your review of available data and field observation. This is illustrated through your fishbone diagram and should be discussed in the paper. (5 pts)
• Suggest both policy and public health practice recommendations and new research directions. (5 pts)
• Writing, formatting, and referencing. (5 pts)
Format guidelines for the final project summary
The final project summary should use the following format:
• 3 pages total
• Single spaced
• 1 OR ½ inch margins
• Arial 11 point font
• Citations should use the American Journal of Epidemiology reference style. See the instructions for authors for details. Do not use footnotes or endnotes, but rather a page entitled “References.”
• Only doc or docx files are accepted.
• The fishbone diagram should be inserted into the document as a figure or jpg.
• Page limits do not include the fishbone diagrams, references, or any tables you wish to present.
Your papers must not plagiarize. See: www.indiana.edu/~wts/wts/plagiarism.html. These papers will be submitted to Turnitin. See also the NYU CGPH Statement of Academic Integrity.
Caution: