Chapter 10 From One to Many: Health on a Large Scale PDF

**[Chapter 10 From One to Many: Health on a Large Scale]** **The Social Ecological Model** - A model acknowledging that the individual is influenced by a collection of larger, inter-related and cumulative contexts, such as organizations, communities and government - Emphasis on the **...

**[Chapter 10 From One to Many: Health on a Large Scale]** **The Social Ecological Model** - A model acknowledging that the individual is influenced by a collection of larger, inter-related and cumulative contexts, such as organizations, communities and government - Emphasis on the **"social"** piece of the biopsychosocial approach In Canada, Langille and Rodgers (2010) **analyzed physical activity** in schools by considering **school board policies** and **societal pressures for academic achievement**, as well as the **individual behavior of children**. This represents a classic application of the **social ecological model.** **Tracking Health and Illness at the Population Level** - **Epidemiology:** the study of changing patterns of health and disease across populations and geographic areas, involves contaminants in the air to poorly handled food - Epidemiologists can explain **disease occurrence** and perhaps **inform interventions** that reduce its impact - Also **identify populations at risk** and more generally describe the **health status of populations** - Epidemiology means **"the study of epidemics"** - **Epidemiology in this regard apply the social ecological model** - **Epidemiologists** 1. start with a single case then trace back to its starting point 2. determine how widespread the problem has become 3. identify factors that all people with that problem share - **Index case:** the first identified instance of a medical problem, Ex: the first case of COVID-19 identified in Canada occurred in Toronto on January 27, 2020; this would be considered the **country's first index case**. At this point, epidemiologists would call this an **outbreak.** **The Nature of COVID-19** **Flu-like outbreak in Wuhan City, China, in December 2019**, novel coronavirus officially labelled **"severe acute respiratory syndrome coronavirus 2,"** or SARS-CoV-2 **spread from China to South Korea** and beyond - **Index case -** the first case of COVID-19 **identified in Canada** occurred in **Toronto** on January 27, 2020; this would be considered the **country's first index case**. At this point, epidemiologists would call this an **outbreak.** - **Pre-symptomatic --** someone who is confirmed to have the virus but is not yet showing **symptoms** - Asymptomatic -- someone who has not had the illness confirmed and has no symptoms - Mutation - - Incubation period -- the time between exposure to the virus and the onset of symptoms can be up to 14 days average is between 4 and 5 days; this is the **14-day self-quarantining regulations** that have been applied to people entering the country, severity and duration vary from person to person - **Reproduction number --** the number of people, on average, an infected person ends up infecting, symbolized by the letter R. When R is less than 1, the rate of spread slows. When it is over 1, the rate increases. For example, an R of 2 will result in an exponential growth of cases. - Epidemiologists are interested in the time it takes for the **number of cases to double**. The shorter the time to double, the **rapid rate of infection** **COVID-19** has been considerably greater for people **over the age of 70** and even more so for people **over 80 years of age** **- median age dropped from 52 years to 39 years in BC** to support that illness was not restricted to older people Symptoms of Covid-19 peaked **after about 10 days**. Transmission of SARS-CoV-2 between humans occurs **through water droplets** that are expelled via such actions such as **coughing, sneezing, and talking**. Small droplets due to aerosol transmission i.e. two people standing less than 2 meters apart and one of these activities take place, droplets may be transmitted. Further research suggested that **surface-borne SARS-CoV-2** is **less likely to lead to disease**. Highly transmissible **variant is the Delta variant**, originally identified in India rapidly became the most common variant in many countries including in the United Kingdom. Inside the body the virus uses the genetic codes of its new host to multiply. The infected individual experience a rise in body temp. and persistent coughing among a range of other flu-like symptoms, **if it reaches the lungs, and if it multiplies quickly**, the disease can progress in ways that make **breathing difficult**, at times **requiring hospitalization.** **On January 30, 2020, the WHO declared COVID-19 to be a pandemic.** **Pandemic --** a large epidemic that occurs on a worldwide basis, crossing international boundaries; usually affects a large number of people - **Prevalence --** the number of cases that have been confirmed or presumed - **Point prevalence --** the number of cases present at a particular point in time - **Period prevalence --** the total number of cases that have occurred over the course of an incident - **Current cases --** the total number of cases minus those who have recovered or died from the disease - **Incidence --** the number of new cases that emerge in a given time period **Psychological Reactions to COVID-19** - **Fear and anxiety** \- fear can motivate cooperation with public health measures or demotivate citizens by engendering a sense of helplessness - **Isolation and compromised social support** \- we are required to treat others as though they are potentially toxic and so elevated levels of eating disorders, anxiety, domestic violence, racist accusations and other worrisome consequences - **Related behaviors: addictions, suicidality and depression** - **Coping: behavioral activation, secondary control, acceptance based-coping** - **Behavioral activation --** mechanisms focused on positive responses that enhance resilience in the face of challenge; refer to three Cs -- control, coherence and connectedness - **Secondary control --** a process where we work on the things we can control in lieu (instead) of the things we cannot, ex: controlling our own behavior when we cannot directly control our environment, like we could focus on social distancing, handwashing and so on. - **Acceptance-based coping --** paying attention to how one relates to emotions rather than letting the emotions take charge of one's behavior, example, fear can be acknowledged as an understandable reaction to pandemic **Gradients of Health** - Relationship between socio-economic status and health -- **gradients of health** - **Health is positively related to wealth. For instance, as poverty increases, health status decreases** - Everywhere one looks, **wealth predicts health** - Vulnerability to health problems is more prevalent among **Canada's poorer citizens** - **Distribution of wealth --** is a predictor of the health of a country's citizens; the smaller the gap between the richest and poorest citizens the better the **country's general health** tends to be - **Healthy life expectancy --** Canada **ranked twelfth among 44 developed countries** in terms of life expectancy. By comparison, the US ranked twenty-ninth - Canadians experience **longer wait times for care** than people from other developed countries do - Canada is doing well compared to other countries **in cancer screening and care**; one notable exception is **lung cancer among women** where Canada fares worse than other developed countries **Social Determinants of Health in Canada** - Factors such as housing, employment, socioeconomic status, education and food availability that affect the health of populations -- **social determinants of health** - Social determinants also refer to **economic** and **political conditions**, such as poverty and war. People focusing on social determinants will refer to **"upstream causes"** **- upstream causes** refer to social, environmental and economic conditions that people experience throughout their lives such as government policies, decent housing, meaningful work - Purely **biomedical approaches** do not give adequate consideration to social determinants because they focus on only biological factors to diagnose and treat illnesses **The Vulnerability of Populations** - Some populations are more likely to encounter a health problem - Vulnerability is the result of: \- increased likelihood of exposure to a threat \- increased likelihood that the threat will become a real problem \- populations lack the resources to deal with the problem. Ex: street youth, elderly On indigenous peoples, the differences in health cannot be explained by **biological differences**, the **long-term effects of colonization**, the **residential schools** and other **racist policies and actions** have resulted in considerable health disparities for Indigenous. In spite of this treatment, people living in indigenous communities have a **COVID-19 case rate that is four times lower than that of the general population**, with a **mortality rate** that is **three times lower than the national average** Those living in **inner-city environments** face numerous vulnerabilities. People living in these environments try to cope with a vast array of health issues and their psychological consequences, including poor nutrition and dental care, high rates of chronic disease, mental illness and infection In 2016, the "State of Homelessness in Canada 2016" reported to estimate that at least **235 000 Canadians** experience **homelessness in a given year**. For the homeless, feelings of **alienation** and **learned helplessness are common** In Toronto, **families represent the largest group of homeless people**. They are not likely to be dealing with substance abuse or mental illness. Many experience **trauma especially women** prior to becoming homeless. Trauma of this kind can have significant consequences on physical health and health-related behaviors **Systemic Racism -- Indigenous people as described above** Health disparities due to - Long-term effects of colonization \- Residential schools \- Racist policies and actions \- Not taking into account traditional healing practices - Need for greater social justice and equity **Harm Reduction Strategy** - Attempts to reduce the harmful effects of a behavior when faced with the reality that the health compromising behavior cannot be eliminated from a population -- **harm reduction strategy** \- because health compromising behavior **cannot be entirely eliminated** from a population, so it is logical to work **to reduce its harmful effects** - Target health compromising behaviors such as drug use, HIV/AIDS - Designed to reduce harmful effects - Built on trust, compassion, non-judgmental - Harm reduction is evidence-based activity that can take place at a range of levels from **individual to macroscopic**, whatever the scope, the **goal is to reduce harm** - **Trust** and **compassion** are also **important psychological factors** - Harm reduction rejects a **"just world belief"** which is the belief that people get what they deserve. Instead, proponents of harm reduction believe that comprehensive health services are a right for all - It might be difficult for the public to accept that harm reduction strategies do not indicate endorsement of health-compromising behaviors, especially those that are illegal - For example, a needle distribution program for heroin users living on city streets does not endorse heroin use rather it acknowledges that heroin is highly addictive, and that certain populations are particularly vulnerable. By distributing clean, unused needles, the risk of disease transmission and the harm associated with heroin use is reduced - Youth believe these programs do little to improve overall life circumstances, also difficult for youth not living near these services to access them - The **pragmatic view** holds that if a method yields positive results, it should be employed - A **moralistic view** counters that some methods are not just right, even if they do have statistics to back their efficacy **Reducing the Harm of Injection Drug Use** - **WHO's goal to prevent HIV and hepatitis C in injection drug users** - Needle exchange programs \- some people have negative attitudes towards needle exchange programs - Evidence to suggest fixed sites are better \- fixed location can be established that is familiar to injection drug users \- needles can also be distributed via more portable methods such as from vans \- there is evidence that fixed sites are more effective \- the fixed site provided more than clean needles - Provide counselling and education - Nurse-led care - Hospital and transportation referrals - Handled requests for clothing and housing - Loitering increased when sites were closed **Indigenous youth in BC who use injection drugs, 59% have hepatitis C infection** **The Psychology of Vaccination** - Relies on **specific immunity:** refers to the immune system's ability to remember and recognize a pathogen and then produce immune cells to deal with it - Introduces a **safe dosage** of a **pathogen** - Causes **body's immune system** to develop a memory for the pathogen - The **immune system** would then be prepared to fight the disease more effectively if exposed to a small, safe amount of it first **Vaccine Development** - Three phases from testing of efficacy to testing of effectiveness - **Efficacy:** the extent to which the drug has the potential to yield its intended outcomes under ideal circumstances - **Effectiveness:** a drug's ability to yield intended outcomes under realistic conditions - Testing a drug's effectiveness represents one of the most time-consuming steps in the testing process. It is usually the third and final phase of the process, and it involves thousands of participants - People receiving the Pfizer vaccine who do get infected are up to 78% less likely to transmit the virus to household members than are unvaccinated people - Those who have been vaccinated are **more likely to transmit the Delta variant than other variants of COVID-19** as current vaccines do a good job of reducing disease burden when the Delta variant is involved - **81% of Canadians** were fully vaccinated for COVID-19; **remaining 19% need full** **vaccination** to achieve the level of "herd immunity" that will allow Canada to return to life as it was before the pandemic - Some are opposed to vaccination **because of the rare co-occurrence of serious illnesses** with vaccination and these cases have become more prominent because of the involvement of children in spite of large amounts of evidence supporting vaccination - For COVID-19 vaccinations the **benefits are considered high** and the **risks low**