Cohesion, Connectivity, and Health PDF

D a n i e l S k i n n e r, P h. D. , A s s o c i a t e P r o f e s s o r o f H e a l t h P o l i c y, D e p a r t m e n t o f S o c i a l M e d i c i n e [email protected] Objectives 1. Define cohesion and factors that can lead to a decline in a community’s social cohesion. 2. Explain how social and...

D a n i e l S k i n n e r, P h. D. , A s s o c i a t e P r o f e s s o r o f H e a l t h P o l i c y, D e p a r t m e n t o f S o c i a l M e d i c i n e [email protected] Objectives 1. Define cohesion and factors that can lead to a decline in a community’s social cohesion. 2. Explain how social and municipal planning can impact cohesion, happiness, and productivity. 3. For patients like Claudette, broaden the range of questions physicians should ask, and provide them with new tools for seeing health in new ways. Cohesion (Social/Community) “…refers to the quantity and quality of interactions among people in a community, as indicated by the degree residents know and care about their neighbors and participate in community activities. It reflects the value of having nearby friends and acquaintances with whom a person can interact and provide physical support if necessary.” (Litman, p. 1) Transportation and Community “Transportation and land use planning decisions can affect community cohesion by influencing the location of activities and the quality of the public realm (places where people often interact, such as sidewalks, local parks and public transport) and therefore opportunities for neighbors to meet and build positive relationships.” (Litman p. 2) Indicators of Cohesion - People assisting strangers. Strangers engaging in spontaneous conversation. Neighbors cooperating on projects. Children playing in public. Diversity in public realm (different incomes, ages, cultures and physical abilities). Community events and activities that attract diverse participants. Children, seniors and people with disabilities traveling independently. Patient-centeredness requires understanding groups “…health care providers should remain vigilant of the influence of social groups on patients’ behaviors, including daily drinking amounts, regardless of age, and discuss methods by which patients can reduce and prevent loneliness and isolation.” (Canham et al, p. 9) Other factors/considerations Planning – broadly construed Different aspects of urban, suburban, and rural living – but avoid stereotypes Crime/safety/environmental issues Housing & Zoning/Tax policy Non-profit responsibilities Social/Contextual History Home LifeLives alone. Her son and other family members check in on her periodically. Marital Status/Partner Status: She was widowed 10 years ago; she had a male companion living with her until 1-2 weeks ago. Kids, Other family relationships: The son next door is the oldest of three adult children. The middle child is a daughter and the youngest child is a son. Autonomy: Driver’s license was taken away several years ago. Public transportation options in her community are limited and unreliable. The son frequently takes her to appointments, runs errands for her and buys groceries for her. Safety: Before now, her main risk was drinking and driving. She had four DUI convictions. ACE (Adverse Childhood Experiences): None known, except that she grew up poor. Work LifeEnvironment: She lives in a 2-bedroom house in the suburbs. Ergonomics: Most of her home is on one level. Schedule: Just taking care of herself. Stress, Satisfaction: These have varied. Education Level: High school diploma. ActivityGeneral level: She occasionally gets outside for walks. Formal Exercise: None known. Recreation, Hobbies: She used to enjoy bingo. NutritionContent (Micros, Macros): Her groceries have included meat and potatoes, but few vegetables or fruits. Mindful eating patterns: No apparent schedule or plan. Tobacco- She smokes 2 ppd of cigarettes and has done so her whole adult life. Alcohol- Principally wine in unknown quantities (not all of which were bought by the son), but she consumes at least one 750 cc bottle daily. She occasionally drinks vodka. Illicits- None known. Sleep- Not known. Stresses/WorriesEmotional: She has been stressed by her male companion’s departure, which occurred for unclear reasons. Financial security: She receives her former husband’s Social Security and an unidentified additional pension check. Insurance Status: She has CareSource Medicaid. Basic needs –housing, transportation, etc.: See above. Support/ResourcesCommunity: She lives in the suburbs, but doesn’t talk much to other people. Family, friends: Her son lives next door. Her other supportive adult children live within 25 miles. Not many friends. D a n i e l S k i n n e r, P h. D. , A s s i s t a n t P r o f e s s o r o f H e a l t h P o l i c y, D e p a r t m e n t o f S o c i a l M e d i c i n e [email protected]