Michael Franks, Gabriela Gmyrek, Nathan Mast, Tofilska

S P R I N G 2 0 2 2 P H R M 4 8 5 - I N T E R C U L T U R A L A N D G L O B A L H E A L T H I S S U E S

SOCIOECONOMIC STATUS AND ITS EFFECT ON HEALTHCARE

Background Information

Socioeconomic status encompasses a huge proportion of the current issues in global health, especially within the United States. Differences in socioeconomic status result in some of the most prominent barriers to high-quality healthcare around the world. Additionally, nutrition and access to food is impacted largely by the socioeconomic status of individuals and communities. The psychological aspect is notable as well, and includes cultural and traditional differences. These cultural issues can create friction in a westernized healthcare system and can result in less positive healthcare interventions. Poverty leads to increased anxiety and creates a plethora of other issues that higher-class individuals do not have to worry about. This increased worry is related to more mental health problems among impoverished communities, highlighting another significant barrier to wellness directly impacted by socioeconomic status. As we have outlined, socioeconomic status covers a huge range of health problems that must be addressed and that we will try to explore further within the context of the United States.

Gabriella Gmyrek (BSPS candidate) Sarah Tofilska (BSPS candidate) Michael Franks (BSPS student) Nathan Mast (BSPS candidate)

By: Nathan Mast

Healthcare access varies in populations due to:

Spatial factors ---> Uneven distributions of healthcare providers and consumers Nonspatial factors ---> Socioeconomic and demographic characteristics

Background

Everyone is affected by their ability to access healthcare resources. Examples are focused on populations strongly impacted by spatial or nonspatial factors

China's Healthcare Reform

China’s healthcare reform launched in 2009 was pointed at improving rural healthcare resources. Absolute inequalities of health resources increased instead. Researchers concluded that improvements needed to include stronger incentives for the health professionals working in remote and poor counties, targeting the precise poor areas to allocate health subsidies for improving working conditions, and sustaining and extending the benefit scope in poor counties The Socioeconomic status of individuals and communities can play a role in healthcare access inequities. Access to health care is defined as the “timely use of personal health services to achieve the best possible health outcomes.”

Sociodemographic variables can be grouped into three categories:

1. Socioeconomic disadvantages 2. Sociocultural barriers 3. High healthcare needs

Identifying Areas of Need

A US analysis integrates spatial and nonspatial factors into one framework, and identifies the areas and population groups for Health Professional Shortage Areas (HPSA) designation. This analysis system enables reforms to be extremely specific and targeted to the areas with the highest needs.

Professional Opinion?

Areas can be intelligently identified and necessary resources ranked by taking advantage of a sophisticated analysis method. Using this information, healthcare systems can be systematically improved and incentivized to help reduce health inequities. ~ N. Mast

https://www.sciencedirect.com/science/article/pii/S1353829204000085 https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health https://www.tandfonline.com/doi/full/10.1080/00045608.2012.657146 https://www.mdpi.com/1660-4601/16/1/49/htm 75

Diet and Nutrition have significant ties to socioeconomic status, especially within the United States. Different cultures across the country have different dietary preferences and tolerances and different classes and races of people have access to different types of food and exercise. Different factors are used as benchmarks for diet and nutrition as they relate to socioeconomic classes. These factors include: Food quality, maternal nutrition, access to food or lack of access (food deserts), and access to exercise.

https://www.forbes.com/sites/sorensoni mpact/2021/01/07/ozs-could-be-theplace-based-solution-we-need-totackle-usda-food-deserts/

Food Deserts

Michael Franks

Quality of Food Intake by Race and Income

Since 1994, the quality of food intake across all races and incomes has increased overall. However, there are still major discrepancies between different races as well as different incomes. Compared to Black and Mexican American populations, the white population has experienced the greatest increase in (about 7%). Regarding income, there has been an increase in the disparity of food qualities between high-income families and low-income families (3% disparity between 1989-1991 and 9% disparity between 2011-2014). Lower income families are more likely to consume energy-dense foods such as carbs and fats compared to nutrient-dense foods. ”

Diet Quality and its Effect on Maternity

Maternal complications have been linked to poor diet quality. Poor quality nutrition can create problems preconception, during pregnancy, and during postnatal periods. These complications include gestational diabetes, hypertension, and postpartum depression. In-utero malnutrition can be defined as either inadequate nutrients or excess of nutrients. In-utero malnutrition can lead to complications for the child that include fetal growth restriction, low/high birth weight, obesity, as well as increased risk of chronic disease in the child.

Food deserts are a lack of spatial accessibility to adequate nutrition. This phenomena is exacerbated by deprived economic and sociocultural conditions. Although the number of low-access food areas has decreased to 5.6% since 2010, an increase in low-income areas since then, 5%, has made the net percent of population in low-income/low-access areas has increased to 5.96%.

Professional Opinion?

There is an abundant need for access to higher quality foods, especially for low- and middle- income families as well as black and non-white hispanic populations Research standards for low-income and marginalized communities are outdated and should be updated to reflect more unbiased observations -F. Michael

Exercise

Exercise and fitness has historically been found to be lower in lower-income communities and higher in high-income communities. However, this has recently been disputed as new studies suggest that past research has failed to fully encompass the different types of exercise that are accessible. In 56-study combined cross-analysis, it was found that out of the four categories of physical activity (transportation, occupational, housing, and leisure time physical activity), only leisure time physical activity showed a directly proportional correlation to socioeconomic status.

Efforts

Education is one of the most powerful forms of change for communities. Already, activists are educating lower income and racially marginalized communities about how important nutrition is to out own health. Many groups are forming programs built around the dietary customs of different cultural groups as well. 76

Patetta, M.A., Pedraza, L.S. & Popkin, B.M. Improvements in the nutritional quality of US young adults based on food sources and socioeconomic status between 1989–1991 and 2011–2014. Nutr J 18, 32 (2019). https://doi.org/10.1186/s12937-019-0460-4 eierlein, A. L., Ghassabian, A., Kahn, L. G., Afanasyeva, Y., Mehta-Lee, S. S., Brubaker, S. G., & Trasande, L. (2021). Dietary Quality and Sociodemographic and Health Behavior Characteristics Among Pregnant Women Participating in the New York University Children's Health and Environment Study. Frontiers in nutrition, 8, 639425. https://doi.org/10.3389/fnut.2021.639425

Aubuchon-Endsley NL, Kennedy TS, Gilchrist M, Thomas DG, Grant S. Relationships among Socioeconomic Status, Dietary Intake, and Stress in Breastfeeding Women. J Acad Nutr Diet. 2015 Jun;115(6):939-46.e1. doi: 10.1016/j.jand.2014.12.017. Epub 2015 Feb 14. PMID: 25687029. Jin, H., & Lu, Y. (2021). SAR-Gi*: Taking a spatial approach to understand food deserts and food swamps. Applied Geography, 134, 102529. https://doi.org/10.1016/j.apgeog.2021.102529

Wang, Y., & Chen, X. (2011). How Much of Racial/Ethnic Disparities in Dietary Intakes, Exercise, and Weight Status Can Be Explained by Nutrition- and Health-Related Psychosocial Factors and Socioeconomic Status among US Adults? Journal of the American Dietetic Association, 111(12), 1904–1911. https://doi.org/10.1016/j.jada.2011.09.036 Stalsberg, R., & Pedersen, A. V. (2018). Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?. International journal of environmental research and public health, 15(5), 922. https://doi.org/10.3390/ijerph15050922 http://www.facebook.com/pages/Food-Empowerment-Project/9151801106. Food Deserts* - Food Empowerment Project. Food Empowerment Project. Published 2021. Accessed April 12, 2022. https://foodispower.org/access-health/food-deserts/

Mental Health Treatment in Areas of Low Socioeconomic Status

By: Gabriella Gmyrek By: Gabriella Gmyrek

Why is it an IGCH issue?

The reason that the effect of socioeconomic status on mental health is a global health issue is that the challenges that members of different socioeconomic statuses face and their access to treatment greatly affect their mental health outcomes. For members of less financially secure communities, the struggles are even greater and the opportunities for treatment are much lower Mental health can have a physical effect on your health. Depression has been linked to causing side effects such as headaches, digestive disorders, and fatigue while anxiety has been linked to an increased risk of hypertension, insomnia, and nausea among other issues. On a general health level, the effect of our minds is quite large.

Efforts and Solutions?

Who Is Affected?

Mental health affects every individual, but in this case, most of the research found will be aimed toward individuals that are in or were raised in more challenging socioeconomic situations. The reason is that individuals growing up with fewer resources have a higher likelihood of developing stress-related disorders and depression. For those members of the community that are in poorer-quality housing, there was a marked increase in feelings of distress, and those growing up in areas with poorer school funding were found to have higher rates of developing mental health issues. “the prevalence of severe mental health problems was around three times higher among children in the bottom quintile of family income than among those in the top quintile”

Many organizations have been trying to help aid members of low-income communities in obtaining access to mental health treatment and care. Unfortunately, this is mostly done on a smaller scale or volunteer basis. However, in many cases, it is up to the individual PCPs to take on the role of both counselor and psychiatrist. Overall, there need to be services put in place to increase the presence and affordability of psychologists, psychiatrists, and counselors in these underserved communities. Moreover, there needs to be a concrete plan to be increased funding to allow better mental health programs within title-1 schools.

Professional Opinion

In my opinion, there needs to be more done starting at a younger age to help children in impoverished communities to have greater access to mental health support growing up. Additionally, there need to be more programs that work to help connect members of underserved communities with mental health professional -G. Gmyrek

Background

SES is a known factor that affects not only people's lifestyles, but also determines their abilities to age in a healthy manner. Various studies indicate that lower SES is associated with worse health outcomes for reasons such as how it influences patient health literacy and overall physician-patient communication.

Health Literacy and Language Barriers

According to the Centers for Disease Control and Prevention, health literacy is the degree to which individuals have the ability to find, understand and use information and services to make health based decisions and actions. Studies show that low SES has a strong correlation with lower levels of education and poor health literacy. As a result, patients with lower SES are more susceptible to poorer health outcomes. In addition, one major issue that is created when healthcare is taken among cultures is difficulty in communication due to language barriers. It has been determined that language barriers contribute to reducing patient and medical provider satisfaction by diminishing the quality of healthcare provided. A person with less education and cultural experience may be less knowledgeable about medical terminology or lack the ability to understand another person speaking a different language. Health literacy and language barriers related to SES are global health issues because they affect everyone around the world that is restricted by communication difficulties in healthcare. Those Affected

Graph obtained from blogs.worldbank.org

The people who are most affected are those of low SES around the world; it is predicted that nearly 700 million people live in extreme poverty as of 2021.

Efforts Made

The U.S. department of Health and Human Services released the National Action Plan to Improve Health Literacy. The plan consists of 7 goals that promote changes in the healthcare system by making health and safety information more available and supporting local efforts to provide adult education.

There are many steps that can be taken to improve patient perception, which include:

- Providers can lead with a language the patient understands by using effective communication skills

- Providers can encourage transparency

- Providers can have the same enthusiasm and approach to patients regardless of patients’ SES and attitude towards consultations

Patient Perception

Patient perception focuses on the overall communicative interaction and experience that occurs between a patient and a physician. Studies have determined that patients with lower SES receive less positive socio-emotional utterances and a more directive and less participatory consulting style. In addition, these patients’ encounters were also detailed with less information giving and less directions. The connection between patient perception and low SES is associated with the communicative relationship between a patient and a physician; patients from higher SES tend to communicate more actively and show more effective expression which elicits more information from the physician and therefore increases the quality of care provided. In contrast, patients with lower SES often receive less information from their physicians because of the physicians’ misperceptions of the patients' desires and needs for information in connection with their abilities to partake in the care process. Opinion: Many studies have shown the negative impact SES can have on patients' health outcomes. Factors such as health literacy, language barriers and patient perception all become issues when connected with low SES. More action needs to be taken to improve the healthcare provided to patients of low SES to ensure their health is well taken care of, especially because this affects a large population worldwide. ~S. Tofilska