- health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health.
- these include early years' experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health.
- we are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies
- what is the range of sexual practices, and in what contexts do they occur? Heterosexual? Same-sex? With migrant workers?
- which is riskiest for HIV transmission: multiple or single partners?
- what types of partners are there, and are risk situations different by type of partner?
- are there situations where sex is forced, or necessary for survival?
- what are the gender rules and relationships that are involved? Can one partner, for example, easily communicate to the other about HIV risk and prevention? Or will this be difficult?
- who are the users of injection drugs?
- do people inject in a public setting, with others, or by themselves?
- is sharing of equipment common or necessary? How is this done?
- do injection drug users know about HIV risks? Are they able to take precautions, or does addiction override such attempts?
- what are the treatment and prevention options? Are there, for example, needle exchange programs? Drug treatment programs?
- individual factors (genetics, taste/food preferences, attitudes, beliefs, knowledge, hunger)
- social factors (interpersonal processes, relationships, social status)
- cultural factors (shared beliefs/values related to food, the body, eating practices)
- physical environment (availability/cost of food or exercise options, physical layout of environment)
○ Individual approaches
● Perceived barriers include:
○ Concern that they won't understand needs or practices of minority culture, family, traditional use of herb medicinals, etc.
○ Physical difficulties (i.e., lack of transportation)
○ Language - health provider doesn't understand patient's language
■ Individual must intend to change behavior, believe there's a positive/valued outcome to changing that behavior, and believe that they're capable of making the behavior change
○ Social, community, and group approaches
■ Community mobilization & advocacy - increases general minority community capacity and empowerment
● Recommended by CDC for tobacco intervention
● Changes in policy and improved access to healthcare facilities can result from this strategy
■ Social marketing/mass media and communications campaigns - focus on disseminating info. to people and maximizing the likelihood that people in a target pop. will adopt healthy behaviors
○ Multilevel programs
■ CDC REACH focuses on linkage among community organizational capacity, targeted action, knowledge and behavior change, and improved health outcomes
■ THRIVE program focuses on building resilient communities
● Based on 4 factors in communities to be strengthened:
○ Social capital
○ Services and institutions
○ Structural factors
○ Organizational theory
■ Focus is on putting pieces together at a local, regional, state, or national level - integrating components that will improve racial/ethnic minority health status
○ Clear purpose
○ Committed leadership to keep the organization on track
○ Collaborations that include the participation of all levels of the system, including both public and private