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NASW New Mexico From the Roots of Social Work

NASW New Mexico From the Roots of Social Work. How Health Disparities Affect Life Course Nanette Concotelli Fisk LISW Phyllis Shingle LMSW Debra Sugar LICSW February 20, 2014. Objectives. Participants will become more familiar with the Life Course Model

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NASW New Mexico From the Roots of Social Work

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  1. NASW New Mexico From the Roots of Social Work How Health Disparities Affect Life Course Nanette Concotelli Fisk LISW Phyllis Shingle LMSW Debra Sugar LICSW February 20, 2014

  2. Objectives • Participants will become more familiar with the Life Course Model • Participants will develop a critical understanding of disparities in birth outcomes and how these disparities result from differences in protective and risk factors between groups of people over the course of their lives. • Participants will be able to apply the Life Course Model to their professional work and consider potential actions for advocacy.

  3. Health Equity Quiz • Children living in poverty are how many times more likely to have poor health, compared with children living in high-income households? a. 2 times b. 4 times c. 5 times d. 7 times e. 10 times

  4. Health Equity Quiz 2. On average, which of the following is the best predictor of one’s health? a. Whether or not you smoke b. What you eat c. Whether or not you are wealthy d. Whether or not you have health insurance e. How often you exercise

  5. Health Equity Quiz 3. Chronic stress increases the risk of all of the following, except: a. Hypertension b. Obesity c. Sickle cell anemia d. Preterm birth e. Diabetes

  6. Health Equity Quiz 4.True or False? The gap between white and African American infant mortality rates is greater today than it was in 1950. a. True b. False

  7. Health Equity Quiz 5.The child poverty rate in Norway is 3.4%, France 7.5%, Hungary 8.8%, and Greece 12.4%. What is it in the U.S.? a. 4.1% b. 8.6% c. 12.8% d. 22.0% e. 32.4%

  8. What Does This Mean? Wealth, Poverty, Race, and Chronic Stress Matter!

  9. Health Disparities (Birth Outcomes) • From the 1970s –2000 the perceived solution to health disparities was to improve health care • Better/more accessible prenatal care • Better/more accessible neonatal care • Governmental and private actions improved prenatal care rates and decreased disparities in health care, • But birth outcomes worsened & disparities increased • “You can’t cure a lifetime of ills in nine months of a pregnancy” (Milton Kotelchuck)

  10. Health and Wellness • Clinical care should go beyond the clinic • Socio-economic-environmental inequities that lead to health inequities have to be addressed to impact health

  11. Diabetes, Hypertension, Obesity An Event Early in Life, Fetal Malnutrition • Produces change in the endocrine system • Endocrine system modified in response to environment • Impaired glucose tolerance • Changes in fat and carbohydrate metabolism • Results in increased risk of diabetes, heart disease, hypertension, obesity later in life • Altered glucose metabolism is associated with malnutrition

  12. Asthma • Exposure to allergen at a critical developmental period in a genetically susceptible individual may result in wheezing in infancy • If exposure is repeated over time = life long asthma • External factors influence whether someone has asthma • Risk factors: Poor pest control, poor access to health care • Protective factors: breast feeding, behavioral and educational interventions, good health care

  13. Heart Disease • Family stress and conflict has been shown to dysregulate the bio-behavioral pathways – autonomic nervous system, hypothalamic/pituitary and limbic system • Early childhood stress (cortisol) in turn may predispose the individual to heart disease

  14. Mental Health Maternal depression causes: • Reduced emotions • Decreased attention to infant • Failure to respond to infant’s emotional signals Leading to: • Shorter attention span • Increased HR & cortisol levels, changing the set point of the child’s response to stress • Negative impact on child’s cognition

  15. School Readiness • Exposure to violence, poor nutrition, social isolation – all may negatively impact a child’s readiness for school • Prompt and effective treatment for parental depression and education/support to enhance the mother-child relationship • Translates to ready for learning • Translates to ready to work

  16. Life Course http://www.cmhnetwork.org/news/science-of-neglect

  17. What is the Life Course Model? The Life Course Model suggests that a complex interplay of • biological, • behavioral, • psychological, and • social protective and risk factors contributes to health outcomes across the span of a person’s life.

  18. Life Course Development Life course development provides a framework to understand how multiple determinants of health interact across the life span and across generations to produce health outcomes. Halfon 2007

  19. Life Course Perspective Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal Child Health J. 2003;7:13-30. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal Child Health J. 2003;7:13-30.

  20. Risk Factors Protective Factors Graphic Concept Adapted from Neal Halfon, UCLA

  21. Key Concepts of the Life Course Model • Today’s experiences and exposures determine tomorrow’s health • Health trajectories are particularly affected during critical or sensitive periods • The broader environment – biologic, physical, and social – strongly affects the capacity to be healthy • Inequality in health reflects more than genetics and personal choice Amy Fine, Milt Kotelchuck, 2009

  22. Life Course Model Four core concepts: • Timeline • Timing • Environment • Equity

  23. Core Concepts of Life Course Model • Timeline conveys movement along a continuum and cumulative impacts over time. • Timing reflects the importance of the earliest experiences and exposures and of critical periods throughout life. • Environment recognizes the importance of family and community in shaping health, including the physical, social, and economic environment in which people live, grow and develop. • Equity refers to the importance of addressing disparities in health and development across populations.

  24. Critical Aspects of the Definition • Health as a positive construct • Emphasizes DEVELOPMENT and long term implications • Interactions between the child and environment • Acknowledges that multiple influences interact with biology over time

  25. MCH Life Course Model

  26. So What is the Problem? Medical model is deeply embedded • We may understand that environment and behavior affect health, but look at our health care system • Payment schemes, institutions, diagnoses, training all focus on providing discrete services to individuals

  27. Summary A person's health takes on a trajectory that results from cumulative influences of multiple risk and protective factors that are programmed into an individual's bio behavioral regulatory systems during critical and sensitive time periods in development.

  28. The Life Course Game: A Simulation Experience

  29. Debriefing the Game • What events occurred during the game? • What comments did you hear as you were playing the game? • What facts were presented in the game about life and health? • What events in the game reminded you of something from your own life? • If you were in the lead in the game, how did that make you feel? • If you were falling behind, how did that make you feel?

  30. Professional Perspective • What aspects of the game reminded you of issues you have experienced in your work? • How did cultural factors (additional factors cards) impact different aspects of the game? • As you played the game, what challenges specific to New Mexico did you encounter?

  31. Next Steps • How can you apply the Life Course Perspective in your day-to-day work? • How can you share the Life Course Perspective with colleagues? • How would you use the Life Course Game?

  32. Questions?

  33. References Brosco, J.P. (2010, October 31). Historical and scientific basis of the life course model. Anything new here? AUCD. Washington, D.C. http://www.aucd.org/template/session_event.cfm?session_event_id=157 Halfon, N., Russ, S. & Regalado, M. (2005). The life course health development model: A guide to children’s health care policy and practice. Zero to Three, 25(3):4-12. HRSA-MCHB. (n.d.). The Life Course Approach. http://www.mchb.hrsa.gov/lifecourseresources.htm IOM-NRC Child Health Report. (2004, June 24). Children’s health, the nation’s wealth. Assessing and improving child health. http://iom.edu/Reports/2004/Childrens-Health-the-Nations-Wealth-Assessing-and-Improving-Child-Health.aspx Kavanaugh, L., et.al (2010, September 10). Integrating the life course model into MCH training programs. Webinar presentation. DRTE, MCHB, HRSA. http://webcast.hrsa.gov/postevents/archivedWebcastDetail.asp?aeid=527 Le Veist, Thomas http://www.jhsph.edu/faculty/profile/3721/LaVeist/Thomas_A Lu MC, Halfon N. (2003) Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal Child Health J, 7:13-30. Shonkoff, JP (n.d.). A theory of change: build adult capabilities and improve child outcomes. Center on the Developing Child. http://developingchild.harvard.edu/resources/multimedia/videos/theory_of_change

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