Social Determinants of Health and the Promotion of Quality Health Care
SHORT ESSAYS ON READINGS
For each reading listed below, write an essay of ~750 words (maximum 1000 words) summarizing the reading. Your response paper should include: 1) the main message of the reading, 2) an overview/explanation of the biological concepts being described (e.g., underlying biological mechanisms of the public health problem), and 3) the scope of the public health problem, including 1 – 2 sentences on outlook (i.e., implications for further research, intervention, or public health policy). The use of 2 – 3 outside sources to support your points is required and you MUST reference all sources – using AMA format (superscripted numbers in-text and then the list of corresponding numbered references at the end of the text).
Example for how to reference articles in your papers:
Within the text (superscripted number): Maternal diet, both prior to conception and during pregnancy, plays an important role in the immediate and long-term health of the mother and her offspring.1
Numbered reference list at end of text:
1. Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359(1):61-73.
Due dates are listed in the class schedule (below). Each essay will count for 10% of the final grade.
Papers must be submitted using Brightspace.
Readings for Short Essays (PDFs are available on course site)
• Reading 1: Powell-Wiley TM, Baumer Y, Baah FO, et al. Social Determinants of Cardiovascular Disease. Circ Res. 2022;130(5):782-799.
doi:10.1161/CIRCRESAHA.121.319811
Short Essays on Readings
Student’s Name
University Affiliation
Professor’s Name
Course Title
Due Date
Scope of public health problem
Social determinants of health (SDOH) including environmental, psychological, and economic components determine the incidence and prevalence of cardiovascular disease (CVD). The morbidity and mortality rates in the U.S have continued to add to the numbers over the years, partly due to the prevalence of CVD. Obesity and the widening health gap between the privileged and minorities continue to cause a sharp increase in the incidence of CVDs.1 SDOH significantly affects disease incidence and health outcomes, especially for CVD patients. Marginalized groups such as ethnic minorities, the elderly, the chronically ill, the LGBTQ community and those with low Social Economic Status (SES) face healthcare discrimination.
Overview of Biological Concepts
Environmental and psychosocial stressors have long-term effects which alter the biological mechanisms leading to the development of CVD. Psychological stress over a long time activates the sympatho-adrenomedullary (SAM) axis and hypothalamic-pituitary-adrenal (HPA) axis which are part of the sympathetic nervous system (SNS).1 Activation of SAM and HPA axis stimulates the release of stress hormones, including cortisol, catecholamines, and adrenocorticotropic hormone resulting in elevated inflammation. Impaired hormonal regulation has been linked to people facing depression, discrimination, and those living in poor neighborhoods. Chronic activation of the SNS leads to resistance of the glucocorticoid receptor leading to poor sensitivity to anti-inflammatory treatment, hence the progression of CVD.
Increased markers of inflammation have been linked to people living in areas with environmental stressors. Low SES is linked to high levels of C-reactive protein (CRP) and IL-6. A study revealed that exposure to low SES during childhood led to elevated CRP levels later in life.2 Poverty, discrimination, and psychosocial stressors have been linked to high levels of inflammatory cytokines. SDoH affects the functioning of immune cells impairing proliferation and clonal hemopoiesis in the spleen and bone marrow. A study conducted on mouse models of atherosclerosis showed high metabolism in the bone marrow due to stem cell multiplication and clonal hematopoiesis leading to inflammation and CVD.3 Chronic exposure to low SES hastens aging as a result of inflammation, shortening...