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There is some evidence that water fluoridation has been particularly beneficial for communities of low socioeconomic status (National Research Council, 1993; Riley, Lennon, and Ellwood, 1999), perhaps attributable to their disproportionate burden and lower access to dental care. Evidence of the effectiveness of water fluoridation in reducing dental caries has led to other approaches to introduce fluoride, including the addition of fluoride in toothpastes and topical fluoride treatment by dental professionals. In more recent years, it has become clear that the nature of health services, rather than simply their presence, is important. The benefits of a strong primary care orientation are even more salutary for children than for adults .
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While his monograph demonstrates the important role of health services, it reinforces the simultaneous importance of other influences. Although few would debate the relevance of health services to improving individual health, many have actively debated the contribution of health services to the health of populations. Although there is increasing recognition of the effect of services in the behavioral and social arenas on health , evidence regarding specific outcomes of these programs is limited. There is evidence that these sources of stress are not limited to low-income populations but are experienced by groups with higher socioeconomic backgrounds as well (McAdoo, 1981; Tatum, 1987). One possibility is that of selection bias; that is, first-generation immigrants to the United States may be the healthiest and most motivated subset of potential immigrant families.
Improving the conditions in which we live, learn, work, and play and the quality of our relationships will create a healthier population, society, and workforce. Understanding the relationship between how population groups experience “place” and the impact of “place” on health is fundamental to the social determinants of health—including both social and physical determinants. The commission created the conceptual framework below that describes relationships among individual and structural variables. The framework represents relationships among variables that are based on scientific studies or substantial evidence. The framework provides a point from which researchers can take action, such as creating targeted interventions, on social determinants of health.
- And you may get others by consuming contaminated food or water or being exposed to organisms in the environment.
- Recognizing and integrating social factors that influence health-related behaviors and health status to develop more effective treatment plans.
- In addition to impacting health, negative social determinants that lead to disparities in health are costly and inhibit the overall quality of care and population health—resulting in added healthcare expenses, loss of productivity, and low testosterone premature death.
- According to the Kaiser Family Foundation, 30% of direct medical costs for blacks, Hispanics and Asian-Americans are excess costs and related to health inequities.
- Infectious diseases are disorders caused by organisms — such as bacteria, viruses, fungi or parasites.
In contrast, the medical literature is replete with reports of the effectiveness of specific biomedical interventions that influence the course of particular diseases. John Bunker has gone further and estimated that health services in general account for about half of improvements in health in the most recent half-century .
The medical and sanitary sciences have provided public health workers with specific measures for prevention of these diseases—vaccination, immunization, safe water and milk supplies, sanitary sewage disposal, and insect vector control. When properly utilized, these measures have protected people from the several communicable diseases.
But even in situations in which individuals do not avail themselves of these protective measures and contract a given disease, there are antibiotics and other chemotherapy agents that are specific and effective. No such specifics exist for preventing the chronic diseases, the degenerative conditions of old age, or accidents. By working to establish policies that positively influence social and economic conditions and those that support changes in individual behavior, we can improve health for large numbers of people in ways that can be sustained over time.
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The two primary publicly funded programs that provide health insurance for children—Medicaid and the State Child Health Insurance Program —require families to demonstrate initial and continuing financial eligibility. Implemented in the 1960s, Medicaid coverage increased dramatically during the 1980s and early 1990s as a result of major policy changes in laws that sought to expand Medicaid eligibility . Fluoridation of drinking water has contributed to reductions in dental caries in both children and adults , and the Centers for Disease Control and Prevention has highlighted water fluoridation as a significant public health achievement . Cross-sectional studies conducted in the mid-1900s showed water fluoridation to have an effect on dental caries and prompted policies to fluoridate water in many cities throughout the United States. A review of studies on the effectiveness of water fluoridation conducted in the United States between 1979 and 1989 found that caries were reduced between 8 and 37 percent among adolescents .