Kine Kine Which agency is a leading medical research center, and the federal focal point for medical research in the United States?
The emphasis in such discussions on the organization and financing of health care is understandable given that health care consumes Access to and quality of health care has been estimated to account for only about 10—20 percent of premature mortality in the United States.
Genetic vulnerabilities account for another 30—40 percent. The remaining determinants, accounting for the largest proportion of lost years of life, involve behavioral and social factors and environmental exposures. It provides evidence-based analysis and data on a wide range of the social and economic characteristics of its 34 member nations.
Despite this, of the 34 OECD nations, the United States ranked 31st in infant mortality, 25th in male life expectancy, and 27th in female life expectancy. A recent study of 30 OECD countries examined the association of five different health indicators with expenditures on both Factors affecting community health essay care and social services including housing.
Given the comparatively greater contribution to health of behavioral and social conditions than of health care, it is not surprising that expenditures on social programs appear to yield better health returns than do equivalent expenditures on medical care.
The analysis of spending by OECD countries suggests that investments in housing along with other social spending are associated with improvements in health. This interpretation is consistent with findings from a number of U.
However, although it follows that community development investments should yield health benefits, this has not yet been well established. Empirical demonstrations of the health impact of community development would be helpful for a number of reasons.
Such demonstrations could provide added impetus for future projects and garner greater public and governmental support. In addition to these indirect benefits, empirical evidence of health care savings resulting from community development could potentially help fund these projects.
In new payment arrangements such as Accountable Care Organizations ACOsa group of health care providers agrees to share risk for the health care costs incurred by a designated population for which they have taken responsibility.
In return, they are offered a chance to share in the savings on expected costs for that population. Health systems operating as ACOs benefit financially if their designated populations stay healthier and require fewer services.
The ability to reward community developers for savings in health care costs will depend on the ability to quantify such savings. It is too early to provide an explicit formula for doing this, but not too early to begin the conversation on how to do so. Research Design The debate will likely be about what evidence is sufficient to conclude that there has been a health benefit from a given project.
Among health researchers, the gold standard for demonstrating causality is the randomized clinical trial RCTbut many feel that reliance on RCTs is too limiting.
When individuals are assigned at random to an experimental or control condition, there is less worry that the differences following treatment are due to pre-existing differences among individuals or to aspects of the research experience unrelated to the treatment itself.
RCTs are expensive and challenging. A double-blind RCT at the social level is impossible; even randomization to group has formidable barriers. Despite this, randomized trials of social programs have been done. One example is Oportunidades, which involved the most impoverished segment of the entire Mexican population.
Families below an income cut-off were randomized by community to participate in an income supplement program tied to incentives for health-promoting behaviors or to a control condition that delayed the start of the program.
Another example is Moving to Opportunity, which randomly assigned residents of housing projects in several U. Specifically, moving to a better neighborhood led to lower rates of extreme obesity and diabetes, psychological distress, and major depression.
The strongest quasi-experimental designs use a well-matched comparison group, measured along with the treated group before and after a treatment. This design helps rule out preexisting differences in the treatment and comparison groups as a reason for different outcomes following the intervention.
Weaker designs examine change from pre- to post-intervention only in the treated group or obtain measures on both groups only after the intervention. There are obvious trade-offs in the difficulty and cost of implementing these designs versus the value of the resulting data.
Health Measures Beyond the designs for evaluation, it is critical to consider when and how health effects should be measured. Unless the outcome measures are well matched to the expected benefits, evaluators may fail to detect positive results.
A community development project could, for example, help delay or prevent the onset of cancer, cardiovascular disease, or diabetes, but these conditions take a number of years to develop, and benefits of the project may not be immediately measureable.
This may lead to an erroneous conclusion that the project had no effect on health. Several strategies can address this problem. One is to focus on conditions e. A third option is to look for risk factors that may appear before actual disease emerges and that can capture effects within a more reasonable time frame.
|At a Glance||The determinants of health Introduction Many factors combine together to affect the health of individuals and communities.|
In addition to considering how a project may affect a specific disease or condition, global assessment of health status may provide a more sensitive indicator of benefits and better capture cumulative effects of community improvement.
Community development projects are likely to affect a range of health problems, whereas their effects on any one disease may be relatively rare in a given time period and hard to detect.
Therefore an overall measure of health will be more informative. Each of these conditions not only has implications for health care costs but also translates into costs associated with lack of productivity in the workplace and with need for care at home.
Data Sources Although some measures of the health effects of community development will require new, targeted data collection, evidence of health impact may also be found in existing data.Some topics that might have an affect include the lifelong importance of health determinants in early childhood, and the effects of poverty, drugs, working conditions, unemployment, social support, good food and transport policy.
Among the cultural factors affecting social change in modern times, the development of science and secularisation of thought have contributed a lot to the development of the critical and innovative character of the modern outlook.
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Sociological factors: These refer to the ever changing social trends in the markets, in which the company operates, culture norms, and expectations, health consciousness, population growth rate, age distribution, career attitudes, emphasis on safety and global warming.
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