HSS1101E Determinants of Health

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HSS1101E Determinants of Health
Prof. Raywat Deonandan

• Mondays, 230-400
• Thursdays, 400-530
• Marion Hall auditorium

Jan 9, 2009 Introduction to the Class
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• There is no textbook for this class. All
  readings may be downloaded for free from the
  class website. Some readings are found online
  (check course outline for details)
• classes.deonandan.com/hss1101
• course outline
• powerpoint slides
• Readings
• important announcements

Textbook Website
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Professor Dr Raywat Deonandan 43 Templeton,
Room 111 613-562-5800 x8377 ray_at_deonandan.
com Office hours Thursdays 10AM
3PM Teaching Assistant TBA
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Evaluation
Details forthcoming
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Rules of Engagement

• You do not have to come to class. If you dont
  want to be here, dont be here.
• If you do decide to come to class, shut up and
  pay attention.
• Slides are posted on the website as a courtesy,
  not a requirement, and may not cover everything
  that is presented. So take notes!
• If you miss class, you are responsible for
  finding out what was presented.

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Rules of Engagement

• This class is taught entirely in English, but
  assignments and exams may be written in either
  English or French
• If you request that I re-mark any given question
  on an exam, I will re-mark the entire exam. My
  new mark supercedes the previous mark, whether it
  is lower or higher.

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Rules of Engagement

• Missed exams are tolerated only in extreme
  situations, requiring documentation (e.g.,
  medical certificate)
• Similarly, extensions on the written assignment
  will not be granted, except for extreme dire
  circumstances, also requiring documentation.
• The university takes academic fraud very
  seriously. At the slightest suspicion of
  plagiarism or cheating, I must report the
  incident to the Dean.

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The Definition of Health

• A state of complete physical, mental and social
  well-being and not merely the absence of disease
  or infirmity. WHO

• Health was widened to include social and
  psychological dimension
• What is a state of complete physical, mental and
  social well-being ?
• "I learned that health was to be had at a certain
  cost.... Thus I am now better than I was, but not
  happier. Sigmund Freud

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What Are Determinants of Health?
Genetics loads the gun, but the environment
pulls the trigger. -Dr. Judith Sen,
University of California, Davis
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Is This The Whole Story?
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Breast Cancer

• Breast cancer risk is highest among women whose
  blood relatives have the disease
• 2/3 of invasive breast cancer cases are diagnosed
  at age 55 or above
• White women are more likely to be diagnosed than
  are Black women
• Black women with breast cancer are more likely to
  be diagnosed at age 35 or younger
• Breast cancer among Black women is 10X more
  likely to be untreatable than among White women
• Black women are less likely than White women to
  receive regular medical care

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Breast Cancer

• Breast cancer is associated with higher levels of
  estrogen

• Higher levels of estrogen are associated with
• earlier puberty
• having children later in life
• Taking fertility drugs
• having no children at all
• hormone replacement therapy
• drinking alcohol

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So What Are the Determinants of Health Associated
with Breast Cancer?

• Gender
• Age
• Genetics
• Race
• Reproductive history
• Medical treatment history
• Socioeconomic status

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So What Are the Determinants of Health Associated
with Breast Cancer?

• Gender
• Age
• Genetics
• Race
• Reproductive history
• Medical treatment history
• Socioeconomic status
• Geography

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So What Are the Determinants of Health Associated
with Breast Cancer?

• Gender
• Age
• Genetics
• Race
• Reproductive history
• Medical treatment history
• Socioeconomic status
• Geography
• Environmental toxins?

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Anything Else to Add to the List?

• Gender
• Age
• Genetics
• Race
• Reproductive history
• Medical treatment history
• Socioeconomic status
• Geography
• Environmental toxins?

• Political environment?
• Medical practice?

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Is this model still sufficient?
NO!
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Why Do We Study Determinants of Health?

• To improve health, we must know what to improve
• We can better direct limited resources
• E.g., a childless woman on HRT is at heightened
  risk for breast cancer, so we can be alert to her
  symptoms

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Question

• We have had a functional treatment for HIV
  (anti-retroviral cocktail) since 1996. Why is
  there still am HIV/AIDS crisis in the world?

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Even if we made AIDS drugs dirt cheap, would
this solve the problem?

• Bill Clinton "90 of HIV positive people in the
  developing world are unaware of their disease
  status.
• Bill Gates "The capacity to treat AIDS is not
  so much gated by access to drugs as it is by the
  availability of trained personnel."

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Determinants of Health of HIV/AIDS

• Gender
• Wealth
• Geography
• Accessibility
• Education
• Political environment
• Poverty
• Insecurity
• Co-morbidities
• Poor infrastructure
• Poor medical system
• Behaviour
• Occupation

How does each interact with drug accessibility?
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Are These Determinants?

• Road quality
• Telephone system
• Diet
• Government emission standards
• Health insurance
• Daycare
• Free public education
• Social networks
• Coping skills
• Your office chair
• Free trade agreements

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In This Class

• We will examine determinants of health in 4
  Modules

• Health, illness disease
• Biology, behaviour and support
• Gender, ethnicity, SES and work
• Politics and economy

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Next Week

• We will continue with our discussion of defining
  health and its determinants
• Do the readings indicated on the course outline