The social and structural determinants play a significant role in community health, and differences in the experience of these factors facilitate some of the health disparities that are seen in the US along racial and socioeconomic lines. In this manuscript, I propose a conceptual model of the social determinants of health hierarchy and discuss the positioning of the structural determinants of the built environment within that hierarchy. I discuss the research connecting some of the structural determinants to health outcomes. Finally, I review several opportunities for local government to alter the built environment in ways that can promote community health and mitigate health inequity. / Urban Bioethics

In this paper, I explore the relationship between academic medical centers and the local school districts in which they are situated within the context of what I experienced as a medical student working in an education non-profit. This analysis is intended to arrive at actionable reccomendations for the non-profit, RISE, with the end goal of transforming the organization into one in line with the principles of urban bioethics. The hope is that applying what I learned in the classroom, in the Urban Bioethics master’s degree program, will improve the success of RISE in its adaptation by the community and result in greater impact on education and mentorship of our students. First, in the introduction, I will describe the general healthcare landscape in the United States and how education is viewed by the healthcare system. I will also discuss in the introduction my personal experience as a medical student at Temple in Philadelphia and my exposure to the school district that led me to be involved with the education non-profit. Second, I demonstrate that education is a key social determinant of health by exploring the literature and research that supports this notion. Third, I explore the economic and political context that I believe foreshadows greater investment in education from academic health centers. Fourth, I describe the Philadelphia RISE educational organization and its current status of operations. Fifth, I consider Temple’s strategy in community engagement as a veteran role model for the fledgling non-profit. Sixth, I discuss the role of urban bioethics in shaping my ultimate recommendations to the non-profit. Seventh (and finally), I articulate the recommendations, which will most notably alter the leadership structure to incorporate community stakeholders. / Urban Bioethics

Data consistently shows that firearm violence affects minority populations disproportionately. In the 1970s, firearm injury related death was the 13th leading cause of death in America. The problem has only worsened, costing the US economy almost $230 million a year and is now the second-leading cause of injury related death. Gun violence should be considered a public health crisis given its costs in terms of morbidity, mortality, and economics, but also can be considered a social determinant of health as it contributes significantly to minority populations’ medical histories and health outcomes. Homicide is the leading cause of death in Black males between the ages of 15 and 34, with 91% of these deaths being the result of firearm injury. However, the way gun violence is portrayed in the media inaccurately generalizes White populations fulfilling the victim role while Black populations in the criminal role. The media considers shootings involving Black populations as “commonplace,” and therefore these incidents receive less attention from media sources. The constant impact of firearm violence places on healthcare providers is also significant, as the incidence of post-traumatic stress disorder is three times higher for trauma surgeons than the general population. Many healthcare organizations have recognized the devastating impact of firearm injury by coming out with position statements, developing patient education and advocacy resources, and community engagement initiatives to help support populations most affected. While more is to be learned in terms of research about the impact of this public health issue, we need to take a multifaceted approach to work towards equitable care for our most vulnerable populations. / Urban Bioethics

ABSTRACT Despite changing demographics, policy, technology, and economics; medical education curriculum has changed very little from its inception over 100 years ago. The United States medical system has been under scrutiny for delivery of affordable, quality and accessible care for years. In order to address these challenges, we need to train physicians to consider these criteria when treating patients. A way to do this is through a curriculum that includes Health Systems Science (HSS). The challenge of HSS is that it adds additional topics and competencies to an already full medical education curriculum. In order to move forward in medical school, students are tested on their knowledge of basic science. Because HSS topics are not included in the required testing, students who have not been exposed to an HSS curriculum perceive HSS topics as less valuable than traditional medical school topics. This research sought to understand if students changed their perception of the value of HSS after exposure to an HSS curriculum. First-year medical students from a large, urban medical school were surveyed using a pre-test and post-test survey before and after exposure to an HSS curriculum. This study was conducted with two cohorts over two years to see if there was a change in student perceptions of HSS. An Institutional Cycle design was applied to compare the post-test from the students in cycle 1 to the pre-test of students in cycle 2. This approach was deployed for two reasons. The first because of restrictions placed on the data collection; the pre-test for each person could not be directly linked to the post-test. The second, because there was no way to create a control group. These cohorts could not be randomly assigned to another curriculum. Comparing the post-test of Cohort 1 to the pre-test of Cohort 2 allows for the analysis of change between the two cohorts. Student perceptions did not change significantly between the pre-test in cycle 2 and the post-test in cycle 1. More research is needed to provide guidance for the development of an HSS curriculum that aligns with traditional medical education components. / Educational Administration

This study explores the influence of chronic stress in college students. It focuses on the broader chronic stressors that college students experience related to physical and mental health, financial health and wellbeing, and presence of social supports, then addresses the more specific chronic stressors related to intersecting identities of race, ethnicity, gender, and sexual orientation. This phenomenon is analyzed under the theoretical frameworks of social determinants of health, intersectionality, and systems theory. An online survey with both open and closed-ended questions was conducted with undergraduate social work students from the Bachelors of Social Work program at the University of Central Florida. The results of the study found that there was links between intersecting identities of participants with higher levels of chronic stress based on their chronic stress scores and participant responses on the influence of their identities on barriers to their physical, mental, and financial health.

Despite the development of an Aboriginal Healing and Wellness Strategy (AHWS), which implemented Aboriginal Health Access Centres (AHACs) to provide integrated healthcare including both mainstream and traditional services, health inequalities persist among the urban Aboriginal population in Ontario. There are multiple social determinants of health (SDOH) besides access to healthcare that affect Aboriginal health. The objectives of this study were to describe the past and current policy strategies to address Aboriginal health in Ontario, and to investigate the ways that service providers perceive health inequalities, demonstrating whether the SDOH are considered in service provision to urban Aboriginal clients. In addition to a document review, interviews were held with representatives from three provincial ministries involved with the AHWS. Through a community engagement research strategy, nine semi-structured interviews were conducted with service providers from various departments within an urban AHAC. Interviews were analyzed using a modified grounded theory, which was guided by the SDOH framework. In understanding policy development, themes included: collaboration with Aboriginal communities and improving access to holistic care. In approaching service provision, themes included: perceived health inequalities and their determinants, what is being done and what must be done to address health inequalities and the use of the SDOH framework in practice. Findings suggest that service providers accurately identify the health needs of their clients, and utilize the SDOH to understand the causes of inequalities, however the SDOH cannot be fully addressed at the service provision level. The SDOH framework must be utilized at the policy level, in order to effectively address the wider determinants of health through intersectoral collaboration between provincial ministries and Aboriginal communities. / Thesis / Master of Arts (MA)

Even if child mortality has decreased significantly since 1990, it is still a substantial issue that is prevalent all over the world. Regional differences are significant, and Sub-Saharan Africa is the most affected area. Traditionally, researchers have turned to the medical field for health-related issues. However, social, and structural factors, among them gender inequality, are also crucial in determining health and life conditions. The purpose of this thesis was to investigate how intrahousehold gender inequality affects child mortality in Sierra Leone. The study was made through a cross-sectional study using data from the Sierra Leone Demographic Health Survey. A quantitative method was used, and analysis was conducted using OLS regression. In contrast to previous research, the results do not show a significant covariation between maternal education and child mortality. Likewise, paternal education and the difference in education between men and women showed no significant covariation with child mortality. However, polygyny, the number of wives and the first event of intimate partner violence were positively associated with child mortality. More studies about gender inequality in relation to child mortality should be conducted to strengthen the results and increase the knowledge and understanding of this subject.

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The psychosocial implications of chronic illnesses (CIs) are an apparent issue as exemplified through the extensive literature put forth on the matter. However, the primary focus of this literature is typically the aging population, and researchers have given less consideration to the experiences of youth. At this point in their life, young adults are already experiencing self-discovery, pursuing anticipated milestones, and defining one’s worth/purpose, therefore, being diagnosed and living with a CI only complicates these matters. Investigating how CIs impact young adults’ mental health (MH) is imperative when trying to understand the various intersecting forces that influence one’s ability to achieve optimal health and well being. This research explores the psychosocial effect of receiving a CI diagnosis using a qualitative, interpretive phenomenological approach ( Van Menen’s viewpoint) in which 12 semi-structured interviews were conducted with university students. Interviews were recorded and transcribed for thematic analysis. Findings indicate that the onset of CIs among young adults adds/perpetuates various types of psychosocial distress, ultimately impacting one’s MH based on their exposure towards such stressors and ability to cope. Irrespective of individualized experiences, all participants unilaterally echoed the need for MH support post diagnosis. Such a finding warrants evaluation of the existing treatment and management of CIs, suggesting that interventions ought to be more holistically designed to include greater MH support. / Thesis / Master of Science (MSc)