In the current healthcare landscape, parents generally make decisions regarding whether or not their children are allowed to take part in clinical research, with the general assumption being that parents know what is best for children. Investigations have been conducted regarding what is likely to lead parents to consent or not consent to their child’s participation in a trial, but research plans seldom incorporate the consideration that not all parents come into the consent process with equal social, academic, and economic footing. Since the burden of the ultimate decision lies primarily on the parents, it is supremely important that they are capable of making a well-informed and thoughtful choice. Bioethical understanding of the influence of parental decisions in clinical research must consider demographic variables and how they may affect parents’ decisions to allow or disallow their child to participate in a clinical trial. Those differences could affect the consent process and have ramifications for the research findings, as research results are affected in numerous ways by which children do, and do not, participate in studies. This paper looks specifically at parents in the process of informed consent for pediatric research, taking into account several social determinants of health and how they affect who participates in research and how that affects research as a whole. / Urban Bioethics

Personalized medicine is the idea that every patient can be treated in a unique manner, tailored specifically to his or her individual needs. Traditionally the field of personalized medicine has focused on using genetic information to determine medical treatment. However, humans are not only the sum of their genetic parts. All people exist within the context of their environment, their experiences, and their relationships. While the connection between this greater context and medical treatment may not be immediately obvious, it exists. If we are to truly tailor medical care, it must occur in a holistic manner, combining both genetics and social context. A thorough understanding of the way that they interact, as well as the individual limitations of both, is the best way to offer individualized care to all patients. / Urban Bioethics

In hospitals situated in the center of underserved communities, such as North Philadelphia, health care workers are often faced with challenges to patient health that stem from their socioeconomic status. This is an obvious problem in stroke prevention, which requires patients to eat healthy, maintain adherence to medications, and exercise, among other things. As social determinants of health limit a patient’s ability to act on these recommendations, health care workers are forced to grapple with the question of how to best care for a patient with limited resources. Though some may label this patient as difficult due to what may be viewed superficially as non-adherence to medications and lack of motivation to change their lifestyle’, a more compassionate and accurate observation is one that acknowledges the fact that these patients are unable to act on any recommendations given to them due to limitations on their autonomy by several social barriers, such as lack of access to follow-up, transportation, income, food, etc. As physicians have a duty to respect a patient’s autonomy, what this also requires is ensuring a patient understands how best to navigate within their limited autonomy, i.e. how to exercise their agency. Instead of waiting for policymakers to incite change, at the micro level, health care workers can take additional measures by providing resources within their limitations that will then improve a patient’s agency and, as a result, improve their health. / Urban Bioethics

The present study investigates the self-care and health maintenance strategies undertaken by individuals from Halton Region, Ontario living with type 2 diabetes and receiving assistance from food acquisition services such as community food re-distribution centres and food banks. This qualitative research project pulls narrative and thematic interview data from 18 semi-structured one-on-one interviews analyzed with syndemic theory and social determinants of health frameworks to demonstrate how clustering non-communicable diseases and social conditions disproportionately affect those in the lowest income category, and interact with each other to exacerbate the negative health effects of each condition alone. The contributions of this study are theoretical and applied. Theoretical contributions augment existing evidence for the study of non-communicable diseases using a syndemic model. The study participants demonstrated syndemic clustering of five conditions: type 2 diabetes, food insecurity, low income, poor mental health, and activity limitation. Further, this study suggests an applied element to the syndemic model through an approach to health and diabetes care that incorporates the whole person as opposed to a single disease as a unit of care. As suggested through the findings of research participant testimony, a diabetes health care centre, in addition to traditional diabetes care, would ideally screen and offer care for the other common clustered conditions listed in the syndemic elements above. Thus, the centre would provide nutrition, physical activity, mental health, and social supports to patients. As well, it is recommended that future research contributes to prevention and treatment of non-communicable diseases through social, political, and economic in form of increasing government and healthcare supports for people living with low-income and food insecurity. / Thesis / Master of Arts (MA) / This study looks at how individuals from Halton Region, Ontario maintain their health while living with type 2 diabetes and reduced access to healthy, fresh food. The project uses interview data from 18 one-on-one interviews to demonstrate how people with low income suffer from poorer overall health. Specifically, five conditions affected the study participants’ health: type 2 diabetes, reduced access to healthy food, low income, poor mental health, and reduced financial or physical access to exercise or activities of daily living (activity limitation). To combat these conditions, this study suggests an approach to health and diabetes care that looks at the whole person. Evidence and participant suggestions indicate a diabetes health care centre that screens and offers care for other common conditions that occur such as the elements listed above, and also provides nutrition care, physical activity, and social support to patients.

In early twentieth century Canada, the tuberculosis (TB) epidemic struck far and wide (Herring, 2007) and its effect was greater on indigenous populations, particularly the Inuit (Public Health Agency of Canada, 2013). In 1906, the Mountain Sanatorium was founded by the Hamilton Health Association (HHA) in an effort to curb the disease (Wilson, 2006) and was designated as a treatment centre for Inuit from the Eastern Arctic. Controlling TB became a movement extensively documented by The Hamilton Spectator – a prime news provider. This research concerns the way in which social problems emerge and the responses they generate. Drawing on the literature on social problems, this thesis examines the HHA’s claims-making activities regarding tuberculosis in 1953-1963 along with The Spectator’s role in helping to define TB as a problem. It examines 1) how the HHA constructed TB as a problem 2) how the HHA understood the problems and solutions of tuberculosis; 3) it ascertains whether the HHA and The Spectator drew from a biomedical model or considered social determinants of health (SDOH) in their control and reportage of the disease; 4) the portrayal and treatment of Inuit patients; 5) the role of legitimacy; and 6) the importance of Pfeffer and Salancik’s resource dependency theory in the Sanatorium’s efforts to survive as an institution. This was executed through a content analysis of the HHA’s annual reports and newspaper articles by The Spectator. The examination of this case through the theory of social problems and resource dependency provides a lens to understand how TB became a problem and why hospitals are more than treatment facilities. / Thesis / Master of Arts (MA)

Social determinants of health are associated with a variety of negative health outcomes, including COVID-19 morbidity and mortality. However, most research evaluating this relationship have been case studies, retrospective cohort studies, and case series studies and/or have used use analytic techniques, such as linear regression, that can struggle to adequately model the social determinants' complex nature. This study used United States county-level social determinants of health data and March 2020-December 2020 COVID-19 morbidity and mortality data. Structural equation modeling was used to develop a latent measurement model for the social determinants of health. Substantial cross-loadings among the social determinants of health precluded the estimation of the originally proposed measurement model. However, a more parsimonious model was estimated, with adequate factor loadings and model fit statistics. A multi-level, two-part structural equation model further validated the relationship between social determinants of health and COVID-19 morbidity and mortality. The model's predictive performance was moderate to strong, which validates and extends previous research using structural equation modeling to evaluate the relationship between social determinants of health and COVID-19 morbidity. The study adds to the theoretical and empirical foundation supporting the use of structural equation modeling to study the social determinants of health.

yes / Efforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives.

Recent public health scholarship finds that health outcomes are explained by the social and individual determinants of health rather than the individual-level determinants alone. The individualistic perspective has dominated the 20th century institutionalization of public health in the United States where the public health system has tended to focus largely, if not exclusively, on individual factors. This persistent orientation lies in contrast to another set of perspectives that have also persisted, focused on social causes, which are currently dominant in contemporary public health academic literature and in major, international health organizations. Whether the orientation within the United States is due to a prevailing paradigm among public health officials or is the result of new ideas about health causation being dampened under organizational weight is unknown. Despite public health being central to decreasing morbidity and mortality in the 20th century, significant gaps remain in researchers' understanding of what influences practice in the American public health system. My dissertation research investigates the broad outlines of the determinants of health as understood by state public health administrators. I study how the understanding of the determinants of health affects the practice of public health through analyzing how the ideas of state public health administrators interact with the organizational dynamics of the public health organizations they lead. This mixed-methods dissertation uses survey research and in-depth interviews and quantitative and qualitative analysis. I find that state public health officials' professionalization, length of tenure, level of education, and gender affect the perspective of health causation to which they adhere. I also find that the state public health officials with a social health frame more commonly report they are situated in organizations that are learning environments. Both organizational and ideational factors influence public health practice. The interview data expand this finding to paint a complex picture of organizational and ideational factors influencing one another as well as resulting practices. This research reveals that state public health officials often have strong health frames that are only able to shape the edges of their practice due to the political and organizational dynamics interacting with state public health departments. / Ph. D.

Yes / The experiences of LGBT asylum seekers in the UK are the focus of this chapter. The relative invisibility of LGBT asylum seekers in social work literature and research is acknowledged. Data from interviews undertaken as part of a small scale research study is used to highlight issues of psychological stress, safety, social isolation and resilience and survival. This material is discussed in relation to models of minority stress, discrimination, social determinants of health, and human rights. A holistic approach to practice in response to an opening vignette, is presented with reference to the importance of advocacy and cross-sector partnership working. / This is a post-peer-review, pre-copy edited version of a chapter published in: Fish J and Karban K (Eds.) Lesbian, Gay, Bisexual and Trans Health Inequalities. Details of the definitive published version and how to purchase it are available online at https://policypress.co.uk/lesbian-gay-bisexual-and-trans-health-inequalities.

Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring mechanisms of violence prevention is increasingly important, especially within the context of multicultural societies. This research does just that by approaching community violence prevention from an interdisciplinary perspective, including aspects of public health, political science, criminology, and sociology. This dissertation explores the interfaith organization InterFaith Leadership Council of Metro Detroit and those in the organization's network. It considers how interfaith leaders, through activism and dialogue, can contribute to community violence prevention. By applying the social ecological model and social disorganization theory, this research considers how to prevent community violence through building social capital, collective efficacy, and community capacity. This inquiry also utilized the social determinants of health to describe how violence and violence prevention is linked to community health. This dissertation uses qualitative data, including interviews, document analysis, and field notes to explore the mechanisms by which interfaith leadership can prevent community violence, specifically gang violence and violent extremism. / Doctor of Philosophy / Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring methods of violence prevention is increasingly important. This dissertation uses qualitative data to explore community violence prevention in Metro Detroit as carried out by the InterFaith Leadership Council and its broader network. Included in this dissertation are insights from interviews, document analysis, and field notes. All this data informs the research and attempts to address how the question of how the interfaith community in Metro Detroit is working to prevent community violence. This research utilizes the social ecological model and social disorganization theory as its overarching framework for analysis. The analysis examines interfaith relationships, collective efficacy, and community capacity. This research also frames violence and violence prevention within the context of the social determinants of health in an attempt to identify the factors that affect violence and violence prevention.