Berks County Medical Society Medical Record Fall 2018 - 14

Health Determinants Beyond the Exam Room
continued from page 13
African Americans are 30 percent more likely to die from heart
attack and almost twice as likely to die from stroke as Whites (NSA,
2016).
Social determinants of health not only influence an individual's
encounter with the health care system, but also shape the
community experience. This creates conditions in a person's
environment in which certain individuals are at higher risk for
long-term comorbidities and premature aging/death. The evidence
is particularly clear with Adverse Childhood Experiences (ACEs).
ACEs are stressful and traumatic events, such as abuse and neglect,
that increase an individual's risk for substance abuse, heart attack,
mental health disorders, and premature aging. Interventions to
address ACEs during adolescence and adulthood have not been
effective due to the permanent biochemical changes that occur
during early childhood as a direct result of such experiences (Brody
et al., 2013). The physiological rationale is based on high cortisol
levels derived from stressors within the environment. Increased
stressors from traumatic events lead to chronically high cortisol
levels, which is linked to deleterious effects on mental and physical
health (Lavretsky, 2012). Eliminating gaps in health outcomes
requires addressing the root cause of health disparities, which
is often social and not medical in nature. Despite technological
advances and innovations in health care, disparities will continue to
exist unless social factors are addressed.
Bruce Link and Jo Phelan's Fundamental Social Cause Theory
(1995) provides a framework based on structural inequalities in
health care access that explains this phenomenon. The theory defines
the fundamental causes of disease as social factors derived from
socioeconomic status and social support. The authors posit that
social factors cause disease because they signify access to important
resources. Differences in socioeconomic status lead to differential
access to flexible resources; education, prestige, power, and money.
A deficiency in flexible resources creates obstacles to health care
access as a result of economic, social, and cultural barriers. Gaps will
continue to exist between different groups due to unequal access to
flexible resources despite the availability of medical resources and

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advances in the health care field.
The Fundamental Social Cause Theory is especially relevant in
Berks County given the evidence of persistent health disparities
despite a high rate of insurance coverage. Compared to the national
average of 88.3 percent, Berks County's insurance coverage is higher
at 90.2 percent (Figure 2). Paradoxically, because a large number of
county residents are economically impoverished, health insurance
coverage is better because more residents qualify for publicly funded
insurance. Among racial groups in Berks County, those identified
as "Asian" and "Black" have higher percentages of uninsured when
compared to the national and state averages. In contrast, those
identified as "White" and "Hispanic" have significantly lower
percentages of uninsured compared to the national and state
averages; however, in comparison to all racial groups, Hispanics have
the highest percentage of uninsured in Berks County (Figure 3).
Data from the Community Health Needs Assessment indicates
that although health care coverage is not a significant barrier to care
in Berks County, social determinants such as transportation and lack
of food security remain factors of the highest concern. These serve as
social and economic barriers to health care that predominately target
individuals without flexible resources.
Access to transportation has a direct influence on an individual's
ability to access community resources. Low income families without
access to a vehicle or public transportation are often forced to walk
to clinics, which hinders routine preventative care and exacerbates
the effects of chronic illness to the point of an acute event. As a
consequence of long transit times and a fragmented transit system,
individuals may have to take time off from work for appointments,
which can also hinder usage of community social resources. In
an example provided by Desha Dickson, Director of Community
Health and Engagement at Tower Health, residents living just one
mile away from the Reading Hospital had difficulty seeking medical
care. Because there was no direct BARTA bus line to the hospital,
residents using public transportation had to transfer downtown,
resulting in their journey taking up to an hour.


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Berks County Medical Society Medical Record Fall 2018

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2018

Berks County Medical Society Medical Record Fall 2018 - 1
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