Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management. The authors make a critical distinction between the structural determinants of health inequities and the intermediary determinants of health. The structural determinants include “all social and political mechanisms that generate … stratification and social class divisions in society and that define individual socioeconomic position within hierarchies of power, prestige and access to resources” (p. 5).
In the absence of national health insurance, national health policy has supported the development of a safety net of services in the form of community health centers in areas with a shortage of health facilities and personnel. Currently there are about 800 such centers across the country, all of which provide high-quality primary care services.
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The structural determinants cause and operate through intermediary determinants of health—housing, physical work environment, social support, stress, nutrition and physical activity—to shape health outcomes. A broad range of social, environmental, psychological, and genetic factors have been associated with tobacco use, including gender, race and ethnicity, age, income level, educational attainment, geographic location, and disability. Motivation to begin and to continue smoking is strongly influenced by the social environment, although genetic factors are also known to play a role. Smoke-free protections, tobacco prices and taxes, and the implementation of effective tobacco prevention programs all influence tobacco use.
Research is warranted to tease out the role that a range of services play in mediating and modifying influences so children can stay healthy, as well as supporting and promoting their optimal health. Improved specification of the effects of services, better targeting and customizing of services for specific populations, and improved monitoring of the effect of specific services on population health measures should be considered important research and analysis priorities. Public health activities to improve nutrition and public health education campaigns have resulted in health improvements. For example, introduction of folic acid in grain-based products decreased the risk of neural tube defects .
The resulting behaviors are both manifestations of their health and have significant implications for it. At each new exposure, the child may respond in a variety of ways that in turn unleash a variety of reactions in his or her caregiver and in others around him. A body of recent research suggests how these behaviors develop and describes the role of family, peers, and social environment, including media, in shaping this developmental process . While behaviors like smoking, drinking, and exercise are known to affect later health, it is not clear how these behaviors develop in childhood . Children’s health is determined by the interaction of a multitude of influences, reflecting complex processes.
- In contrast, the medical literature is replete with reports of the effectiveness of specific biomedical interventions that influence the course of particular diseases.
- The health of children in the United States is affected by laws, rules, and regulations developed at the national, state, and local levels.
- These governmental actions determine the availability of publicly supported services and often regulate the provision of privately administered services.
Systematic approaches to evaluate the effect of policies on children of this sort are the exception, rather than the rule, and few other systematic attempts can be identified. Health insurance of any type cannot facilitate access to health care services when the necessary resources are not present.
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We divide these influences into biological, behavioral, and environmental even though our model of children’s health views their effects as highly intertwined and difficult to isolate. This chapter provides a summary of published literature and a framework for understanding those influences. Dr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness.
Evidence on the likely effects of welfare reforms comes both from random-assignment experiments and from longitudinal survey studies . A key finding from the experiments is that effects on the achievement and behavior of younger children were consistently more positive in programs that provided financial and in-kind supports for work than in those that did not. The packages of work supports were quite diverse, ranging from generous earnings supplements provided alone to more comprehensive packages of earnings supplements, child care assistance, health insurance, and even temporary community service jobs.
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An emerging literature suggests that the long-term consequences of childhood exposure to community violence are similar to those noted for child victimization. It is important to note, however, that this emerging literature lacks specificity, as it is currently not clear which types of exposure to violent events pose the greatest threat to children in terms of resulting in impaired good diet plans social and emotional development and functioning. The elements of a safe and healthy physical environment differ according to a child’s developmental stage.