Reflection: Distal Causes of Mortality


There is continued discussion related to numerous environmental effects on mortality rates in the United States (Browning et al. 2011; Browning et al. 2006; Meijer et al. 2012). There is a focus on urban mortality rates in much of the research (Browning et al. 2006; Meijer et al. 2012; Nandi et al. 2012; Nandi &Kawachi 2011; Wight et al. 2010). There is a focus on urban areas along with attempts to explain the contributions to increasing mortality rates among minority populations (Bond Huie et al. 2002; Browning et al. 2011; Meijer et al. 2012). The purpose of this response is to discuss the impact of individual and contextual level effects on mortality. The continued differentials in mortality rates indicates further research is needed on contextual factors particularly related to neglected or underserved populations. Current research continues to highlight the increased effect of segregation on mortality rates (Bond Huie et al. 2002; Geronimus et al. 2014; Browning et al. 2006). Those who live in low-income, high-minority communities are found to be at increased risk for mortality (Meijer et al.; Browning et al. 2006; Nandi and Kawachi; Wight et al; Geronimus et al; Bond Huie et al). With the consistent findings that negative health effects continue to be positive for low-income, poor neighborhoods indicates that more needs to be done regarding transforming the health and environments of neighborhoods. This would include investing in long-term structural improvements in both the environment (housing conditions, air pollution) and also in preventative health measures including nutritional education that would help to prevent continued worsening health outcomes.
The research focuses on individual versus neighborhood effects on mortality. Bond Huie and colleagues found that the effects were the same for minority populations regardless of individual or neighborhood effects (Bond Huie et al. 2002). This leads to a pessimistic outlook for minority populations. It also emphasizes the importance of the role of environment on overall health and health outcomes. (Browning et al. 2011; Browning et al. 2006; Meijer et al. 2012; Nandi et al. 2011; Wight et al. 2010). If it is known that low-income, poor communities are bad for the health of minority populations, more policy and resources are needed to help buffer these communities from poor health effects that are the result of direct contact with these environmental hazards. There are a number of different ideas related to the reason for individuals to continue to live in poor health inducing environments. We are often left with more questions than answers in relation to what should be done in order to see change in these areas (Bond Huie et al. 2002; Geronimus et al. 2014). This is one reason why there is a continued discussion regarding how neighbhorhoods are measured and how we discuss environment (Wight et al. 2010; Browning et al. 2011). The research also indicates that the impact of neighborhoods on individual health is a complex system and a multi-measure approach is preferred over a single measure approach when determining the impact on health.
The research discusses the impact of social isolation on mortality. Usually social isolation refers to social isolation at the individual level (Browning et al. 2011Browning et al. 2006; Nandi & Kawachi 2011). I would take this idea a step further and suggest that low income communities as a whole are socially isolated and as a result, this negatively impacts individual level mortality rates exponentially. Social isolation in a poor built environment would seem to have a negative impact on health compared to social isolation in a healthy built environment. Poor built environments are also associated with increased mortality rates. Higher income suburban areas have higher rates of new built environments while low income areas may have a slight increase in built environment improvements that are often inaccessible to those who live in the area.
There is limited research on health effects and mortality in the Hispanic and Latino populations (Bond-Huie et al. 2002; Wight et al. 2010; Browning et al. 2006). With the continued growth of the Hispanic and Latino populations in the United States it would be indicative to include datasets that include these populations along with research to include longitudinal studies to give a more complete picture of the health impacts on these populations. Although mortality data was not always available for these populations, the data that is available can offer insight into new areas to pursue.
Bond-Huie and colleagues along with Browning and colleagues link low income communities to the concept of disorder (Bond Huie et al. 2002; Browning et al. 2011). Disorder is seen as a constant tax on the mental, emotional, and physical health of residents in low-income neighborhoods. Usually this would be likened to the hustle and bustle of city life but due to the numerous negative exposure points that groups of people will face each day, it can wear down health and well-being. This constant barrage of toxic elements on health contribute to higher mortality rates (Bond Huie et al. 2002; Wight et al. 2010).
An interesting finding was that individual and contextual effects did not have much of an impact on the elderly population (Geronimus et al. 2014; Browning et al. 2006). This could be due to their bodies adapting to various outside effects over the course of the lifespan. More research is needed regarding the health of older people in the population. This can give much needed information regarding how to better serve this population and also how to approach health and wellness of younger populations.
The readings give further proof that individual and contextual effects need to continue to be studied in order to have more insight into mortality rates and also mortality prevention. Individual effects on health cannot be studied independent of contextual effects or there is a risk of having incomplete findings. Having a multi-level approach to measurement and also how neighborhoods are viewed is vital in current day.


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