Portland, OR – ¿Qué impacto tienen en nuestra salud las estructuras y condiciones de nuestra sociedad? Esa es una pregunta que los panelistas explorarán en un evento este viernes, auspiciado por el Foro de la Salud de Oregon (“Oregon Health Forum”).

Rebecca Ramsay, penalista y directora ejecutiva de CareOregon, dice que los grandes factores estructurales, como el ingreso, nivel de educación y grupo étnico determinan el desarrollo de la salud. Luego, hay factores que tienen una relación más clara la salud, como una vivienda estable, el acceso a una alimentación nutritiva y el estrés.

Ramsey pone un ejemplo: las caries dentales, que estadísticamente son el factor más determinante para que una niña o niño asistan o no al “kindergarten”. Esto es importante, porque estadísticamente los pequeños que no asisten al “kindergarten” tienen menos posibilidades de graduarse de “High School”, y la gente que no supera este nivel escolar tiene, en promedio, una menor expectativa de vida.

“Y puede verse cómo todos estos factores se entrelazan y crean un círculo vicioso en el que, realmente, la sola experiencia de vivir en la pobreza se vuelve la determinante social más crítica de los factores de salud.”


El Foro comienza a las 7 am en el Club Atlético Multnomah, en Portland. Contará con la presencia de especialistas invitados de otras organizaciones de salud como “Oregon Health”, “Science University” y “Northwest Permanente”.

Ramsay afirma que entre más factores de riesgo experimente una persona, como inseguridad alimentaria, violencia doméstica o racismo institucional, más posibilidades tienen ser afectada negativamente. Y un individuo ciertamente no tiene control sobre estos factores y muchos más.

Es por eso que Ramsay insiste en la importancia de que la gente lo comprenda y también comprenda que cuidar su salud no debería terminar siendo un tema de culpar a alguien por sus elecciones.

“Sin duda lo que hacemos y elegimos en temas de la salud tiene un efecto, y muy importante, en este campo, pero esa elección se vuelve muy diferente cuando te enfrentas con que el dinero no te alcanza, por ejemplo, ni siquiera para comer sano.”

Ramsay dice que el estrés juega un papel crítico en la salud de las personas. Por ese motivo, CareOregon mantiene programas que ayudan a familias con el apoyo de los padres para prevenir el estrés tóxico en la infancia.

CareOregon también apoya programas de nutrición prenatal y de planificación familiar, para evitar embarazos adolescentes, que son un factor que determina enormemente si alguien se gradúa de “highschool”.

Visite la página del Oregon Health Forum, con el tema "El impacto social de los determinantes sociales sobre la salud" (en inglés) www.oregonhealthforum.org/2018/02/21/april-27-the-impact-of-social-determinants-on-health/


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While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"

Today, Connecticut health care advocates are holding a student day of action.

They will speak to state lawmakers about raising the age limit for undocumented immigrants eligible for HUSKY, the state's Medicare program. Undocumented people up to age 15 are eligible and the General Assembly is considering raising it to 18.

Yenimar Cortes, New Haven organizer for the group Connecticut Students for a Dream, said undocumented people not having health insurance is problematic.

"When it came to some stuff, like even a simple physical, my mom would have to like work and my dad would have to work like more shifts to be able to cover the costs," Cortes recounted. "It also meant getting sick was something we didn't want to do."

She added if they got sick, they would try home remedies before going to the hospital. Some people pay for visits out of pocket and take on medical debt. Some lawmakers opposed the age limit increase due to high costs, which studies estimated to be $83 million. However, the study noted expanding HUSKY could save hospitals between $63 million and $72 million.

Though uninsured rates fell during the pandemic, health officials are trying to ensure people maintain any coverage they have.

Luis Luna, coalition manager for the nonprofit HUSKY 4 Immigrants, said the pandemic helped advocates see the problem as a whole.

"It helped us see that health care is a fundamental human right," Luna asserted. "It helped us see that when people get sick and they don't take care of themselves their family suffers, and it helped us see that there's a really big disparity with health care access."

Several states have made health care affordable or available to undocumented immigrants. Luna added the hope is to make all immigrants, regardless of their status eligible for HUSKY.

A 2022 survey found most people support expanding HUSKY to all immigrants.

Today is National Healthcare Decisions Day, a day when everyone is encouraged to review their end-of-life planning. The 2024 Alzheimer's Association annual report predicts that the number of Americans 65 and older who are living with the most common form of dementia will double from nearly 7 million to 14 million patients by 2050.

Jessica Empeño, national director of clinical engagement with the end-of-life advocacy group Compassion & Choices, said legal matters are just part of the equation.

"The most important part is to have conversations about what matters most to you, what your wishes are, and share those things, not only with your family and your loved ones but with your health-care team," she explained.

People may want to put in writing who they want to be able to make decisions on their behalf once dementia progresses. They might consider whether in the future they would be OK with things like artificial hydration or nutrition, aggressive treatments or surgeries.

Compassion & Choices' website offers a free End of Life Decisions tool and a Dementia Values & Priorities Tool that helps people communicate and document their future health-care wishes, both for those who have early-stage dementia or those who just want to be prepared for the possibility.

Angela Schultz, California state advocacy director for Compassion & Choices, said people need to make a plan sooner rather than later.

"We just did recent polling, and 93% of Americans said that having an advanced directive and a health-care proxy and sharing that with your doctor is very important. But only 37% of Americans have done that," she said.

National Healthcare Decisions Day falls on April 16th, the day after tax day. It is a reference to the famous quote from Benajmin Franklin that "In this world, nothing is certain but death and taxes."