Wednesday, January 29, 2014

Necessary and Sufficient Cause of Disease



Necessary Cause of Disease
 A necessary cause of disease is always associated with a particular outcome because an exposure is required for a particular outcome. For example; HIV is a necessary cause of AIDS. An individual cannot be diagnosed with AIDS if they are not infected with HIV.

Sufficient Cause of Disease

A sufficient cause of disease is an exposure that may produce a particular outcome but may not be the only cause of that outcome. An example would include poor nutrition leading to obesity, however, sedentary lifestyle, stress and other factors could have also caused the disease.  

http://minorityhealth.hhs.gov/templates/content.aspx?ID=3024

According to the US Department of Health and Human Services, American Indians and Alaska Natives are twice as likely to develop diabetes than non-Hispanic white individuals. Risk factors associated with diabetes include hypertension, obesity, high cholesterol and tobacco use. Biologically, American Indians/Alaska Natives and non-Hispanic white individuals are equal. Non-Hispanic white individuals have not developed an immunity to hypertension or obesity. In fact, risk factors such as high cholesterol, hypertension and obesity plague every society, race and ethnicity. So why are certain ethnicity's more susceptible to diseases than others? 

Simply stated, social determinants of health impact disease prevalence. Social determinants of health include; gender, income level, place of residence, age, occupation, education level and socioeconomic status. The documentary series Unnatural Causes explores the topic of inequality and its effect on health. In the first episode, In Sickness and In Wealth, investigates the connection between physical health, wealth and race. After interviewing several individuals in different income brackets, they discovered that the individuals with the highest income were the most healthy. Reasons include; access to better housing, more comprehensive healthcare, better transportation and increased availability of healthy foods. Along the health-wealth gradient, they observed 5 to 10 year gaps between the cities rich, middle and working class neighborhoods. As indicated in this documentary series, social determinants of health can be a sufficient cause of disease. Individually they may not produce a particular outcome but collectively, determinants such as poverty, poor nutrition and increased stress can impact an individual's health. 

There are several determinants that play a role in the increased prevalence of diabetes in minorities including lack of proper nutrition and increased stress levels. American Indians, especially those living on reservations, are also challenged because of their place of residence and occupation. American Indians have typically made a living off growing and harvesting crops. Over the recent decades, water sources and irrigation systems have been rerouted in the mid-west to better accommodate bigger farms that produce more crops. Consequently, American Indians harvest less crops and therefore have minimal access to nutrient dense food. In an effort to preserve American Indian culture, the government has created  subsidized housing  and provided food to various reservations throughout the region. However, the food that they are providing is high in fat, sodium and cholesterol. As a result, there has a been a rise in obesity and diabetes among American Indians. In addition, there is a lack of health education and health promotion on reservations. This exemplifies the impact that occupation and place of residence can have on an individual's health. 
















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