A dual-path psychosocial model of social determinants of health in the community: Results from the Cause Commune program

The progressive place paradox: Status-based health inequalities are magnified in more economically progressive Swiss localities

Low socioeconomic status (measured both objectively and subjectively) is systematically associated with worse health. Amid renewed interest in contextual influences on health inequalities, we ask whether variation in the prevailing ideological climate moderates the size of the health gap between low and high status individuals. Based on the minority stress hypothesis, we expect that living in an economically progressive place within Switzerland - places where more residents endorse the need for change to the economic status quo - will reduce the magnitude of the health gap. Multilevel modelling of MOSAiCH 2015-2020 data shows the opposite: low status individuals in progressive places report markedly lower subjective health and life satisfaction than similarly low status individuals in conservative places, such that status-based health inequalities are maximised in progressive places. We interpret this apparent progressive place paradox in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.

The Prevalence and Trends of Instrumental Activities of Daily Living Impairments in the United States from 2008-2018

Background

Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States.

Objective

This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans.

Methods

A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates.

Results

Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks.

Conclusion

IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

Beyond Geography: Social Quality Environments and Health

The concept of social quality has garnered increasing attention as a composite indicator of the well-being of societies as well as individuals embedded within them. Prior research suggests four domains of social quality: socio-economic security, social cohesion, social inclusion, and social empowerment, based on the assumption that these domains influence health and well-being. In this paper, we investigate whether and to what extent social quality environments defined with reference to the cross-cutting social quality domains reliably predict various types of health, using data collected in a municipality in Switzerland as part of a participatory action research project. We found that social inclusion had the highest predictive power for mental health and functional health, while economic security had the highest predictive power for physical capacity and overall self-rated health. Results indicate interaction among various domains of social quality for a subset of health measures. Findings suggest that environments defined as combinations of social quality domains effectively distinguish between population segments with varying levels of health. Social quality represents a promising avenue for policy and intervention development, particularly from the social determinants of health perspective, as it jointly captures the multiple domains of social well-being relevant to population health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11205-023-03073-1.