Wednesday, January 6, 2010

10 social determinants tips to a healthier pregnancy

Via The Fat Nutritionist (and originally, I gather, grabbed from a Wikipedia entry):

"Don’t be poor (and other New Year’s resolutions.)"

The traditional 10 Tips for Better Health

* 1. Don’t smoke. If you can, stop. If you can’t, cut down.
* 2. Follow a balanced diet with plenty of fruit and vegetables.
* 3. Keep physically active.
* 4. Manage stress by, for example, talking things through and making time to relax.
* 5. If you drink alcohol, do so in moderation.
* 6. Cover up in the sun, and protect children from sunburn.
* 7. Practice safer sex.
* 8. Take up cancer-screening opportunities.
* 9. Be safe on the roads: follow the Highway Code.
* 10. Learn the First Aid ABCs: airways, breathing, circulation.

The social determinants 10 Tips for Better Health

* 1. Don’t be poor. If you can, stop. If you can’t, try not to be poor for long.
* 2. Don’t have poor parents.
* 3. Own a car.
* 4. Don’t work in a stressful, low-paid manual job.
* 5. Don’t live in damp, low-quality housing.
* 6. Be able to afford to go on a foreign holiday and sunbathe.
* 7. Practice not losing your job and don’t become unemployed.
* 8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled.
* 9. Don’t live next to a busy major road or near a polluting factory.
* 10. Learn how to fill in the complex housing benefit/asylum application forms before you become homeless and destitute.

I loved this, and it got me thinking how these could be applied to pregnancy outcomes, which are rife with social determinants. I started coming up with my own list, and while I wandered off the social determinants course on a couple, they're all structural.

My (kind of) social determinants 10 Tips for a Healthier Pregnancy:

1. See all of the above social determinants; and if those aren't possible, then:
2. Don't go to a busy impersonal OB clinic, and don't choose at a high-volume public teaching hospital with high c-section rates. Instead, get a midwife and/or attend group prenatal care, which are shown to improve outcomes for socially high-risk women.
3. Don't be on Medicaid or other public insurance program that may or may not cover alternative care options.
4. Don't be uninsured yet have too much money to qualify for Medicaid, because then you won't be able to buy health insurance at all due to your "pre-existing condition" of pregnancy.
5. Don't be a victim of domestic violence, which is statistically more likely to occur during pregnancy.
6. If things get really desperate, for god's sake just make sure you're don't end up in jail, where you can be denied basic care and then shackled to the hospital bed when it's time for you to have your baby.
7. Practice not having to go back to work immediately postpartum to survive financially. Also, practice having a job that allows flexibility and breastfeeding/pumping breaks. Breastfeeding mitigates many of the infant mortality risks associated with being low-income.
8. Don't be African-American; if you have to be African-American, be a recent immigrant or make sure your ancestors have immigrated very recently, so that lifetimes of stress have as minimal an impact as possible on your childbearing.
9. Don't be isolated and experiencing a lot of stress. Just don't!
10. Practice having access to family planning. Sure, you may have trouble affording birth control because emergency Medicaid cuts you off after 6 weeks, but do your best.

I could go on (of course) but we don't want people to feel overwhelmed by all the things they have to not do. Happy New Year!


Raine said...

SO don't be poor, a minority [including a woman], or stressed out?
Damn! I knew I was doing something wrong.

Snarkiness not directed at you, just at the system in general and all of the "well-meaning" advice out there that seems to disregard that most people don't choose to be poor, uninsured, or in shitty living and employment conditions. [And yeah, I've had more than one person comment "If you had more money...., better insurance...., a different job...." etc during this pregnancy].

Rebecca said...

There's plenty of snark to go around, don't worry ;-)

It is frustrating to see the system focus so many resources on individuals, and so much blame on individuals when there's a bad outcome... while ignoring the big system forces.

Greta's family said...

Does having multiple shitty cars give you more points or less points in the car ownership department? I'm just trying to calculate my odds here... hmmm. Definitely mixed.

Rebecca said...

It depends on if the shitty cars are causing you a lot of stress ;-) So just practice not being stressed out by them, right??