Environmental impacts on health

I recently read a blog post by Adrianna McIntyre that I found quite interesting. It was a review on a recent journal article that looked at hospitalizations for hypoglycemia (by a person’s income) and its relation to day of the month. The authors hypothesized that for low income households, they experienced a “pay cycle” that impacted their financial resources which would change their food consumption. This exhibit from the article nicely sums it up.
Admissions attributable to hypoglycemia and appendicitis among patients ages eighteen and older to accredited California hospitals on each day of the month by income level, 2000-2008.

Adrianna quotes the article’s abstract and adds emphasis which does a good job of summing up the study.

One in seven US households cannot reliably afford food. Food budgets are more frequently exhausted at the end of a month than at other points in time. We postulated that this monthly pattern influenced health outcomes, such as risk for hypoglycemia among people with diabetes. Using administrative data on inpatient admissions in California for 2000–08, we found that admissions for hypoglycemia were more common in the low-income than the high-income population (270 versus 200 admissions per 100,000). Risk for hypoglycemia admission increased 27 percent in the last week of the month compared to the first week in the low-income population, but we observed no similar temporal variation in the high-income population. These findings suggest that exhaustion of food budgets might be an important driver of health inequities.

What gets lost in the health care debate is that there is more to health, than health care. Blum in 1981 proposed an “Environment of Health” model that proposes four main determinants of health. These are environment, lifestyle, heredity, and medical care. Based on his model, he proposes that envioronment is the biggest determinant, followed by lifestyle and heredity. Medical care is the smallest determinant. This study further provides evidence to this claim.


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