Question

Jose and Jorge were identical twins separated at birth. Jose grew up in a large family in an impoverished slum in the middle of a crime-ridden and polluted district of a major city. Jorge grew up in an upper-middle-class professional family with one other brother in a sub­ urban community in the same city. Despite the fact the Jose and Jorge were identical twins, their lives and health could not have been more different.

Jose had few opportunities for medical care or public health services as a child. His nutrition was always marginal and he developed several severe cases of diarrhea before he was 1 year of age. He received a polio vaccine as part of a community vaccination program, but never received vaccinations for measles, mumps, rubella, or other childhood illnesses. At age 4, he developed measles and was so sick his mother was sure he would not make it.

As a child, Jose also developed asthma, which seemed to worsen when he played outdoors on hot smoggy days. Dropping out of school at age 14, Jose went to work in a factory, but quit when he found himself panting for breath at the end of the day.

As a teenager, Jose was repeatedly exposed to crime and drugs. Once, he was caught in the cross fire of gangs fighting for control of drugs in his com­munity. Experimenting with drugs with his teenage friends, Jose contracted HIV from use of contam­inated needles. Jose did not know he had HIV until he was nearly 30 years old and developed tuberculosis (TB). He did receive treatment for the TB free of charge from the health department, but once he felt better, he did not follow up with treatment.

By the time the TB returned, Jose had lost 30 pounds and could barely make it into the emer­ gency room of the public hospital because of his shortness of breath. He was hospitalized for the last 2 months of his life, mostly to prevent others from being exposed to what was now drug-resistant tuberculosis. No one ever knew how many people Jose exposed to HIV orTB.

Jorge's life as a child was far less eventful. He received "well child" care from an early age. His fam­ily hardly noticed that he rarely developed diarrhea and had few sick days from diseases of childhood. He did well in school, but like Jose, he developed asthma. With good treatment, Jorge was able to play on sports teams, at least until he began to smoke cigarettes at age 14.

Jorge soon began to gain weight, and by the time he graduated from college, he was rapidly becoming obese. In his 20s, he developed high blood pressure, and in his 30s he had early signs of diabetes. Jorge had a heart attack in his mid-40s and underwent bypass surgery a few years later. The treatments for diabetes, hypertension, and high cholesterol worked well and Jorge was able to lead a productive professional life into his 40s.

By the time that Jorge turned 50, his diabetes began to worsen and he developed progressive kid­ ney disease. Jorge soon needed twice-a-week dial­ ysis, which kept him alive as he awaited a kidney transplant.

1.How do social determinants of health contrib­ ute to the different disease patterns of Jose and Jorge?

2.How do factors in the physical environment explain differences in the health of Jose and Jorge?

3.What role does medical care play in the differ­ ences between the health outcomes of Jose and Jorge?

4.What roles do public health services play in the health outcomes of Jose and Jorge?

Answer 1

1. SOCIAL DETERMINANTS OF HEALTH: The social determinants of Health include the

• Community
• Economic status
• Neighbourhood Environment
• Health care facilities
• Education
• Nutrition intake

SOCIAL DETERMINANTS OF HEALTH	JOSE	DISEASE PATTERNS	JORGE	DISEASE PATTERNS
Community	Impoverished slum	Diarrhoea due to lack of cleanliness	Upper middle class and Sub urban	No case of diarrhoea or allergic symptoms
Economic status	Poor with a large family	Lack of vaccination for measles, mumps , rubella Didnot get treated for Asthma and has to leave  his job	Upper Middle class professional with a small family	Good child care and proper vaccination and proper schooling Got treated for Asthma and participated in sports
Neighbourhood Environment	Crime ridden community and polluted	Drugs and contaminated syringes leading to HIV AIDS. Pollution lead to Asthma	Sub Urban	Developed obesity with the food habits
Health care facilities	Minimal	Only emergency medications such as polio vaccination and TB treatment	Good	All types of care from Heart surgery to dialysis are taken care of
Education	Drop out	Jobless and moved with Gangs causing infectious disease due to lack of scientific knowledge and drug resistant TB	Good with better job	Hypertension is developed due to stress levels
Nutrition intake	Marginal	Easily prone to diarrohea multiple times in early childhood	Improper intake of nutrition	Lead to early Hyper tension and Diabetes

2. The factors in the physical environment that caused differences in health of Jose and Jorge are

Physical Environment	Jose	Jorge
Hygeine	Poor - Diarrohea Polluted - increased Asthma	Good - No diarrhoea Got treated for Asthma
Health care Facilities	Minimal -Only polio vaccination Developed Measles Got treatment for primary Tuberculosis but not Drug resistant Tuberculosis	Good - No vaccination lack diseases developed in the life Got treatment for heart surgery and dialysis.
Community	Crime ladden - HIV due to drugs	Sub urban - Stress causing Hyper tension and food habits lead to diabetes

3. The factors in the Medical care health facilities resulted in health outcomes

Health care facilities	Jose	Jorge
Vaccination	Developed measles	No diseases in the life due to lack of vaccination
Both have Asthma	Didnot receive treatment and cannot able to perform his job duties	Can able to cope up with it due to treatment and participated in sports
Treatment	No treatment of Tuberculosis and died with drug resistant TB No treatment for Asthma - caused short of breath	All facilities available and can able to survive with Heart stroke and dialysis

4. Public Health services are the one who monitor health services in the community. They diagnose the health hazards and health problems in the community. They educate and empower the people about health issues. In the health outcomes of both Jose and Jorge, the poor public health services affected the health and lead to the death of Jose. Jose didnot get proper vaccination. He suffered from measles. Due to lack of knowledge of the community, there prevaled diarrhoea in Jose area. He suffered to death due to HIV and TB due to lack of knowledge for using unsterilised needles and not continuing the treatment for TB and developing Drug resistant TB. As Jorge is from rich family, the public health services dinot play much role on his health.