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Upstream determinants of health and healthcare decision making, featuring a reproductive health perspective

Saturday, November 15, 1:45 to 3:15pm, Property: Hyatt Regency Seattle, Floor: 5th Floor, Room: 511 - Quinault Ballroom

Session Submission Type: Panel

Abstract

Structural determinants are the predecessors found further upstream from social determinants of health. Fundamental cause theory, the socio-ecological model, and other population health theories posit that some of the key inequities and disparities in sexual and reproductive health (e.g., pregnancy-related mortality and morbidity, disparate quality of care or coercion, or disparities in birth outcomes) are determined by systemic inequalities that permeate through local, state, and federal public policies that have bi-directional relationships with public opinion. Therefore, furthering the study and operationalization of the upstream–the social and structural–determinants of health requires deliberate attention. Moreover, the politicization of reproductive health care offers a crucial opportunity to study the structural levers that impact population health and well-being. 

While three of the four papers study reproductive health or healthcare attitudes specifically, one paper approaches systemic issues affecting health coverage and health outcomes more broadly. Three of the four included studies offer perspectives on how diverging state policy landscapes relate to disparate health outcomes at the population level. Two of the four papers discuss social-economic policies, or safety net policies, as a particular policy lever that must be addressed in order to alleviate the health and healthcare burdens of the most historically disadvantaged populations. Three of the studies offer Medicaid as a particular policy area that states pursue for alleviating these burdens in particular. And one paper offers the crucial perspective of how public opinion on reproductive healthcare and public policy can be studied concurrently to understand these diverging policy landscapes. Together, these papers offer an essential multidimensional perspective on how social and structural determinants predict and can be manipulated to improve reproductive health outcomes, but also health and healthcare outcomes more broadly.

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