Search This Blog

Wednesday, January 9, 2019

Evolutionary developmental psychology

From Wikipedia, the free encyclopedia

Evolutionary developmental psychology (EDP) is a research paradigm that applies the basic principles of Darwinian evolution, particularly natural selection, to understand the development of human behavior and cognition. It involves the study of both the genetic and environmental mechanisms that underlie the development of social and cognitive competencies, as well as the epigenetic (gene-environment interactions) processes that adapt these competencies to local conditions.
 
EDP considers both the reliably developing, species-typical features of ontogeny (developmental adaptations), as well as individual differences in behavior, from an evolutionary perspective. While evolutionary views tend to regard most individual differences as the result of either random genetic noise (evolutionary byproducts) and/or idiosyncrasies (for example, peer groups, education, neighborhoods, and chance encounters) rather than products of natural selection, EDP asserts that natural selection can favor the emergence of individual differences via "adaptive developmental plasticity." From this perspective, human development follows alternative life-history strategies in response to environmental variability, rather than following one species-typical pattern of development.

EDP is closely linked to the theoretical framework of evolutionary psychology (EP), but is also distinct from EP in several domains, including research emphasis (EDP focuses on adaptations of ontogeny, as opposed to adaptations of adulthood) and consideration of proximate ontogenetic and environmental factors (i.e., how development happens) in addition to more ultimate factors (i.e., why development happens), which are the focus of mainstream evolutionary psychology.

History

Development and evolution

Like mainstream evolutionary psychology, EDP is rooted in Charles Darwin's theory of natural selection. Darwin himself emphasized development, using the process of embryology as evidence to support his theory. From The Descent of Man:
Man is developed from an ovule...which differs in no respect from the ovules of other animals. The embryo itself at a very early period can hardly be distinguished from that of other members of the vertebrate kingdom.
Darwin also published his observations of the development of one of his own sons in 1877, noting the child's emotional, moral, and linguistic development.

Despite this early emphasis on developmental processes, theories of evolution and theories of development have long been viewed as separate, or even opposed to one another (for additional background, see nature versus nurture). Since the advent of the modern evolutionary synthesis, evolutionary theory has been primarily "gene-centric", and developmental processes have often been seen as incidental. Evolutionary biologist Richard Dawkins's appraisal of development in 1973 illustrates this shift: "The details of embryological developmental processes, interesting as they may be, are irrelevant to evolutionary considerations." Similarly, sociobiologist E. O. Wilson regarded ontogenetic variation as "developmental noise".

As a consequence of this shift in perspective, many biologists interested in topics such as embryology and developmental systems subsequently branched off into evolutionary developmental biology.

Evolutionary perspectives in developmental psychology

Despite the minimization of development in evolutionary theory, early developmental psychology was influenced by evolution. Both Darwin's theory of evolution and Karl Ernst von Baer's developmental principles of ontogeny shaped early thought in developmental psychology. Wilhelm T. Preyer, a pioneer of child psychology, was heavily inspired by Darwin's work and approached the mental development of children from an evolutionary perspective.

However, evolutionary theory has had a limited impact on developmental psychology as a whole, and some authors argue that even its early influence was minimal. Developmental psychology, as with the social sciences in general, has long been resistant to evolutionary theories of development (with some notable exceptions, such as John Bowlby's work on attachment theory). Evolutionary approaches to human behavior were, and to some extent continue to be, considered a form of genetic determinism and dismissive of the role of culture and experience in shaping human behavior (see Standard social science model).

One group of developmental psychologists who have embraced evolutionary perspectives are nativists, who argue than infants possess innate cognitive mechanisms (or modules) which allow them to acquire crucial information, such as language (for a prominent example, see universal grammar).

Evolutionary developmental psychology

Evolutionary developmental psychology can be viewed as a more focused theoretical framework derived from the larger field of evolutionary psychology (EP). Mainstream evolutionary psychology grew out of earlier movements which applied the principles of evolutionary biology to understand the mind and behavior such as sociobiology, ethology, and behavioral ecology, differing from these earlier approaches by focusing on identifying psychological adaptations rather than adaptive behavior. While EDP theory generally aligns with that of mainstream EP, it is distinguished by a conscious effort to reconcile theories of both evolution and development. EDP theory diverges from mainstream evolutionary psychology in both the degree of importance placed on the environment in influencing behavior, and in how evolution has shaped the development of human psychology.

Advocates of EDP assert that evolutionary psychologists, while acknowledging the role of the environment in shaping behavior and making claims as to its effects, rarely develop explicit models (i.e., predictions of how the environment might shape behavior) to support their claims. EDP seeks to distinguish itself from mainstream evolutionary psychology in this way by embracing a developmental systems approach, and emphasizing that function at one level of organization (e.g., the genetic level) effects organization at adjacent levels of an organization. Developmental systems theorists such as Robert Lickliter point out that the products of development are both genetic and epigenetic, and have questioned the strictly gene-centric view of evolution. However, some authors have rebutted the claim that mainstream evolutionary psychologists do not integrate developmental theory into their theoretical programs, and have further questioned the value of developmental systems theory. 

Additionally, evolutionary developmental psychologists emphasize research on psychological development and behaviors across the lifespan. Pioneers of EDP contrast their work with that of mainstream evolutionary psychologists, who they argue focus primarily on adults, especially on behaviors related to socializing and mating.

Evolutionary developmental psychologists have worked to integrate evolutionary and developmental theories, attempting to synthesize the two without discarding the theoretical foundations of either. This effort is evident in the types of questions which researchers working in the EDP paradigm ask; in reference to Nikolaas Tinbergen's four categories of questions, EP typically focuses on evolutionary ("Why") questions, while EDP explicitly integrates proximate questions ("How"), with the assumption that a greater understanding of the former category will yield insights into the latter. See the following table for an overview of Tinbergen's questions.


Sequential vs. Static Perspective
Historical/Developmental Explanation of current form in terms of a historical sequence
Current Form Explanation of the current form of species
How vs. Why Questions Proximate How an individual organism's structures function
Ontogeny Developmental explanations for changes in individuals, from DNA to their current form
Mechanism Mechanistic explanations for how an organism's structures work
Evolutionary Why a species evolved the structures (adaptations) it has
Phylogeny The history of the evolution of sequential changes in a species over many generations
Adaptation A species trait that evolved to solve a reproductive or survival problem in the ancestral environment

Basic assumptions

The following list summarizes the broad theoretical assumptions of EDP. From "Evolutionary Developmental Psychology," in The Handbook of Evolutionary Psychology:
  1. All evolutionarily-influenced characteristics in the phenotype of adults develop, and this requires examining not only the functioning of these characteristics in adults but also their ontogeny.
  2. All evolved characteristics develop via continuous and bidirectional gene-environment interactions that emerge dynamically over time.
  3. Infants and children are prepared by natural selection to process some information more readily than others.
  4. Development is constrained by genetic, environmental, and cultural factors.
  5. Infants and children show a high degree of developmental plasticity and adaptive sensitivity to context.
  6. An extended childhood is needed in which to learn the complexities of human social communities.
  7. Many aspects of childhood serve as preparations for adulthood and were selected over the course of evolution (deferred adaptations).
  8. Some characteristics of infants and children were selected to serve an adaptive function at specific times in development and not as preparations for adulthood (ontogenetic adaptations).

Developmental adaptations

EDP assumes that natural selection creates adaptations for specific stages of development, rather than only specifying adult states. Frequently, EDP researchers seek to identify such adaptations, which have been subdivided into deferred adaptations, ontogenetic adaptations, and conditional adaptations.

Deferred adaptations

Some behaviors or traits exhibited during childhood or adolescence may have been selected to serve as preparations for adult life, a type of adaptation that evolutionary developmental psychologists have named "deferred adaptations". Sex differences in children's play may be an example of this type of adaptation: higher frequencies of "rough-and-tumble" play among boys, as well as content differences in fantasy play (cross-culturally, girls engage in more "parenting" play than boys), seem to serve as early preparation for the roles that men and women play in many extant contemporary societies, and, presumably, played over human evolutionary history.

Ontogenetic adaptations

In contrast to deferred adaptations, which function to prepare individuals for future environments (i.e., adulthood), ontogenetic adaptations adapt individuals to their current environment. These adaptations serve a specific function during a particular period of development, after which they are discarded. Ontogenetic adaptations can be physiological (for example, when fetal mammals deriving nutrition and oxygen from the placenta before birth, but no longer utilize the placenta after birth) and psychological. David F. Bjorklund has argued that the imitation of facial gestures by infants, which has a predictable developmental window and seemingly different functions at different ages, shows evidence of being an ontogenetic adaptation.

Conditional adaptations

EDP emphasizes that children display considerable developmental plasticity, and proposes a special type of adaptation to facilitate adaptive developmental plasticity, called a conditional adaptation. Conditional adaptations detect and respond to relevant environmental cues, altering developmental pathways in ways which better adapt an individual to their particular environment. These adaptations allow organisms to implement alternative and contingent life history strategies, depending on environmental factors.

Related research

Social learning and the evolution of childhood

The social brain (or Machiavellian) hypothesis posits that the emergence of a complex social environment (e.g., larger group sizes) served as a key selection pressure in the evolution of human intelligence. Among primates, larger brains result in an extension of the juvenile period, and some authors argue that humans evolved (and/or expanded) novel developmental stages, childhood and adolescence, in response to increasing social complexity and sophisticated social learning.

While many species exhibit social learning to some degree and seemingly possess behavioral traditions (i.e., culture), humans can transmit cultural information across many generations with very high fidelity. High fidelity cultural learning is what many have argued is necessary for cumulative cultural evolution, and has only been definitively observed in humans, although arguments have been made for chimpanzees, orangutans, and New Caledonian crows. Developmentally-oriented researchers have proposed that over-imitation of behavioral models facilitates cultural learning, a phenomenon which emerges in children by age three and is seemingly absent in chimpanzees.

Cooperation and prosociality

Behaviors that benefit other members of one's social group, particularly those which appear costly to the prosocial or "altruistic" individual, have received considerable attention from disciplines interested in the evolution of behavior. Michael Tomasello has argued that cooperation and prosociality are evolved characteristics of human behavior, citing the emergence of "helping" behavior early in development (observed among 18-24 month old infants) as one piece of evidence. Researchers investigating the ontogeny and evolution of human cooperation design experiments intended to reveal the prosociality of infants and young children, then compare children's performance with that of other animals, typically chimpanzees. While some of the helping behaviors exhibited by infants and young children has also been observed in chimpanzees, preschool-age children tend to display greater prosociality than both human-raised and semi-free-ranging adult chimps.

Life history strategies and developmental plasticity

EDP researchers emphasize that evolved strategies are context dependent, in the sense that a strategy which is optimal in one environment will often be sub-optimal in another environment. They argue that this will result in natural selection favoring "adaptive developmental plasticity," allowing an organism to alter its developmental trajectory in response to environmental cues.

Related to this is the idea of a life history strategy, which can be conceptualized as a chain of resource-allocation decisions (e.g., allocating resources towards growth or towards reproduction) that an organism makes. Biologists have used life history theory to characterize between-species variation in resource-allocation in terms of a fast-slow continuum (see r/K selection theory), and, more recently, some anthropologists and psychologists have applied this continuum to understand within-species variation in trade-offs between reproductive and somatic effort.

Some authors argue that childhood environment and early life experiences are highly influential in determining an individual's life history strategy. Factors such as exposure to violence, harsh child-rearing, and environmental unpredictability (e.g., frequent moving, unstable family composition) have been shown to correlate with the proposed behavioral indicators of "fast" life history strategies (e.g., early sexual maturation, unstable couple relationships, impulsivity, and reduced cooperation), where current reproduction is prioritized over future reproduction.

Criticism

John Tooby, Leda Cosmides, and H. Clark Barrett have refuted claims that mainstream evolutionary psychology neglects development, arguing that their discipline is, in reality, exceptionally interested in and highly considerate of development. In particular, they cite cross-cultural studies as a sort of natural developmental "experiment," which can reveal the influence of culture in shaping developmental outcomes. The authors assert that the arguments of developmental systems theorists consists largely of truisms, of which evolutionary psychologists are well aware, and that developmental systems theory has no scientific value because it fails to generate any predictions.

Debra Lieberman similarly objected to the characterization of evolutionary psychology as ignorant of developmental principles. Lieberman argued that both developmental systems theorists and evolutionary psychologists share a common goal of uncovering species-typical cognitive architecture, as well as the ontogeny of that architecture.

Global health

From Wikipedia, the free encyclopedia

Headquarters of the World Health Organization in Geneva, Switzerland.

Global health is the health of populations in the global context; it has been defined as "the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide". Problems that transcend national borders or have a global political and economic impact are often emphasized. Thus, global health is about worldwide health improvement (including mental health), reduction of disparities, and protection against global threats that disregard national borders. Global health is not to be confused with international health, which is defined as the branch of public health focusing on developing nations and foreign aid efforts by industrialized countries. Global health can be measured as a function of various global diseases and their prevalence in the world and threat to decrease life in the present day.
The predominant agency associated with global health (and international health) is the World Health Organization (WHO). Other important agencies impacting global health include UNICEF and World Food Programme. The United Nations system has also played a part with cross-sectoral actions to address global health and its underlying socioeconomic determinants with the declaration of the Millennium Development Goals and the more recent Sustainable Development Goals.

Definition

Global health employs several perspectives that focus on the determinants and distribution of health in international contexts:
Both individuals and organizations working in the domain of global health often face many questions regarding ethical and human rights. Critical examination of the various causes and justifications of health inequities is necessary for the success of proposed solutions. Such issues are discussed at the bi-annual Global Summits of National Ethics/Bioethics Councils, next in March 2016 in Berlin, with experts from WHO and UNESCO, by invitation of the German Ethics Council.

History

The 19th century held major discoveries in medicine and public health. The Broad Street cholera outbreak of 1854 was central to the development of modern epidemiology. The microorganisms responsible for malaria and tuberculosis were identified in 1880 and 1882, respectively. The 20th century saw the development of preventive and curative treatments for many diseases, including the BCG vaccine (for tuberculosis) and penicillin in the 1920s. The eradication of smallpox, with the last naturally occurring case recorded in 1977, raised hope that other diseases could be eradicated as well.
Important steps were taken towards global cooperation in health with the formation of the United Nations (UN) and the World Bank Group in 1945, after World War II. In 1948, the member states of the newly formed United Nations gathered to create the World Health Organization. A cholera epidemic that took 20,000 lives in Egypt in 1947 and 1948 helped spur the international community to action. The WHO published its Model List of Essential Medicines, and the 1978 Alma Ata declaration underlined the importance of primary health care.
At a United Nations Summit in 2000, member nations declared eight Millennium Development Goals (MDGs), which reflected the major challenges facing human development globally, to be achieved by 2015. The declaration was matched by unprecedented global investment by donor and recipient countries. According to the UN, these MDGs provided an important framework for development and significant progress has been made in a number of areas. However, progress has been uneven and some of the MDGs were not fully realized including maternal, newborn and child health and reproductive health. Building on the MDGs, a new Sustainable Development Agenda with 17 Sustainable Development Goals (SDGs) has been established for the years 2016-2030. The first goal being an ambitious and historic pledge to end poverty. On 25 September 2015, the 193 countries of the UN General Assembly adopted the 2030 Development Agenda titled Transforming our world: the 2030 Agenda for Sustainable Development.
In 2015 a book titled "To Save Humanity" was published, with nearly 100 essays regarding today's most pressing global health issues. The essays were authored by global figures in politics, science, and advocacy ranging from Bill Clinton to Peter Piot, and addressed a wide range of issues including vaccinations, antimicrobial resistance, health coverage, tobacco use, research methodology, climate change, equity, access to medicine, and media coverage of health research.

Measures

Measures of global health include disability-adjusted life year (DALY), quality-adjusted life years (QALYs), and mortality rate.

Disability-adjusted life years

Disability-adjusted life years per 100,000 people in 2004.
  No data
  Less than 9,250
  9,250–16,000
  16,000–22,750
  22,750–29,500
  29,500–36,250
  36,250–43,000
  43,000–49,750
  49,750–56,500
  56,500–63,250
  63,250–70,000
  70,000–80,000
  Over 80000
The DALY is a summary measure that combines the impact of illness, disability, and mortality by measuring the time lived with disability and the time lost due to premature mortality. One DALY can be thought of as one lost year of "healthy" life. The DALY for a disease is the sum of the years of life lost due to premature mortality and the years lost due to disability for incident cases of the health condition.

Quality-adjusted life years

QALYs combine expected survival with expected quality of life into a single number: if an additional year of healthy life is worth a value of one (year), then a year of less healthy life is worth less than one (year). QALY calculations are based on measurements of the value that individuals place on expected years of survival. Measurements can be made in several ways: by techniques that simulate gambles about preferences for alternative states of health, with surveys or analyses that infer willingness to pay for alternative states of health, or through instruments that are based on trading off some or all likely survival time that a medical intervention might provide in order to gain less survival time of higher quality.

Infant and child mortality

Infant mortality and child mortality for children under age 5 are more specific than DALYs or QALYs in representing the health in the poorest sections of a population, and are thus especially useful when focusing on health equity.

Morbidity

Morbidity measures include incidence rate, prevalence, and cumulative incidence, with incidence rate referring to the risk of developing a new health condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during a time period, morbidity is better expressed as a proportion or a rate.

Health conditions

The diseases and health conditions targeted by global health initiatives are sometimes grouped under "diseases of poverty" versus "diseases of affluence", although the impact of globalization is increasingly blurring the lines between the two.

Respiratory infections

Infections of the respiratory tract and middle ear are major causes of morbidity and mortality worldwide. Some respiratory infections of global significance include tuberculosis, measles, influenza, and pneumonias caused by pneumococci and Haemophilus influenzae. The spread of respiratory infections is exacerbated by crowded conditions, and poverty is associated with more than a 20-fold increase in the relative burden of lung infections.

Diarrheal diseases

Diarrhea is the second most common cause of child mortality worldwide, responsible for 17% of deaths of children under age 5. Poor sanitation can increase transmission of bacteria and viruses through water, food, utensils, hands, and flies. Dehydration due to diarrhea can be effectively treated through oral rehydration therapy with dramatic reductions in mortality. Important nutritional measures include the promotion of breastfeeding and zinc supplementation. While hygienic measures alone may be insufficient for the prevention of rotavirus diarrhea, it can be prevented by a safe and potentially cost-effective vaccine.

Maternal health

Maternal health clinic in Afghanistan (source: Merlin)
Complications of pregnancy and childbirth are the leading causes of death among women of reproductive age in many developing countries: a woman dies from complications from childbirth approximately every minute. According to the World Health Organization's 2005 World Health Report, poor maternal conditions are the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal deaths and injuries can be prevented, and such deaths have been largely eradicated in the developed world. Targets for improving maternal health include increasing the number of deliveries accompanied by skilled birth attendants.
68 low-income countries tracked by the WHO- and UNICEF-led collaboration Countdown to 2015 are estimated to hold for 97% of worldwide maternal and child deaths.

HIV/AIDS

The HIV/AIDS epidemic has highlighted the global nature of human health and welfare and globalisation has given rise to a trend toward finding common solutions to global health challenges. Numerous international funds have been set up in recent times to address global health challenges such as HIV. Since the beginning of the epidemic, more than 70 million people have been infected with the HIV virus and about 35 million people have died of HIV. Globally, 36.9 million [31.1–43.9 million] people were living with HIV at the end of 2017. An estimated 0.8% [0.6-0.9%] of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. The WHO African region remains most severely affected, with nearly 1 in every 25 adults (4.1%) living with HIV and accounting for nearly two-thirds of the people living with HIV worldwide. Human immunodeficiency virus (HIV) is transmitted through unprotected sex, unclean needles, blood transfusions, and from mother to child during birth or lactation. Globally, HIV is primarily spread through sexual intercourse. The risk-per-exposure with vaginal sex in low-income countries from female to male is 0.38% and male to female is 0.3%. The infection damages the immune system, leading to acquired immunodeficiency syndrome (AIDS) and eventually, death. Antiretroviral drugs prolong life and delay the onset of AIDS by minimizing the amount of HIV in the body.

Malaria

Malaria is a mosquito-borne infectious disease caused by the parasites of the genus Plasmodium. Symptoms may include fever, headaches, chills, and nausea. Each year, there are approximately 500 million cases of malaria worldwide, most commonly among children and pregnant women in developing countries. The WHO African Region carries a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths. The use of insecticide-treated bednets is a cost-effective way to reduce deaths from malaria, as is prompt artemisinin-based combination therapy, supported by intermittent preventive therapy in pregnancy. International travellers to endemic zones are advised chemoprophylaxis with antimalarial drugs like Atovaquone-proguanil, doxycycline, or mefloquine.

Nutrition

In 2010, about 104 million children were underweight, and undernutrition contributes to about one third of child deaths around the world. (Undernutrition is not to be confused with malnutrition, which refers to poor proportion of food intake and can thus refer to obesity.) Undernutrition impairs the immune system, increasing the frequency, severity, and duration of infections (including measles, pneumonia, and diarrhea). Infection can further contribute to malnutrition. Deficiencies of micronutrient, such as vitamin A, iron, iodine, and zinc, are common worldwide and can compromise intellectual potential, growth, development, and adult productivity. Interventions to prevent malnutrition include micronutrient supplementation, fortification of basic grocery foods, dietary diversification, hygienic measures to reduce spread of infections, and the promotion of breastfeeding.

Violence against women

Violence against women has been defined as: "physical, sexual and psychological violence occurring in the family and in the general community, including battering, sexual abuse of children, dowry-related violence, rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women, forced prostitution and violence perpetrated or condoned by the state." In addition to causing injury, violence may increase "women’s long-term risk of a number of other health problems, including chronic pain, physical disability, drug and alcohol abuse, and depression".
Although statistics can be difficult to obtain as many cases go unreported, it is estimated that one in every five women faces some form of violence during her lifetime, in some cases leading to serious injury or even death. Risk factors for being a perpetrator include low education, past exposure to child maltreatment or witnessing violence between parents, harmful use of alcohol, attitudes accepting of violence and gender inequality. Equality of women has been addressed in the Millennium development goals.

Chronic disease

Approximately 80% of deaths linked to non-communicable diseases occur in developing countries.For instance, urbanization and aging have led to increasing poor health conditions related to non-communicable diseases in India. The fastest-growing causes of disease burden over the last 26 years were diabetes (rate increased by 80%) and ischemic heart disease (up 34%). More than 60% of deaths, about 6.1 million, in 2016 were due to NCDs, up from about 38% in 1990. Increases in refugee urbanization, has led to a growing number of people diagnosed with chronic noncommunicable diseases.
In September 2011, the United Nations is hosting its first General Assembly Special Summit on the issue of non-communicable diseases. Noting that non-communicable diseases are the cause of some 35 million deaths each year, the international community is being increasingly called to take measures for the prevention and control of chronic diseases and mitigate their impacts on the world population, especially on women, who are usually the primary caregivers.
For example, the rate of type 2 diabetes, associated with obesity, has been on the rise in countries previously plagued by hunger. In low-income countries, the number of individuals with diabetes is expected to increase from 84 million to 228 million by 2030. Obesity, a preventable condition, is associated with numerous chronic diseases, including cardiovascular conditions, stroke, certain cancers, and respiratory disease. About 16% of the global burden of disease, measured as DALYs, has been accounted for by obesity.

Neglected tropical diseases

More than one billion people were treated for at least one neglected tropical disease in 2015. Neglected tropical diseases are a diverse group of infectious diseases that are endemic in tropical and subtropical regions of 149 countries, primarily effecting low and middle income populations in Africa, Asia, and Latin America. They are variously caused by bacteria (Trachoma, Leprosy), viruses (Dengue, Rabies), protozoa (Human African trypanosomiasis, Chagas), and helminths (Schistosomiasis, Onchocerciasis, Soil transmitted helminths). The Global Burden of Disease Study concluded that neglected tropical diseases comprehensively contributed to approximately 26.06 million disability-adjusted life years in 2010, as well as significant deleterious economic effects. In 2011, the World Health Organization launched a 2020 Roadmap for neglected tropical diseases, aiming for the control or elimination of 10 common diseases. The 2012 London Declaration builds on this initiative, and called on endemic countries and the international community to improve access to clean water and basic sanitation, improved living conditions, vector control, and health education, to reach the 2020 goals. In 2017, a WHO report cited 'unprecedented progress' against neglected tropical diseases since 2007, especially due to mass drug administration of drugs donated by pharmaceutical companies.

Health interventions

Global interventions for improved child health and survival include the promotion of breastfeeding, zinc supplementation, vitamin A fortification, salt iodization, hygiene interventions such as hand-washing, vaccinations, and treatments of severe acute malnutrition. The Global Health Council suggests a list of 32 treatments and health interventions that could potentially save several million lives each year.
Many populations face an "outcome gap", which refers to the gap between members of a population who have access to medical treatment versus those who do not. Countries facing outcome gaps lack sustainable infrastructure. In Guatemala, a subset of the public sector, the Programa de Accessibilidad a los Medicamentos ("Program for Access to Medicines"), had the lowest average availability (25%) compared to the private sector (35%). In the private sector, highest- and lowest-priced medicines were 22.7 and 10.7 times more expensive than international reference prices respectively. Treatments were generally unaffordable, costing as much as 15 days wages for a course of the antibiotic ceftriaxone. The public sector in Pakistan, while having access to medicines at a lower price than international reference prices, has a chronic shortage of and lack of access to basic medicines.
Journalist Laurie Garrett argues that the field of global health is not plagued by a lack of funds, but that more funds do not always translate into positive outcomes. The problem lies in the way these funds are allocated, as they are often disproportionately allocated to alleviating a single disease.
In its 2006 World Health Report, the WHO estimated a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide, especially in sub-Saharan Africa.

Global Health Security Agenda

The Global Health Security Agenda (GHSA) is "a multilateral, multi-sector effort that includes 60 participating countries and numerous private and public international organizations focused on building up worldwide health security capabilities toward meeting such threats" as the spread of infectious disease. On March 26-28, 2018, the GHSA held its last high-level meeting which was located in Tbilisi, Georgia on biosurveillance of infectious disease threats, "which include such modern-day examples as HIV/AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza, multi-drug resistant tuberculosis — any emerging or reemerging disease that threatens human health and global economic stability." This event brought together GHSA partner countries, contributing countries of Real-Time Surveillance Action Package, and international partner organizations supporting the strengthening of capacities to detect infectious disease threats within the Real-Time Surveillance Action Package and other cross-cutting packages. Georgia is the lead country for the Real-Time Surveillance Action Package.

Technology Feels Like It’s Accelerating — Because It Actually Is

This is the second in a four-part series looking at the big ideas in Ray Kurzweil’s book The Singularity Is Near. ​Be sure to read the other articles:

Technology goes beyond mere tool making; it is a process of creating ever more powerful technology using the tools from the previous round of innovation. –Ray Kurzweil
A decade ago, smartphones (as we know them by today’s standards) didn’t exist. Three decades earlier, no one even owned a computer. Think about that—the first personal computers arrived about 40 years ago. Today, it seems nearly everyone is gazing at a glowing, handheld computer. (In fact, two-thirds of Americans own one, according to a Pew Report.)

Intuitively, it feels like technology is progressing faster than ever. But is it really? According to Ray Kurzweil—yes, it absolutely is. In his book The Singularity Is Near, Kurzweil shows technology’s quickening pace and explains the force behind it all.

This article will explore Kurzweil’s explanation of this driving force, which he dubbed the law of accelerating returns, and the surprising implications of technology’s acceleration.

Moore’s Law is famous—but it isn’t special

Computer chips have become increasingly powerful while costing less. That’s because over the last five decades the number of transistors—or the tiny electrical components that perform basic operations—on a single chip have been doubling regularly.

This exponential doubling, known as Moore’s Law, is the reason a modern smartphone affordably packs so much dizzying capability into such a small package.

[Moore’s Law may be nearing certain physical limitations that will be challenging to overcome. Go here to learn how broad exponential growth in computing can continue.]

The technological progress in computer chips is well known—but surprisingly, it isn’t a special case. A range of other technologies demonstrate similar exponential growth, whether bits of data stored or DNA base pairs recorded. The outcome is the same: capabilities have increased by thousands, millions, and billions for less cost in just decades.

law-accelerating-returns-12
The above charts show a few examples of accelerating technologies, but more examples are plentiful. These do not directly depend on the doubling of transistor counts—and yet each one moves along its own exponential curve just as computer chips do.

So, what’s going on?

According to the law of accelerating returns, the pace of technological progress—especially information technology—speeds up exponentially over time because there is a common force driving it forward. Being exponential, as it turns out, is all about evolution.

Technology is an evolutionary process

Let’s begin with biology, a familiar evolutionary process.

Biology hones natural “technologies,” so to speak. Recorded within the DNA of living things are blueprints of useful tools known as genes. Due to selective pressure—or “survival of the fittest”—advantageous innovations are passed along to offspring.

As this process plays out generation after generation over geological timescales, chaotically yet incrementally, incredible growth takes place. By building on genetic progress rather than starting over, organisms have increased in complexity and capability over time. This innovative power is evident nearly everywhere we look on Earth today.  As Kurzweil writes:
Evolution applies positive feedback.  The more capable methods resulting from one stage of evolutionary progress are used to create the next stage.”
Biology’s many innovations include cells, bones, eyes, thumbs, brains—and from thumbs and brains, technology. According to Kurzweil, technology is also an evolutionary process, like biology, only it moves from one invention to the next much faster.

law-of-accelerating-returns-chart2
Civilizations advance by “repurposing” the ideas and breakthroughs of their predecessors. Similarly, each generation of technology builds on the advances of previous generations, and this creates a positive feedback loop of improvements.

Kurzweil’s big idea is that each new generation of technology stands on the shoulders of its predecessors—in this way, improvements in technology enable the next generation of even better technology.

Technological evolution speeds up exponentially

Because each generation of technology improves over the last, the rate of progress from version to version speeds up.

To see this, imagine making a chair with hand tools, power tools, and finally assembly lines. Production gets faster after each step. Now imagine each generation of these tools is also used to design and build better tools. Kurzweil suggests such a process is at play in the design of ever-faster computer chips with the software and computers used by engineers.
The first computers were designed on paper and assembled by hand. Today, they are designed on computer workstations with the computers themselves working out many details of the next generation’s design, and are then produced in fully automated factories with only limited human intervention. – Ray Kurzweil, The Singularity Is Near
This acceleration can be measured in the “returns” of the technology—such as speed, efficiency, price-performance, and overall “power”—which improve exponentially too.

law-of-accelerating-returns-51
The acceleration of acceleration: It’s a bit like climbing a mountain and receiving a jetpack.

Further, as a technology becomes more effective, it attracts more attention. The result is a flood of new resources—such as increased R&D budgets, recruiting top talent, etc.—which are directed to further improving the technology.

This wave of new resources triggers a “second level” of exponential growth, where the rate of exponential growth (the exponent) also begins accelerating.

However, specific paradigms (e.g., integrated circuits) won’t grow exponentially forever. They grow until they’ve exhausted their potential, at which point a new paradigm replaces the old one.

The surprising implications of the law of accelerating returns

Kurzweil wrote in 2001 that every decade our overall rate of progress was doubling, “We won’t experience 100 years of progress in the 21st century—it will be more like 20,000 years of progress (at today’s rate).” 

This suggests that the horizons for amazingly powerful technologies may be closer than we realize. Some of Ray Kurzweil’s predictions from the last 25 years may have seemed a stretch at the time—but many were right.

Like in 1990 when he predicted that a computer would beat a pro chess player by 1998, which came true in 1997 when Garry Kasparov lost to IBM’s Deep Blue. (Now, in 2016, a computer has mastered the even more complex game Go—an accomplishment not expected by some experts for another decade.)

We’re only 15 years into the 21st century and the progress has been pretty stunning—the global adoption of the Internet, smartphones, ever-more agile robots, AI that learns. We sequenced the first human genome in 2004 at a cost of hundreds of millions of dollars. Now, machines can sequence 18,000 annually for $1,000 a genome.

These are just a few examples of the law of accelerating returns driving progress forward. Because the future is approaching much faster than we realize, it’s critical to think exponentially about where we’re headed and how we’ll get there.



To learn more about the exponential pace of technology and Ray Kurzweil’s predictions, read his 2001 essay “The Law of Accelerating Returns” and his book, The Singularity Is Near.

Image Credit: Shutterstock

Social determinants of health

From Wikipedia, the free encyclopedia

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease, or vulnerability to disease or injury. The distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area. The World Health Organization says, "This unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics."

Commonly accepted determinants

Social Determinants of Health Map
 
There is no single definition of the social determinants of health, but there are commonalities, and many governmental and non-governmental organizations recognize that there are social factors which impact the health of individuals. 

In 2003, the World Health Organization (WHO) Europe suggested that the social determinants of health included:
In Canada, these social determinants of health have gained wide usage.
  1. Income and income distribution
  2. Education
  3. Unemployment and job security
  4. Employment and working conditions
  5. Early childhood development
  6. Food insecurity
  7. Housing
  8. Social exclusion/inclusion
  9. Social safety network
  10. Health services
  11. Aboriginal status
  12. Gender
  13. Race
  14. Disability
These social determinants of health are related to health outcomes, public policy, and are easily understood by the public to impact health. They tend to cluster together – for example, those living in poverty experience a number of negative health determinants.

In 2008, the WHO Commission on Social Determinants of Health published a report entitled "Closing the Gap in a Generation." This report identified two broad areas of social determinants of health that needed to be addressed. The first area was daily living conditions, which included healthy physical environments, fair employment and decent work, social protection across the lifespan, and access to health care. The second major area was distribution of power, money, and resources, including equity in health programs, public financing of action on the social determinants, economic inequalities, resource depletion, healthy working conditions, gender equity, political empowerment, constitution of reserves and a balance of power and prosperity of nations.

The 2011 World Conference on Social Determinants of Health brought together delegations from 125 member states and resulted in the Rio Political Declaration on Social Determinants of Health. This declaration involved an affirmation that health inequities are unacceptable, and noted that these inequities arise from the societal conditions in which people are born, grow, live, work, and age, including early childhood development, education, economic status, employment and decent work, housing environment, and effective prevention and treatment of health problems.

The United States Centers for Disease Control defines social determinants of health as "life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life". These include access to care and resources such as food, insurance coverage, income, housing, and transportation. Social determinants of health influence health-promoting behaviors, and health equity among the population is not possible without equitable distribution of social determinants among groups.

Steven H. Woolf, MD of the Virginia Commonwealth University Center on Human Needs states, "The degree to which social conditions affect health is illustrated by the association between education and mortality rates". Reports in 2005 revealed the mortality rate was 206.3 per 100,000 for adults aged 25 to 64 years with little education beyond high school, but was twice as great (477.6 per 100,000) for those with only a high school education and 3 times as great (650.4 per 100,000) for those less educated. Based on the data collected, the social conditions such as education, income, and race were dependent on one another, but these social conditions also apply to independent health influences.

Marmot and Bell of the University College London found that in wealthy countries, income and mortality are correlated as a marker of relative position within society, and this relative position is related to social conditions that are important for health including good early childhood development, access to high quality education, rewarding work with some degree of autonomy, decent housing, and a clean and safe living environment. The social condition of autonomy, control, and empowerment turns are important influences on health and disease, and individuals who lack social participation and control over their lives are at a greater risk for heart disease and mental illness.

International health inequalities

Even in the wealthiest countries, there are health inequalities between the rich and the poor. Researchers Labonte and Schrecker from the Department of Epidemiology and Community Medicine at the University of Ottawa emphasize that globalization is key to understanding the social determinants of health, and as Bushra (2011) posits, the impacts of globalization are unequal. Globalization has caused an uneven distribution of wealth and power both within and across national borders, and where and in what situation a person is born has an enormous impact on their health outcomes. The Organization for Economic Cooperation and Development found significant differences among developed nations in health status indicators such as life expectancy, infant mortality, incidence of disease, and death from injuries. Migrants and their family members also experience significant negatives health impacts.

These inequalities may exist in the context of the health care system, or in broader social approaches. According to the WHO's Commission on Social Determinants of Health, access to health care is essential for equitable health, and it argued that health care should be a common good rather than a market commodity. However, there is substantial variation in health care systems and coverage from country to country. The Commission also calls for government action on such things as access to clean water and safe, equitable working conditions, and it notes that dangerous working conditions exist even in some wealthy countries. In the Rio Political Declaration on Social Determinants of Health, several key areas of action were identified to address inequalities, including promotion of participatory policy-making processes, strengthening global governance and collaboration, and encouraging developed countries to reach a target of 0.7% of gross national product (GNP) for official development assistance.

Theoretical approaches

The UK Black and The Health Divide reports considered two primary mechanisms for understanding how social determinants influence health: cultural/behavioral and materialist/structuralist. The cultural/behavioral explanation is that individuals' behavioral choices (e.g., tobacco and alcohol use, diet, physical activity, etc.) were responsible for their development and deaths from a variety of diseases. However, both the Black and Health Divide reports found that behavioral choices are determined by one's material conditions of life, and these behavioral risk factors account for a relatively small proportion of variation in the incidence and death from various diseases. 

The materialist/structuralist explanation emphasizes the people's material living conditions. These conditions include availability of resources to access the amenities of life, working conditions, and quality of available food and housing among others. Within this view, three frameworks have been developed to explain how social determinants influence health. These frameworks are: (a) materialist; (b) neo-materialist; and (c) psychosocial comparison. The materialist view explains how living conditions – and the social determinants of health that constitute these living conditions – shape health. The neo-materialist explanation extends the materialist analysis by asking how these living conditions occur. The psychosocial comparison explanation considers whether people compare themselves to others and how these comparisons affect health and wellbeing. 

A nation's wealth is a strong indicator of the health of its population. Within nations, however, individual socio-economic position is a powerful predictor of health. Material conditions of life determine health by influencing the quality of individual development, family life and interaction, and community environments. Material conditions of life lead to differing likelihood of physical (infections, malnutrition, chronic disease, and injuries), developmental (delayed or impaired cognitive, personality, and social development), educational (learning disabilities, poor learning, early school leaving), and social (socialization, preparation for work, and family life) problems. Material conditions of life also lead to differences in psychosocial stress. When the fight-or-flight reaction is chronically elicited in response to constant threats to income, housing, and food availability, the immune system is weakened, insulin resistance is increased, and lipid and clotting disorders appear more frequently. 

The materialist approach offers insight into the sources of health inequalities among individuals and nations. Adoption of health-threatening behaviours is also influenced by material deprivation and stress. Environments influence whether individuals take up tobacco, use alcohol, consume poor diets, and have low levels of physical activity. Tobacco use, excessive alcohol consumption, and carbohydrate-dense diets are also used to cope with difficult circumstances. The materialist approach seeks to understand how these social determinants occur. 

The neo-materialist approach is concerned with how nations, regions, and cities differ on how economic and other resources are distributed among the population. This distribution of resources can vary widely from country to country. The neo-materialist view focuses on both the social determinants of health and the societal factors that determine the distribution of these social determinants, and especially emphasizes how resources are distributed among members of a society.

The social comparison approach holds that the social determinants of health play their role through citizens' interpretations of their standings in the social hierarchy. There are two mechanisms by which this occurs. At the individual level, the perception and experience of one's status in unequal societies lead to stress and poor health. Feelings of shame, worthlessness, and envy can lead to harmful effects upon neuro-endocrine, autonomic and metabolic, and immune systems. Comparisons to those of a higher social class can also lead to attempts to alleviate such feelings by overspending, taking on additional employment that threaten health, and adopting health-threatening coping behaviors such as overeating and using alcohol and tobacco. At the communal level, widening and strengthening of hierarchy weakens social cohesion, which is a determinant of health. The social comparison approach directs attention to the psychosocial effects of public policies that weaken the social determinants of health. However, these effects may be secondary to how societies distribute material resources and provide security to its citizens, which are described in the materialist and neo-materialist approaches.

Life-course perspective

Life-course approaches emphasize the accumulated effects of experience across the life span in understanding the maintenance of health and the onset of disease. The economic and social conditions – the social determinants of health – under which individuals live their lives have a cumulative effect upon the probability of developing any number of diseases, including heart disease and stroke. Studies into the childhood and adulthood antecedents of adult-onset diabetes show that adverse economic and social conditions across the life span predispose individuals to this disorder.

Hertzman outlines three health effects that have relevance for a life-course perspective. Latent effects are biological or developmental early life experiences that influence health later in life. Low birth weight, for instance, is a reliable predictor of incidence of cardiovascular disease and adult-onset diabetes in later life. Nutritional deprivation during childhood has lasting health effects as well. 

Pathway effects are experiences that set individuals onto trajectories that influence health, well-being, and competence over the life course. As one example, children who enter school with delayed vocabulary are set upon a path that leads to lower educational expectations, poor employment prospects, and greater likelihood of illness and disease across the lifespan. Deprivation associated with poor-quality neighborhoods, schools, and housing sets children off on paths that are not conducive to health and well-being.

Cumulative effects are the accumulation of advantage or disadvantage over time that manifests itself in poor health, in particular between women and men. These involve the combination of latent and pathways effects. Adopting a life-course perspective directs attention to how social determinants of health operate at every level of development – early childhood, childhood, adolescence, and adulthood – to both immediately influence health and influence it in the future.

Chronic stress and health

Stress is hypothesized to be a major influence in the social determinants of health. There is a relationship between experience of chronic stress and negative health outcomes. This relationship is explained through both direct and indirect effects of chronic stress on health outcomes. 

The direct relationship between stress and health outcomes is the effect of stress on human physiology. The long term stress hormone, cortisol, is believed to be the key driver in this relationship. Chronic stress has been found to be significantly associated with chronic low-grade inflammation, slower wound healing, increased susceptibility to infections, and poorer responses to vaccines. Meta-analysis of healing studies has found that there is a robust relationship between elevated stress levels and slower healing for many different acute and chronic conditions. However, it is also important to note that certain factors, such as coping styles and social support, can mitigate the relationship between chronic stress and health outcomes.

Stress can also be seen to have an indirect effect on health status. One way this happens is due to the strain on the psychological resources of the stressed individual. Chronic stress is common in those of a low socio-economic status, who are having to balance worries about financial security, how they will feed their families, housing status, and many other concerns. Therefore, individuals with these kinds of worries may lack the emotional resources to adopt positive health behaviours. Chronically stressed individuals may therefore be less likely to prioritize their health. 

In addition to this, the way that an individual responds to stress can influence their health status. Often, individuals responding to chronic stress will develop potentially positive or negative coping behaviors. People who cope with stress through positive behaviors such as exercise or social connections may not be as affected by the relationship between stress and health, whereas those with a coping style more prone to over-consumption (i.e. emotional eating, drinking, smoking or drug use) are more likely to be see negative health effects of stress.

The detrimental effects of stress on health outcomes are hypothesised to partly explain why countries that have high levels of income inequality have poorer health outcomes compared to more equal countries. Wilkinson and Picket hypothesise in their book The Spirit Level that the stressors associated with low social status are amplified in societies where others are clearly far better off.

Improving health conditions worldwide

Reducing the health gap requires that governments build systems that allow a healthy standard of living for every resident.

Interventions

Three common interventions for improving social determinant outcomes as identified by the WHO are education, social security and urban development. However, evaluation of interventions has been difficult due to the nature of the interventions, their impact and the fact that the interventions strongly affect children's health outcomes.
  1. Education: Many scientific studies have been conducted and strongly suggests that increased quantity and quality of education leads to benefits to both the individual and society (e.g. improved labor productivity). Health and economic outcome improvements can be seen in health measures such as blood pressure, crime, and market participation trends. Examples of interventions include decreasing size of classes and providing additional resources to low-income school districts. However, there is currently insufficient evidence to support education as an social determinants intervention with a cost-benefit analysis.
  2. Social Protection: Interventions such as “health-related cash transfers”, maternal education, and nutrition-based social protections have been shown to have a positive impact on health outcomes. However, the full economic costs and impacts generated of social security interventions are difficult to evaluate, especially as many social protections primarily affect children of recipients.
  3. Urban Development: Urban development interventions include a wide variety of potential targets such as housing, transportation, and infrastructure improvements. The health benefits are considerable (especially for children), because housing improvements such as smoke alarm installation, concrete flooring, removal of lead paint, etc. can have a direct impact on health. In addition, there is a fair amount of evidence to prove that external urban development interventions such as transportation improvements or improved walkability of neighborhoods (which is highly effective in developed countries) can have health benefits. Affordable housing options (including public housing) can make large contributions to both social determinants of health, as well as the local economy.
The Commission on Social Determinants of Health made recommendations in 2005 for action to promote health equity based on three principles: "improve the circumstances in which people are born, grow, live, work, and age; tackle the inequitable distribution of power, money, and resources, the structural drivers of conditions of daily life, globally, nationally, and locally; and measure the problem, evaluate action, and expand the knowledge base." These recommendations would involve providing resources such as quality education, decent housing, access to affordable health care, access to healthy food, and safe places to exercise for everyone despite gaps in affluence. Expansion of knowledge of the social determinants of health, including among healthcare workers, can improve the quality and standard of care for people who are marginalized, poor or living in developing nations by preventing early death and disability while working to improve quality of life.

Challenges of measuring value of interventions

Many economic studies have been conducted to measure the effectiveness and value of social determinant interventions but are unable to accurately reflect effects on public health due to the multi-faceted nature of the topic. While neither cost-effectiveness nor cost-utility analysis is able to be used on social determinant interventions, cost-benefit analysis is able to better capture the effects of an intervention on multiple sectors of the economy. For example, tobacco interventions have shown to decrease tobacco use, but also prolong lifespans, increasing lifetime healthcare costs and is therefore marked as a failed intervention by cost-effectiveness, but not cost-benefit. Another issue with research in this area is that most of the current scientific papers focus on rich, developed countries, and there is a lack of research in developing countries.

Policy changes that affect children also present the challenge that it takes a significant amount of time to gather this type of data. In addition, policies to reduce child poverty are particularly important, as elevated stress hormones in children interfere with the development of brain circuitry and connections, causing long term chemical damage. In most wealthy countries, the relative child poverty rate is 10 percent or less; in the United States, it is 21.9 percent. The lowest poverty rates are more common in smaller well-developed and high-spending welfare states like Sweden and Finland, with about 5 or 6 percent. Middle-level rates are found in major European countries where unemployment compensation is more generous and social policies provide more generous support to single mothers and working women (through paid family leave, for example), and where social assistance minimums are high. For instance, the Netherlands, Austria, Belgium and Germany have poverty rates that are in the 7 to 8 percent range.

Public policy

The Rio Political Declaration on Social Determinants of Health embraces a transparent, participatory model of policy development that, among other things, addresses the social determinants of health leading to persistent health inequalities for indigenous peoples. In 2017, citing the need for accountability for the pledges made by countries in the Rio Political Declaration on Social Detereminants of Health, the World Health Organization and United Nations Children's Fund called for the monitoring of intersectoral interventions on the social detereminants of health that improve health equity.

The United States Department of Health and Human Services includes social determinants in its model of population health, and one of its missions is to strengthen policies which are backed by the best available evidence and knowledge in the field  Social determinants of health do not exist in a vacuum. Their quality and availability to the population are usually a result of public policy decisions made by governing authorities. For example, early life is shaped by availability of sufficient material resources that assure adequate educational opportunities, food and housing among others. Much of this has to do with the employment security and the quality of working conditions and wages. The availability of quality, regulated childcare is an especially important policy option in support of early life. These are not issues that usually come under individual control but rather they are socially constructed conditions which require institutional responses. A policy-oriented approach places such findings within a broader policy context. In this context, Health in All Policies has seen as a response to incorporate health and health equity into all public policies as means to foster synergy between sectors and ultimately promote health. 

Yet it is not uncommon to see governmental and other authorities individualize these issues. Governments may view early life as being primarily about parental behaviors towards their children. They then focus upon promoting better parenting, assist in having parents read to their children, or urge schools to foster exercise among children rather than raising the amount of financial or housing resources available to families. Indeed, for every social determinant of health, an individualized manifestation of each is available. There is little evidence to suggest the efficacy of such approaches in improving the health status of those most vulnerable to illness in the absence of efforts to modify their adverse living conditions.

A team of the Cochrane Collaboration conducted the first comprehensive systematic review of the health impact of unconditional cash transfers, as an increasingly common up-stream, structural social determinant of health. The review of 21 studies, including 16 randomized controlled trials, found that unconditional cash transfers may not improve health services use. However, they lead to a large, clinically meaningful reduction in the likelihood of being sick by an estimated 27%. Unconditional cash transfers may also improve food security and dietary diversity. Children in recipient families are more likely to attend school, and the cash transfers may increase money spent on health care.

One of the recommendations by the Commission on the Social Determinants of Health is expanding knowledge – particularly to health care workers.

Although not addressed by the WHO Commission on Social Determinants of Health, sexual orientation and gender identity are increasingly recognized as social determinants of health.

Operator (computer programming)

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Operator_(computer_programmin...