Hello, I'm Dr Sheila smith. I use she/her pronouns. I'm a clinical professor at the University of Minnesota school of nursing. This is part one of the two current series. Minority stress theory as a component of social determinants of health and health disparities. I hope you enjoy this content and find it meaningful to your overall understanding of disparities and social determinants. Four learning objectives have been identified for this module. They offer you to describe minority stress theory and understand its relationship to social determinants of health. Explain how systemic discrimination creates and sustains minority stress. Appraised the impact of minority stress on the health and well being of non dominant population sectors. And proposed ways to use data to counter the effects of minority stress and decrease health disparities. Learning activities from one of this module include video for you to watch on Youtube. Excuse me, two videos for you to watch on Youtube in an article by Elon musk Myrrh on the minority stress theory, which will help describe the theory overall. In earlier modules, we were introduced to the hourglass model of data to action for social determinants of health. In this module, the content is situated at the person, family, community and social political levels. We'll start by examining the relationship between health disparities and disadvantaged social status. We know that large and persistent health disparities for minority populations have been more documented. Many disparities are attributed to widespread stigmatization and discrimination against persons with disadvantaged social status. An example we have seen in this graph comparing chronic disease, death rates in the US by race and ethnicity where diabetes is representative. Heart disease in red and cancers in the brain. Grids for white americans are on the left followed by black americans, Hispanic americans, Native americans in the asian pacific island groups. In the US death rates for these three disease categories are highest for african americans with over twice as many diabetes death as compared to whites. Over 25% more heart disease deaths and 20% more cancer deaths. This clearly points to health disparities with the question becoming, why would such health disparities exist and why have they been so stable and stubborn over time? One explanation can be found in the power and privilege paradigm. This is an explanatory framework in which those with greater access to social power and privilege also have greater access to social resources, advantages and protections. And those with historically less social power, those who are minorities or marginalized have fewer social resources, fewer protections and are disadvantaged by these differences and privileges. For those in disadvantaged groups, the structural systems of power and privilege, resulting pervasive social and structural inequalities, stigma and actual discrimination events with impacts far beyond the control of the individual. Minority stress is a term that was developed in 2003 to describe this phenomenon. The concept of minority stress describes the chronically high levels of stress faced by members of stigmatized minority groups. The way in which these stressors are caused by multiple intersecting factors such as historical discrimination and disenfranchisement experiences of interpersonal prejudice. And discrimination prejudice events .for social supports, low socioeconomic status and decrease access to resources and opportunities. Minority stress theory provides a causal model to explain how adverse social conditions cause chronic and accumulating stress to an individual or to groups, families and communities. This slide shows the general elements of minority stress theory. There are overarching conditions of the lived social environment, minority status and identity and general life suppressors. These lead to both distal and proximal stressors, distal stressors are defined as those objectives. Prejudicial events directed towards the individual or the community, including discrimination events and finals. Proximal stressors are defined as the individual's personal subjective response to both the large social environment and medicinal stressors. This frequently result in personally damaging responses such as stereotype threat, expectations of rejection, concealment and the attendant isolation and marginalization. Internalized bias towards oneself among community members. The distal and proximal stressors and combination of various coping and social support combined over a lifetime to affect overall physical and health outcomes leading to health disparities and more negative outcomes. Ultimately, minority stress is a social determinant of health that leads to an excess and cumulative impact from prejudice stigma, discrimination experienced by members of the socially disadvantaged groups. And that results in significant personal family and community distress. These are accompanied by negative social economic and health implications. These next four slides show some examples of population and health demographics illustrating the relationship between health disparities and disadvantaged status. The first example shows US chronic disease death rates by race and ethnicity for the conditions of diabetes, heart disease and cancer. As can be seen across all these categories, death rates for white americans are much lower than for black americans. This example shows health statistics for LGBT group, LGBT persons with LGBT persons. Twice as likely to smoke 10 times more likely to get cancer screenings and for gay and bisexual men, times more likely to be diagnosed with HIV low and middle income. LGBT persons are also uninsured and higher rates. The next example shows health disparities between white and native american populations. Looking at these rates of obesity, diabetes, hypertension and heart disease across the two groups. Other differences can be attributed to health disparities, some of which are caused by the social determinant of minority stress. The final example shows elderly, American Indian and Alaska native self perception of overall health. As compared to the US general population of persons age 65 and older,as can be seen in the column on the right twice as many Alaska Native and American Indian elders report for health than the general population. Collectively, these examples illustrate some of the widespread health disparities that have been documented for socially disadvantaged groups and that serve as examples of the impact of minority stress theory. We can summarize some of the important aspects of minority stress with research of Dr Miner and his colleagues demonstrating that minority stress is unique, it is chronic and it's socially based. It's unique in that minority stress it's additive to general stressors that are experienced by all people and therefore socially stigmatized persons carry an additional burden. And are required adaptation effort above that required of similar others who are not stigmatized. It is chronic and that it is related to relatively stable underlying social and cultural structures of power and inequality. And it is socially based and that it stems from social processes, institutions and structures beyond the individual and therefore can be categorized as a social determinant of health. Part of this equation is the experience of stigma, stigma can be defined as a shared discrimination against an identifiable group of people or a distinguishing characteristic or trade that is socially undervalued or disapproved by the dominant social group. Stigma is a socially accepted form of negative regard for others associated with devaluated circumstances, quality or characteristics. Stigma relates to both proximal and distal stressors where you might recall that distal stressors are the impact of external objective stressful events of social conditions. And proximal stressors are the internal subjective appraisal and state of mind creating distal stressors. To summarize stigma structural inequalities and real discrimination events, both exert distal and proximal effects. Basically to significant distress negative social and economic effects and negative health implications over time. This concludes part one of the module on minority stress theory. I invite you now to complete the module activities and then proceed to part two of this module for further discussion of the effects of minority stress as a social determinant of health. Thank you.