1. Work with the concepts of life course and exposure and susceptibility in relation to risk of having and surviving a cerebral vascular accident, with potentials for good or bad outcomes when there is class, racial, gender, or geographic inequality
2. Discuss potential stroke prevention interventions at different stages of the life course and different levels of the social-ecological model, taking into account class, racial, gender or geographic inequality

Why this topic:
It is important to recognize that over the course of one’s life there are exposures that can put someone at advantage or disadvantage regarding health risks. This is true for stroke. What are the upstream exposures? How can we explain these exposures and their health consequences to others including our patients?

Before class: (what is written below is also in a word doc version)

1. Review risk factors for stroke at link (Links to an external site.)Links to an external site..
2. Explore the CDC website: Interactive Atlas of Heart Disease and Stroke (Links to an external site.)Links to an external site.

  Think about the following questions:

  • How does the WWAMI compare to the rest of the country with regards to stroke prevalence and death from stroke?
  • What does the prevalence of stroke look like in your Foundations WWAMI state?
  • When looking at your WWAMI state, are there disparities among individual counties?
  • Are there risk factors, social and economic characteristics, health behaviors, or access to care measures that you find surprising for your Foundations state and its individual counties? Use data and filter options to see disparities within individual counties.

3. Read the “Future Directions” section (pages 887-888) pdf which is extracted from Harvanek et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association Circulation 2015  (Links to an external site.)Links to an external site.(link for those who want to read the entire article) about social determinants of health and their impact on cardiovascular disease. Cardiovascular disease risk is often used as a surrogate for stroke risk.

4. Come to class prepared to think about influences on a person’s risk of having a stroke (remember that the impact is multi-factorial) and be prepared to discuss the article. In particular, how might physicians communicate inequities within risk factors that lead to disparities for strokes and their outcomes.

5. Read Perzynski et al., Informing Policy for Reducing Stroke Health Disparities from the Experience of African American Male Stroke Survivors 2015 and think about how one can improve stroke health disparities as a society and as an individual physician.

In Class

Stroke SDH PowerPoint

During the session you will be divided into smaller groups. Each of small groups will be provided with a clinical vignette highlighting a patient diagnosed with a stroke. Keep the following concepts in mind.

1. Over a life course there are various pathways to health and disease.
2. There are effects of exposures, with cumulative interplay and effects.

Working as a groups and using the Social Ecological Model, give examples of the pathways and exposures that might have advantaged or disadvantaged the patient described in the clinical vignette. One member from your group will type out your group’s thoughts into a public Google spreadsheet. Specifics for using the spreadsheet will be given in class. Consider these questions:

  • What elements of the individual’s history suggest possible positive and negative pathways and exposures?
  • If you were to write the fictional (but realistic) story of the individual’s life, what other possible positive and negative pathways and exposures can you think of? Do NOT stereotype the individual. DO think of the complex interplay of factors throughout the life course, and the influence of factors at all levels of the social ecological model. Use the case as a sketch, and paint the rest of the picture.
  • What factors, if present in the case, or worth exploring, might have put this person at increased risk for stroke?
  • What factors might influence the likelihood of surviving the stroke?