Equilibrium and Social Determinants of Health

    When we study the causes of a disease, our focus is placed on the biochemical and molecular aspects of the condition. New discoveries and breakthroughs in genetics and molecular biology have changed diagnosis and treatment in the medical field. However, these advances have been coupled with a growing interest from medical organizations and providers about the context and conditions where patients live, and the influence of their environment. For example, why non-Caucasian ethnicities have more prevalence on Diabetes? -especially Diabetes II. Is it only about predisposition due to slight variances in the genetic makeup of different racial groups? Or is it more related to social, cultural and economic factors?

The idea of everything being related and equilibrium has always resonated with me. Growing up, my family believed in many different forms of alternative medicine that had equilibrium and balance as an important tenant in their ideology. My favorite class in undergrad was Biochemistry because I could finally use the knowledge gathered during my introductory Biology and Chemistry classes. Additionally, I learned how interconnected all the cellular pathways in the body are. What impressed me was how a slight biochemical change inside our organism can cause an imbalance on a different step of another metabolic pathways. For example, Glucagon and Insulin are two sides of the same coin. They’re strictly regulated by other hormones and their opposite functions are carefully connected. The hepatic insulin response depends on the feeding state of the organism. Once released, the muscles get their energy after glucose enters peripheral tissues. This repeating cycle wouldn’t be possible without numerous interconnections, regulators and intermediates. In the same way that airplanes follow air routes at specific locations and altitudes, we have similar interconnected pathways where biomolecules travel to perform their function. 

 

Learning about Ayurveda made me reflect on how their principles are in accord to what we know about organisms. For example, in the cell, no organelle acts completely independent of the others. Instead, they share functions and pathways. It follows then, that parts of our bodies are interconnected and can suffer similar fate once the normal equilibrium is disrupted. Ayurveda emphasizes balance. When illness is present, the biochemical balance in our organ systems is affected. Some molecular compounds become elevated while others suffer the opposite fate. This correlates to what Ayurveda proclaims: disease is born once the bodily and mental doshas have an imbalance. For them, health is achieved when balance exists between the fundamental 3 doshas. Ayurveda uses of herbs, diet, exercise, meditation and yoga to promote a healthy lifestyle as part of their treatment; practices which are also supported by research as promoters of good health. Ayurveda seeks balance through some of the most promoted ideas of the last few decades, and their objective is the same as western allopathic medicine: prevent illness and foster wellness and longevity. Additionally, Ayurveda doesn’t only care about physical symptoms. Their pursuit of harmony and balance is also meant for spiritual, mental and social health. Contrastingly, allopathic medicine has come a long way to finally recognize the significant impact of mental and emotional problems in individuals. Internal and external factors can disrupt our mental equilibrium, and Ayurveda attempts to give people the skills necessary to recover it.  

 

A classic example regarding the effects of the disruption of equilibrium in our organisms is Diabetes. A chronic condition with such significant effects on patients and their families that it’s considered a pandemic. When we learn evaluate the socioeconomic toll of Diabetes on the overall healthcare system in the U.S., we can better understand why a chronic condition can be labelled as such. For example, the annual average costs of a diabetic person are 2.3 times higher than of any other patient. Most diabetic patients are elders who are covered by Medicare, thus the responsible party to cover those costs are the taxpayers who fund this government program. Furthermore, these costs are severely impacted by the complications provoked by Diabetes, so expenses keep piling up as we continue to explore all the difficulties that Diabetes produces. And things get considerably more complex when we have to evaluate the socioeconomic aspect of the condition. Low-income, family composition, stressors, level of physical activity, job situation, living conditions and many other factors that will influence not only the diagnosis, but the follow-up and treatment of individuals who don’t get sick in a vacuum. Rather, their conditions frequently are a natural consequence of their social determinants and their prognosis is also strictly dependent on them. 

 

An additional illustration of social determinants of health can be found in the relationship between aggression and low blood glucose concentration. The paper Sweetened blood cools hot tempers: physiological self-control and aggression dug deep on the science behind self-control. The authors explained that act of self-control consumes more glucose than other regular processes and this study confirmed their hypothesis of participants behaving less aggressively if they had a glucose beverage beforehand compared to those who only consumed a placebo drink. Further studies found correlation between the low blood glucose diabetic patients have and aggressiveness through low self-control, and high violent crime rates. Being diabetic or having another condition that lowers blood glucose are certainly not taking into account when prosecuting individuals who commit such crimes, but according to this study, it surely influences their capacity to self-control. 

 

How are balance and equilibrium related to the larger context and conditions of patients that are called social determinants? The socioeconomic aspects of patients and public health are becoming areas that are increasingly taken into consideration for medical professionals. A research article called Determinants of Health and Well-Being for Children of Immigrants: Moving From Evidence to Action concludes: “A growing body of evidence indicates that the psychological, behavioral, and physical health of populations in general—and child and youth populations in particular—are strongly socially determined.” This is just another evidence that the bigger picture and broader perspective need to be taken into consideration when dealing with patients. The challenges present for immigrants and their children influence their health, but are they being evaluated by their medical providers? What do these families are doing to overcome their challenges? And what about diabetic patients? What can they do to achieve healthy lives despite the imbalances present in their organisms? Ayurveda promotes many complimentary practices such as healthy diet, exercise, yoga or meditation that can positively influence the health of struggling individuals. But, are these practices enough? Are they effective? These are some questions that usually can only be answered by ourselves. At the end of the day, it’s our responsibility to figure out what works for us and make plans to achieve healthy lifestyles. 

 

References

 

DeWall CN, Deckman T, Gailliot MT, Bushman BJ. Sweetened blood cools hot tempers: physiological self-control and aggression.  Aggress Behav. 2011;37(1):73-80. doi:10.1002/ab.20366

 

Rojas-Flores, L., Vaughn, J. M., & Foundation for Child Development. (2019). Determinants of Health and Well-Being for Children of Immigrants: Moving from Evidence to Action. Young Scholars Program Research Summary. In Foundation for Child Development. Foundation for Child Development.