Case Analysis: Social Determinants of Health in DOH222 - Mr. AB's Case

This report provides a comprehensive analysis of Mr. AB's health, focusing on the social determinants impacting his well-being. The case study reveals Mr. AB, a 27-year-old IT specialist and vlogger, faces multiple health challenges, including obesity, high blood sugar, and elevated cholesterol levels, placing him at risk for type 2 diabetes and cardiovascular diseases. The report examines Mr. AB's unhealthy lifestyle, including irregular eating habits, high consumption of sugary drinks and snacks, a sedentary lifestyle, and an unbalanced diet lacking essential nutrients like proteins, carbohydrates, and vitamins. The analysis highlights the influence of employment and working conditions, health behaviors, and limited social interaction as key social determinants affecting his health. The report discusses the risks associated with chronic periodontal disease, and the lack of essential nutrients. The report concludes by emphasizing the interconnectedness of these factors and recommends lifestyle changes, including dietary modifications, increased physical activity, and the development of healthier behaviors to mitigate his health risks and improve his overall quality of life.

DOH222 Assessment Item 2 – Social determinates of health case analysis

Introduction
‘this assignment is based on the case study of Mr AB. He is a 27 years old IT specialist who
lives and works in Canberra. He has recently been advised that his blood sugar levels are
higher than normal and his weight is also higher than normal weight with the current
cholesterol level is 5.7mmol/L. He works in the day as the IT specialist and also work in
night as a Vlogger. He is not very enthusiastic about cooking his own meal at home therefore,
he eats out most of the night. Due to his two jobs, his meal and snack times is often irregular.
Case study also informs that he has high intake of the sugary drinks and snack, so that he
could stay alert at night or day while working. Although, he is a vegetarian, but he has a
sedentary lifestyle and do not take part in exercise or social interactions, rather prefers to
have online presence and interactions. Through all his meals from morning till night, he
intakes sugary food, high level of carbs, caffeine, fast food and energy drinks.
All the information about the patient informs that through his unhealthy lifestyle, he has
compromised his health and may suffer from significant chronic diseases. Some of the
significant health risks are obesity, diabetes and cardiovascular diseases (Berenson &
Bogalusa Heart Study Group, 2012). Mr AB currently suffers from Chronic Periodontitis,
which is a chronic condition affecting the teeth and gums. Therefore, there are various risk
factors that can influence the health outcomes for the patient. Such social determinants of
health may include employment and working condition, physical environment, social support
and healthy behaviour (American Academy of Family Physicians, 2018). Therefore, this
report will provide a critical analysis of the case study and will focus on identifying the major
health risks associated with patient’s condition, main social determinants of health affecting
Mr AB and how these determinants can affect his quality of life and well-being.

Assessment of Individual Health and Health Outcomes
There are various social determinants of health associated with the health of Mr AB.
According to the study of Marmot, & Allen, (2014), social determinants of health are the
social, environments and physical factors that influence the health status of the individual.
These determinants can also be considered as the social, environmental, and physical
conditions in which an individual grow, live, work and age (Braveman & Gottlieb, 2014).
According to the evidences from the case study, patient is overweight. His weight is 115 Kgs,
while the ideal weight of such individual should be between 50 to 60 Kgs. Therefore, the
patient suffers from Obesity. According to the study of Polikandrioti, & Stefanou, (2009)
Obesity has can be defined “as the accumulation of fat in the human body beyond the amount
required for the normal body function” (p. 133). According to various studies the risk of
diabetes mellitus significantly increases in the case of obese patients. Al-Goblan, Al-Alfi, &
Khan, (2014) have also identified that body mass index has a strong relationship with
diabetes and insulin resistance in patient, whose body weight is very high than normal.
In the individuals suffering from obesity, “the amount of nonesterified fatty acids, glycerol,
hormones, cytokines, proinflammatory markers, and other substances that are involved in the
development of insulin resistance, is increased” (Al-Goblan, Al-Alfi, & Khan, 2014, p. 587).
According to the evidence from the case study it is clear that Mr AB has also been diagnosed
with the higher level of blood glucose. Therefore, the patients suffering with obesity have the
impaired β-islet cells, which results in poor control over the blood glucose levels (Esser et al,
2014). Therefore, Mr AB is at significant risk of developing the problem of type 1 diabetes or
type 2 diabetes.
Type 1 diabetes is characterised with the damage of the pancreatic cells due to various
environmental of infectious agents (Lumeng, & Saltiel, 2011). Sometimes the patients are

susceptible to genetic alterations and due to this the immune system is triggered and produce
an immune response against the affected β-cells (Lumeng, & Saltiel, 2011). However, such
type of diabetes is more common in children and can also occur in adults who are in their late
thirties and forties. Type 2 diabetes is more common in the patients suffering with obesity,
have poor diet and are physically inactive (sedentary lifestyle) (Park, Sadanala, & Kim,
2015). The main risks associated with type 2 diabetes that can affect health outcomes of
patient are renal diseases, blurred vision, foot ulcers, and significantly affects the quality of
life (Lee et al, 2016).
Another health problem that patient suffers from is chronic periodontal disease. This disease
is caused due to the high intake of sugar and characterised by plaque building and slow
destruction of the gums and bones and can also result in loss of teeth if not effectively treated
(Stabholz, Soskolne, & Shapira, 2010). According to the study of AlJehani (2014)
“Periodontitis is one of the most ubiquitous diseases and is characterized by the destruction
of connective tissue and dental bone support following an inflammatory host response
secondary to infection by periodontal bacteria” (p. 1). Some of the symptoms of this disease
identified in the case of Mr AB are building of plaque, interproximal calculus and generalised
black and green staining.
The diet or the meal that individual take also affects the health and well-being of the
individual (Varucha, et al, 2016). Studies have identified that high level of the sugar intake is
very harmful for the body. Therefore, in the case of Mr AB the level of blood glucose level
has increased due to the obesity. The diet also has the link with increased level of blood
glucose. Mr AB takes sugary food in all meals of the day. Therefore, the level of sugar is
very high in the body. However, the impaired pancreatic cells could not absorb this blood
sugar and could not cover them in energy, therefore, the level of sugar increases in blood,
resulting in the risk of type 2 diabetes (Sami et al, 2017).

Another health risk is sedentary lifestyle that affects the well-being of the patient. Case study
informed that Mr. AB is not very interested in exercise and spend more time in displaying the
online presence. Owen et al (2010) has also identified sedentary lifestyle behaviour is very
risky, as it can result multiple chronic conditions. Some of the chronic conditions or the
diseases that could affect health and well-being of individuals due to sedentary lifestyle are
cardiovascular disease, obesity, diabetes mellitus etc (Klaren, Hubbard, & Motl, 2014).
Klaren, Hubbard, & Motl, (2014) has further identified that sedentary lifestyle is significantly
associated with the employment status, occupation and lifestyle choices of the individuals
and such sedentary behaviour is associated with significant disability and chronic health
outcomes. The may key nutrients that are missing from the diet of Mr AB are proteins,
carbohydrates and vitamins, because he is mainly dependent in the sugary drinks and fast
food that have high levels of cholesterol.
Nutritional Analysis
Protein is the very significant part of the human diet. Intake of the protein is important for
enhancing the muscle strength and encourage fat burning. According to the study of
Comerford, & Pasin, (2016), adequate intake of protein is associated with the lower risk of
type 2 diabetes and obesity. Protein also have the glucoregulatory qualities that help in
reducing the risk of type 2 diabetes. The effective balance of the protein can be maintained
through higher intake of the dairy products and various plant based and animal-based food
products. Studies have also identified that protein intake is equally important as the intake of
the carbohydrate stimulating the insulin secretion and reducing the risk of obesity and type 2
diabetes (Bray et al, 2016). However, the lack of protein resulted in increasing the sugar level
and increased weight in the case of Mr. AB.

Evidences from the literature has shown that carbohydrates can significantly help in
managing weight and preventing diabetes, heart disease, intestinal disease and heart diseases
(Ludwig et al, 2018). Carbohydrates are also considered as the only micronutrient that has no
minimum intake requirement. However, Mr AB have the high intake of the starchy and
sugary food and have the lack of the fibre in the diet. This results in affecting the health
condition because the sugary, sweetened drinks have the higher level of the ectopic fat, which
results in increasing the body weight (Kokkinidou et al, 2018).
Another important micronutrient that is significant for the human health is vitamin. Vitamin
A, B, C and D are significant for the proper functioning of the body. Vitamin help in the
production of energy in the body, helps body to use the protein, carbohydrates and fat to
make energy, helps in storing energy in in muscles and liver by using protein and glycogen,
helps in making white blood cell and prevents cell damage (Carr, & Lykkesfeldt,
2018; Abbaspour, Hurrell, & Kelishadi, 2014). Mr AB’s diet significantly lack the
appropriate intake of whole grains, vegetables, fruits and milk products that are significant
source of vitamin (Carr & Lykkesfeldt, 2018). These are some significant reason that affect
the well-being of Mr. AB, because of the imbalanced and inappropriate diet.
Social determinants
Therefore, some of the significant social determinants of health for Mr AB are employment
and work condition, health education, and social interactions. The first main social
determinant that affects the health of individual is employment and work conditions
(Andermann, 2016). Mr AB has two jobs, sue to which he did not get time to access quality
and healthy food and has adopted an unhealthy behaviour. Due to the employment and
working conditions the individual is affected by limited availability of fresh food and few
recreational opportunities. This further results in suboptimal nutrition and lack of physical

activity. Lack of supportive environment is considered as very important for physical activity
and nutritional intake (Nobel et al, 2015).
Studies have identified that health behaviour is significantly affected by the social and
environmental factors (Andermann, 2016). Health behaviour of the individual is a significant
risk factor, because it affects the adoption of healthy lifestyle, physical activity and intake of
appropriate nutrients (Braveman, & Gottlieb, 2014). Mr AB lacks the appropriate health
behaviour, such as lack of physical activity, intake of unhealthy food, lack of social
interactions and lack of rest, which significantly affects his health condition. According to the
analysis of his diet, it has been identified that he has unbalanced diet through out his day and
in all his meal, which results in increasing fat, cholesterol and glucose level (Braveman, &
Gottlieb, 2014). These are some significant determinants that affect is health and well-being.
Conclusion
The main aim of this assignment was to discuss the case study of Mr AB and to analyse his
health behaviour that affects his physical health condition. This report informs that Mr AB
has various health condition that are linked to his sedentary lifestyle, lack of nutrients and his
health behaviour. This report informs that all of the identified problems are interlinked and
are affecting the condition of Mr. AB. He is at the high risk of developing diabetes,
cardiovascular disease and other chronic condition in near future. His chronic periodontal
disease is mainly due to the high level of the sugary food that he intakes through out his day
and in all his meal.
This report provides various comprehensive evidences from the current review of literature.
Mr AB is suffering from obesity, as his weight is significantly higher than normal body
weight. He has also been diagnosed with the high blood glucose and cholesterol levels, which
indicate the risk of type 2 diabetes and heart diseases. Therefore, it can be recommended that

it is significant for Mr AB to adopt a healthy lifestyle, reduce the intake of sugar,
participating in physical exercise and developing healthy behaviour that could reduce the risk
of various chronic diseases.
References

Abbaspour, N., Hurrell, R., & Kelishadi, R. (2014). Review on iron and its importance for
human health. Journal of research in medical sciences: the official journal of Isfahan
University of Medical Sciences, 19(2), 164.
AlJehani, Y. A. (2014). Risk factors of periodontal disease: review of the
literature. International journal of dentistry, 2014. 1-9
Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes
mellitus and obesity. Diabetes, metabolic syndrome and obesity: targets and
therapy, 7, 587.
American Academy of Family Physicians. (2018). Social Determinants of Health guide to
social needs screening tool and resources. Retrieved from:
https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/sdoh-
guide.pdf
Andermann, A. (2016). Taking action on the social determinants of health in clinical practice:
a framework for health professionals. CMAJ, 188(17-18), E474-E483.
Berenson, G. S., & Bogalusa Heart Study Group. (2012). Health consequences of
obesity. Pediatric blood & cancer, 58(1), 117-121.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider
the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Bray, G. A., Redman, L. M., de Jonge, L., Rood, J., & Smith, S. R. (2016). Effect of three
levels of dietary protein on metabolic phenotype of healthy individuals with 8 weeks
of overfeeding. The Journal of Clinical Endocrinology & Metabolism, 101(7), 2836-
2843.

Carr, A. C., & Lykkesfeldt, J. (2018). Vitamin C in health and disease. MDPI-
Multidisciplinary Digital Publishing Institute.
Comerford, K., & Pasin, G. (2016). Emerging evidence for the importance of dietary protein
source on glucoregulatory markers and type 2 diabetes: different effects of dairy,
meat, fish, egg, and plant protein foods. Nutrients, 8(8), 446.
Esser, N., Legrand-Poels, S., Piette, J., Scheen, A. J., & Paquot, N. (2014). Inflammation as a
link between obesity, metabolic syndrome and type 2 diabetes. Diabetes research and
clinical practice, 105(2), 141-150.
Klaren, R. E., Hubbard, E. A., & Motl, R. W. (2014). Efficacy of a behavioral intervention
for reducing sedentary behavior in persons with multiple sclerosis: a pilot
examination. American journal of preventive medicine, 47(5), 613-616.
Kokkinidou, S., Peterson, D., Bloch, T., & Bronston, A. (2018). The Important Role of
Carbohydrates in the Flavor, Function, and Formulation of Oral Nutritional
Supplements. Nutrients, 10(6), 742.
Lee, B., Trence, D., Inzucchi, S., Lin, J., Haimowitz, S., Wilkerson, E., ... & Dex, T. (2016).
Improving type 2 diabetes patient health outcomes with individualized continuing
medical education for primary care. Diabetes Therapy, 7(3), 473-481.
Ludwig, D. S., Hu, F. B., Tappy, L., & Brand-Miller, J. (2018). Dietary carbohydrates: Role
of quality and quantity in chronic disease. Bmj, 361, k2340.
Lumeng, C. N., & Saltiel, A. R. (2011). Inflammatory links between obesity and metabolic
disease. The Journal of clinical investigation, 121(6), 2111-2117.

Marmot, M., & Allen, J. J. (2014). Social determinants of health equity. American Journal of
Public Health, 104(S4), S517-S519. Retrieved from:
https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2014.302200
Noble, N., Paul, C., Turon, H., & Oldmeadow, C. (2015). Which modifiable health risk
behaviours are related? A systematic review of the clustering of Smoking, Nutrition,
Alcohol and Physical activity (‘SNAP’) health risk factors. Preventive medicine, 81,
16-41.
Owen, N., Sparling, P. B., Healy, G. N., Dunstan, D. W., & Matthews, C. E. (2010,
December). Sedentary behavior: emerging evidence for a new health risk. In Mayo
Clinic Proceedings (Vol. 85, No. 12, pp. 1138-1141). Elsevier.
Park, S., Sadanala, K. C., & Kim, E. K. (2015). A metabolomic approach to understanding
the metabolic link between obesity and diabetes. Molecules and cells, 38(7), 587.
Polikandrioti, M., & Stefanou, E. (2009). Obesity disease. Health science journal, 3(3), 133-
138.
Stabholz, A., Soskolne, W. A., & Shapira, L. (2010). Genetic and environmental risk factors
for chronic periodontitis and aggressive periodontitis. Periodontology 2000, 53(1),
138-153.
Sami, W., Ansari, T., Butt, N. S., & Ab Hamid, M. R. (2017). Effect of diet on type 2
diabetes mellitus: A review. International journal of health sciences, 11(2), 65.
Varucha, M., A.K. Shrivastava, S.P. Shukla, Mohammad Israil Ansari. (2016). Effect of
sugar intake towards human health. Saudi Journal of Medicine, 1(2), 29-36. Retrieved
from:

https://www.researchgate.net/publication/309490279_Effect_of_sugar_intake_toward
s_human_health