Jose and Jorge were identical twins separated at birth. Josegrew up in a large family in an impoverished slum in the middle ofa crime-ridden and polluted district of a major city. Jorge grew upin an upper-middle-class professional family with one other brotherin a sub urban community in the same city. Despite the fact theJose and Jorge were identical twins, their lives and health couldnot have been more different.
Jose had few opportunities for medical care or public healthservices as a child. His nutrition was always marginal and hedeveloped several severe cases of diarrhea before he was 1 year ofage. He received a polio vaccine as part of a community vaccinationprogram, but never received vaccinations for measles, mumps,rubella, or other childhood illnesses. At age 4, he developedmeasles and was so sick his mother was sure he would not makeit.
As a child, Jose also developed asthma, which seemed to worsenwhen he played outdoors on hot smoggy days. Dropping out of schoolat age 14, Jose went to work in a factory, but quit when he foundhimself panting for breath at the end of the day.
As a teenager, Jose was repeatedly exposed to crime and drugs.Once, he was caught in the cross fire of gangs fighting for controlof drugs in his comÂmunity. Experimenting with drugs with histeenage friends, Jose contracted HIV from use of contamÂinatedneedles. Jose did not know he had HIV until he was nearly 30 yearsold and developed tuberculosis (TB). He did receive treatment forthe TB free of charge from the health department, but once he feltbetter, he did not follow up with treatment.
By the time the TB returned, Jose had lost 30 pounds and couldbarely make it into the emer gency room of the public hospitalbecause of his shortness of breath. He was hospitalized for thelast 2 months of his life, mostly to prevent others from beingexposed to what was now drug-resistant tuberculosis. No one everknew how many people Jose exposed to HIV orTB.
Jorge's life as a child was far less eventful. He received\"well child\" care from an early age. His famÂily hardly noticedthat he rarely developed diarrhea and had few sick days fromdiseases of childhood. He did well in school, but like Jose, hedeveloped asthma. With good treatment, Jorge was able to play onsports teams, at least until he began to smoke cigarettes at age14.
Jorge soon began to gain weight, and by the time he graduatedfrom college, he was rapidly becoming obese. In his 20s, hedeveloped high blood pressure, and in his 30s he had early signs ofdiabetes. Jorge had a heart attack in his mid-40s and underwentbypass surgery a few years later. The treatments for diabetes,hypertension, and high cholesterol worked well and Jorge was ableto lead a productive professional life into his 40s.
By the time that Jorge turned 50, his diabetes began to worsenand he developed progressive kid ney disease. Jorge soon neededtwice-a-week dial ysis, which kept him alive as he awaited akidney transplant.
1.How do social determinants of health contrib ute to thedifferent disease patterns of Jose and Jorge?
2.How do factors in the physical environment explaindifferences in the health of Jose and Jorge?
3.What role does medical care play in the differ encesbetween the health outcomes of Jose and Jorge?
4.What roles do public health services play in the healthoutcomes of Jose and Jorge?
