{
  "module": "101.3",
  "title": "101.3 Upstream: The Social Determinants of Health",
  "pass_percent": 75,
  "pre_test": {
    "graded": false,
    "questions": [
      {
        "question": "Social determinants of health are best described as:",
        "options": [
          "The genes we inherit",
          "Conditions where people live, learn, work, play, worship and age",
          "The medicines a doctor prescribes",
          "Only a person's daily choices"
        ],
        "correct": 1,
        "explanation": "Healthy People 2030 defines SDOH as the conditions in the places where people live their lives."
      },
      {
        "question": "Which is one of the five Healthy People 2030 domains?",
        "options": [
          "Neighborhood and built environment",
          "Genetics and family history",
          "Personal responsibility",
          "Hospital ratings"
        ],
        "correct": 0,
        "explanation": "Neighborhood and built environment is one of the five domains."
      },
      {
        "question": "In the river story, going upstream means:",
        "options": [
          "Swimming faster",
          "Ignoring the people in the river",
          "Finding and fixing the cause of the problem",
          "Calling for more boats"
        ],
        "correct": 2,
        "explanation": "Upstream work looks for the root cause so fewer people are harmed."
      },
      {
        "question": "In 2019, the gap in life expectancy between two Cuyahoga County tracts less than two miles apart was about:",
        "options": [
          "2 years",
          "5 years",
          "10 years",
          "23 years"
        ],
        "correct": 3,
        "explanation": "The Center for Community Solutions found a gap of more than 23 years."
      },
      {
        "question": "A rental home with mold that worsens a child's asthma is an example of which domain?",
        "options": [
          "Education access and quality",
          "Neighborhood and built environment",
          "Health care access and quality",
          "Social and community context"
        ],
        "correct": 1,
        "explanation": "Housing quality belongs to the neighborhood and built environment domain."
      },
      {
        "question": "A clinic calls a client noncompliant for missed visits. What should the CHW do first?",
        "options": [
          "Agree and close the case",
          "Tell the client to try harder",
          "Report the client to the insurance company",
          "Listen to learn what barriers keep him from coming"
        ],
        "correct": 3,
        "explanation": "Missed visits often have upstream causes like transportation, phone or money."
      },
      {
        "question": "Which is a spiritual impact on health?",
        "options": [
          "Losing a sense of meaning or hope",
          "A high blood pressure reading",
          "A broken arm",
          "A missed bus"
        ],
        "correct": 0,
        "explanation": "Spiritual health involves meaning, purpose, faith and connection."
      },
      {
        "question": "A grandmother skips meals so her grandsons can eat. What should the CHW do?",
        "options": [
          "Tell her to eat more",
          "Ignore it because it is private",
          "Help her connect to SNAP, a food pantry and kinship supports",
          "Report her to children services"
        ],
        "correct": 2,
        "explanation": "Food insecurity is an economic stability need; the CHW connects her to resources."
      },
      {
        "question": "A worker with a month-long cough cannot take time off. The best CHW action is:",
        "options": [
          "Tell him it is probably allergies",
          "Help him find a clinic with evening or weekend hours",
          "Suggest a cough medicine dose",
          "Tell him to wait until it gets worse"
        ],
        "correct": 1,
        "explanation": "The CHW removes barriers to care without diagnosing or advising on medicine."
      },
      {
        "question": "Which statement about upstream and downstream care is true?",
        "options": [
          "Only downstream care matters",
          "Only upstream work matters",
          "Upstream work replaces doctors",
          "We need both: care for people now and fix causes upstream"
        ],
        "correct": 3,
        "explanation": "CHWs help people today and work with the community on root causes."
      }
    ]
  },
  "post_test": {
    "graded": true,
    "questions": [
      {
        "question": "Which is a spiritual impact on health?",
        "options": [
          "Losing a sense of meaning or hope",
          "A high blood pressure reading",
          "A broken arm",
          "A missed bus"
        ],
        "correct": 0,
        "explanation": "Spiritual health involves meaning, purpose, faith and connection."
      },
      {
        "question": "In the river story, going upstream means:",
        "options": [
          "Swimming faster",
          "Ignoring the people in the river",
          "Finding and fixing the cause of the problem",
          "Calling for more boats"
        ],
        "correct": 2,
        "explanation": "Upstream work looks for the root cause so fewer people are harmed."
      },
      {
        "question": "In 2019, the gap in life expectancy between two Cuyahoga County tracts less than two miles apart was about:",
        "options": [
          "2 years",
          "5 years",
          "10 years",
          "23 years"
        ],
        "correct": 3,
        "explanation": "The Center for Community Solutions found a gap of more than 23 years."
      },
      {
        "question": "A grandmother skips meals so her grandsons can eat. What should the CHW do?",
        "options": [
          "Tell her to eat more",
          "Ignore it because it is private",
          "Help her connect to SNAP, a food pantry and kinship supports",
          "Report her to children services"
        ],
        "correct": 2,
        "explanation": "Food insecurity is an economic stability need; the CHW connects her to resources."
      },
      {
        "question": "Which statement about upstream and downstream care is true?",
        "options": [
          "Only downstream care matters",
          "Only upstream work matters",
          "Upstream work replaces doctors",
          "We need both: care for people now and fix causes upstream"
        ],
        "correct": 3,
        "explanation": "CHWs help people today and work with the community on root causes."
      },
      {
        "question": "A rental home with mold that worsens a child's asthma is an example of which domain?",
        "options": [
          "Education access and quality",
          "Neighborhood and built environment",
          "Health care access and quality",
          "Social and community context"
        ],
        "correct": 1,
        "explanation": "Housing quality belongs to the neighborhood and built environment domain."
      },
      {
        "question": "Which is one of the five Healthy People 2030 domains?",
        "options": [
          "Neighborhood and built environment",
          "Genetics and family history",
          "Personal responsibility",
          "Hospital ratings"
        ],
        "correct": 0,
        "explanation": "Neighborhood and built environment is one of the five domains."
      },
      {
        "question": "Social determinants of health are best described as:",
        "options": [
          "The genes we inherit",
          "Conditions where people live, learn, work, play, worship and age",
          "The medicines a doctor prescribes",
          "Only a person's daily choices"
        ],
        "correct": 1,
        "explanation": "Healthy People 2030 defines SDOH as the conditions in the places where people live their lives."
      },
      {
        "question": "A clinic calls a client noncompliant for missed visits. What should the CHW do first?",
        "options": [
          "Agree and close the case",
          "Tell the client to try harder",
          "Report the client to the insurance company",
          "Listen to learn what barriers keep him from coming"
        ],
        "correct": 3,
        "explanation": "Missed visits often have upstream causes like transportation, phone or money."
      },
      {
        "question": "A worker with a month-long cough cannot take time off. The best CHW action is:",
        "options": [
          "Tell him it is probably allergies",
          "Help him find a clinic with evening or weekend hours",
          "Suggest a cough medicine dose",
          "Tell him to wait until it gets worse"
        ],
        "correct": 1,
        "explanation": "The CHW removes barriers to care without diagnosing or advising on medicine."
      }
    ]
  }
}