0721 - social determinants of health - AHF

Question 1

What are the social determinants of health?

Answer 1

Defined by WHO as the conditions in which people are born, grow, live, work and age; shaped by distribution of money, power and resources at global, national and local levels; improvements to health can be achieved by:

• fair distribution of power, money and resources
• improved daily living conditions
• empowerment (material, psychosocial, political)
• health equity

Question 2

Explain the social determinants approach to health.

Answer 2

• largely based on disparity

- tries to achieve health equity through action on the social determinants of health

Question 3

Where did the social determinants approach start?

Answer 3

• public health in the UK, and

- Marmot’s early work

Question 4

Briefly describe the findings of Marmot et al. (2010) (Fair society healthy lives)

Answer 4

This review identified:

• the importance of social determinants for addressing disparities in health outcomes for people having varying “social positions” across the lifespan
• the building of “sustainable communities and places” as a key area of action relevant to all stages of life course

Question 5

Outline the generational differences, in the context of interaction between age and social inequalities.

Answer 5

• reduced life chances of a cohort who came of age before post-war improvement in educations, careers, housing, health care, and living standards; their stoicism shaped popular attitudes and expectations
• contrasts sharply with the aspirations of baby boomers
• particularly sharp for women (e.g. in the 1960s, if a woman was in the APS and got married, she had to quit)
• as people grow older, disparities of wealth and other socioeconomic resources are accentuated (with ageing combined with inequalities grounded in gender, class, ethnicity, sexual orientation, etc.)

Question 6

Define “active ageing”.

Answer 6

The process of optimising opportunities for health, participation, and security in order to enhance quality of life as people age; to change things, need to look at the environment as well as the person (looking at an old person, without looking at their environment, is like doing a one-handed clap).

Question 7

Why is consideration of the environment important for older people (in terms of ageing)?

Answer 7

• 80% of the time of people aged over 70 is spent at home, so physical environment must be of a high quality
• urban areas may pose health and social risks (e.g. length of exposure to damaging environmental effects; older people may be highly sensitive changes in the physical and built environment given its significance for the maintenance of identity)

Question 8

What is an age-friendly city?

Answer 8

• reliable, frequent transportation
• affordable, support to age in place housing
• social participation
• respect and social inclusion (anti-discrimination)
• civic participation and employment
• communication and information (good access to information about services and activities)
• community support and health services

Question 9

Outline some local action that can aid in developing age-friendly cities.

Answer 9

• achieving recognition of the needs of different generations within cities
• “age-friendly environments” approach offers a practical paradigm for facilitating independence, participation, health and well-being for older people
• using the “age-friendly” approach to challenge health and social inequalities at the local level
• developing further research (including rigorous evaluation)