10: social determinants of health Flashcards
what is social determinants of health?
set of fators that influence health & comm (17 in total)
social gradient in health
- [xxxx]: live ____ life, les ____
- on the flip side, more ___ , ____, ___ ___, __ ___
- better income, better health: live longer lifes, less suicide
- CVD/ DM/ respiratory disease / infant mortality
individual preventative action is much easier to do if…….
have less 1 SDOH while tryna fight health hazard
SDDOH
most improtant SDOH
when there’s income equality,
_ expectancy, 👶, ____ is better
- __ __, obesity, __ ___, 🔪 is lower
income = most impt determinant of health
=> allows access to other SDOH
- life expectancy, child wellbeing, literacy
- infant mortality, child pregnancy, homocide rate
why are more seniors going bankrupt that before?
live longer => outlive their savings
retire w/ debt: give money to adult mbers, healthcare, 2 housing cost (when i person in nursing home)
loosing $ in stock market
SDOH
2nd SDOH
better edu, better health
why? betters their literacy and ind preventative action
more opportunities if loose your job when middle-aged
=> facilitates civic engagement
3rd SDOH: employment and job insecurity
income, self-hood, structure to day to day life
IF NOT, mat & soc deprived
psych stress
dvlop coping addictive action
3rd SDOH: employment and job insecurity
w/ ____, __, __ ___-> more of these now
often invovle __-___ ___ __ so harder to manage
< __ + ___ stress
harms:
why?
w/ pt, contract, precarious employmnt -. more of these now
often involve non-standard working hrs -> so it’s hard to manage transport, childcare (esp when schedule is posted weekly)
< physc, psych stress
harm: rel, child, parenting
give me an e.g of non-standard working hrs
some workers are paid only for direct care time, regardless of commute or waiting in between
4th SDOH: working conditions
those w/ bad health often exp poor working conditions
factors of health outcome?
last: opportunities for __ __ &__ ___
1. job security
- physc conditions
- pace
- hrs & the degree of control over it
- opportunities for self-expression and ind dvlopmnt
```
- SDOH: early child dvlopment
there’s this latency effect: early childhood predispose to either good or bad health
have a cummulative effect:
longer the child is mat. & soc deprived, the more likely to have bad health & dvlopmental outcomes
6/ SDOH: food insecurity
inadequte or insecure access
=> not enough nutr, chronic disease & low birth weight
COST MORE to cure
prove that it cost more to cure for food insecrity
SOO…..
a recent study of 60,000 ontarians found that annual healthcare cost in food INSECURE fam»_space;» much more than in food secure
- 23% higher for marginal
- 49% higher for moderate
- 121% higher cor severe
=> INDEPENDENT OF OTHER SDOH
Policy & prov.fed lvl could offset this cost
what ist he paradox of hunger & obesity?
it can exist in 🏠 and in same 🧍
WHYYYY?
- need to max cal intake
- tradeoff btw quality & quantity
- overeat when food is available
4 sides of food insecurity
- quantitive: not enough food
- qualitive: cheap, nutr food
- psych: daily stress
- social: your dignity and pride
food banks: pros
give poverty a public profile
transport network for excess food
satisfy the present & urgent need
own property i.e comm garden
food banks: cons
naturalise poverty, gov inaction, is institutionalised now
SDOH: housing
lead, mold & pest < health risk
some house on aboriginal reserves lack clean water & basic sanitation -> adopt addictive coping action
early death rate among the homeless is 8-10x greater
socially excluded cAD are more likely tb ____, earn __ __, have less access to ____ ___ & can’t __ ___
give 3 e.g
unemployed, lwoer wage, social service, further edu
e.g senior living alone, outcast kid, immigrants who can’t speak the lang & dont have fam here
social safety nets?
= many programs & services that protect u from changes
could be normative: going to uni
or non-normative: car crash
e.g unemployment insurance or disability benefits
```
although we have universal healthcare,….
there’s health insurance and …? give 3 e.g
many services still provided by for-profit company or ind: dentist
=> not covered by health insurance
instead, it’s employer or we pay out of pocket: dental, med, home care
geography influence: 💨
death rate is higher in: A. city B. surburbs C. rural & remote areas
💨 air/ food/ 💧/ enviro pollution
also access to healthrcare & edu (basic needs)
note: C– death rate is higher in rural & remote areas
waste sites & landfills are clower to comm of color / hood/ aboriginal reserves
disability
many rely on social assistance; bt the benfits are low & vring them to poverty lines
BEING INDIGENOUS .
effects of residential school system
- fck up their health
- cultural genocide
3.* low socioeconomic status * - lack competencies
=> create intergenerational trauama
proximal SDOH < intermediate SDOH < distal SDOH for Indigenous ppl
proximL: healtjh action & physc enviro
intermediate: healthcare syst, edu syst & community
distal: colonialism & racism
why do women exp more adverse SDOH than men?
often employ in __ ___ jobs and when they do, do less
raise the children & do the housework
often employ in lower paying jobs & work Full Time more
face more workplace discrim
men & SDOH
mental & physc health, crime
more likely tb offenders & victims of __ & __ => rep.
suicide rate is 4x higher than fem; for physc health, influenced by unhealthy aspects of amsculinity
more likely tb offenders & victims of robbery & physc assault
=> rep Canada 95% prison population
often young, disadvantaged men w. anti-social behaviours
immigrants
as a group, have better health than their CAD-born counterpart, bt health flunks due to sical exclusion & racialised poverty
how does race effect health outcome?
via institutionalised racism:
personally mediated…:
internalised racism.
globalisation
a process in which natins, business, & ppl become interconnected via economic intergration, comm exchange, cultural diffusion
]
globalisation
(+) share __ ___, ____, global __ on __ ___
(-) deregulated
(+) share health knowledge, immunisation, global treaties on human rights
(-) deregualted global finance, enviro disaster, less social protection programs
what is the approach to all of this?
upstream thinking: target SDOH, poor quality of lifem premature death
downstream thinking: deal w/ outcomes of that SDOH w/ doctors & nurses
removing obstacles to health such as poverty
eliminate ———
health equity
eliminate social disparities in health & its determinants (poverty)
to measure progress of health equity, track how disparities change over time ->
prove that gov should spend more on social services
if 1 cent spent on social services / every 1$ on healthcare,
life expectancty <5%
avoidable mortality > 3$
is basic min income possible?
for a half a year would cost 98 bil
bt federal spending on pandemic was 134 bil.
POSSIBLE
benefits that gov provide instead of targeted social benefits
basic min income
has basic min income been implemented before>
yes in manitoba.
less hospitalisation
better mental health, more high grad
while employment rates stay the same
invest in social service
spend less on healthcare, more on scoial programs
early childhood edu, cheap & good childcare
financial literacy
achieve financial stability: deal w/ imbalances before they cbeomce a threat
financial security: not worried abt your financial goal
in a survey w/ saudi uni students
they think that savings & investment = financial security
AND NOT budget or emergency funds
how can we respons in a patient lvl?
ask abt social history in a sensitive way
care for their health AND social needs
refer patients to social programs
how can we respons in a practice lvl?
< access & quality of care to the unaccessible: bus fare
have patient social support team in prim care: help filling out form
how can we respons in a community lvl?
partner w/ comm groups, public health, local leader
use clin exp to adovocate for social change
