Ch2

Question 1

Explain the levels of determinants

Answer 1

• Ds affect health in a variety of ways along a continuum from proximal through intermediate to distal determinants- and these levels guide actions
• proximal- direct affect at micro and macro levels - smoking, nutrition, diabetes that requires health management
• intermediate- material factors- personal wealth, access to material resources; the natural, physical and built environments, education and transport
• Distal- distant in time or place from the change in health status- distal determinants of lung cancer are damage from second hand smoke, smoke availability and pricing. they are about the distribution of money, power and resources and are less easily changed.

Question 2

What is the origin of the SDoH and provide a framework for reference

Answer 2

• the social, economic and political conditions in which ppl live and work, or the characteristics of societies, the economy and politics, within which living takes place.
• Baum- the causes of the causes of ill health and emphasise social context, social stratification, the differential exposure ppl experience and their vulnerability to illness and injury.
• specific features of social contexts that affect health and how social conditions translate into health outcomes
  -Virchow- Typhus physician who connected the living conditions to the worsening of the outbreak
• commission on SDoH 2004- provided solid info that theory wasn’t enough to create change in policy- the C worked with countries who were committed to health policy change with D focus to produce more equity.
• the CSDH made clear from the outset that equity was the cornerstone of the work and that it intended to build on the public health and primary health traditions of social justice movements and the social model of health.
  3 key action areas:
  -1- tackling health disadvantages in targeted population groups
  -2- reducing health gaps
  -3- addressing the health gradient across the spectrum of socio-economic positions.
• at the heart of a D approach is a whole of population approach

Question 3

Explain the different categories of determinants

Answer 3

• Social gradient- where ppl live on the socio- economic scale often show that lower on the scale also equals poorer health. Health inequalities are almost always underpinned and preceded by social inequalities- as they are socially produced they can also be avoided.
• Poverty and deprivation: (absolute or relative) chronic poverty can also be inter generational and where basic necessities are not met.
• Where you live/housing and neighbourhoods: where you live also affects education, and social and economic opportunities. Quality of housing, hygiene, water and air quality, crime, infrastructure/roads, access to quality food supplies. As neighbourhood have great impact on child development it is vital that urban planning focus on this byway of all-ability parks, libraries, child and maternal health access.
• Education: lower education is a pathway to poorer health- good education allows for consistent employment, lifelong learning, healthy relationships, healthy food choices, healthier physical choices, better parenting. Poor health literacy is thought to be a better predictor of health status than socioeconomic status, employment, race or gender.
• Environment: healthy built environments- well built housing with grasses and outdoor recreation areas, good street lighting, good bus routes etc. low exposure to toxic substances. Climate change affects quality of air, water, food growth and supply, secure shelter.
• Employment/working conditions: generates income for shelter, food, educations and the goods and services that promote health. Also, the conditions affect psychosocial wellbeing.
• Transport: access to transport means access to health services, education, recreation, shops. Distal actions would include transport policies that support public transport and bike lines. Social isolation and lack of community interaction are strongly associated with poor health.
• Early years of life: healthy early childhood development holds great implication for the future as this is when children development is most pliable and as they will be the future generations it is vital that public policy work to ensure good outcomes at this level- eg funding/policy for children at risk of poverty, family deprivation. Early intervention is much more cost-effective.
  -Personal health practices/coping skills: individual actions that ppl take to prevent disease and promote self-care and resilience, and health choices. Greatly impacted by ses and environment.
• Social Support: the nature of support and quality of rships affect health outcomes. They have implications for coping with adversity, and control over life- implicit ons for mental health also.
  -Social exclusion/Marginalisation: being at the outer edge of society affects access to community and social life. Form of impoverishment and costs health and lives.
  Food: food insecurity impacts on ppls physical, mental and social wellbeing and their ability to work. The social gradient is very apparent in food- access to healthy food and its nutrients is one of the key dif fences btwn ppl who have sufficient income and those who do not. Poorer ppl tend to make poorer and cheaper food choices, also tend to lack food prep skills.
  -Health systems and services: access to affordable, appropriate health care is a key factor in health outcomes- particular for low ses.
• Gender/Gender equity: arises from inequitable social, economic, and political DoH that, in turn, arise from disempowering social norms and unequal distribution of power and resources. Gender inequity magnifies the experience for women of reproduction, racism, ethnicity, disability and illness.
  -Violence, discrimination, racism and social disorder: affect physical and mental health and have long-term and intergenerational implications.

Question 4

List the most commonly accepted DoH

Answer 4

Social gradient
Poverty and deprivation
Where you live- housing and neighbourhoods
Education
Environments
Employment and working conditions
Transport
Early years of life
Personal health practices and coping skills
Social support
Social exclusion
Food
Health systems and services
Gender and gender equity
Violence, discrimination, racism, and social disorder

Question 5

What is meant by intersectoral actions?

Answer 5

Major influences of health are located outside the health sector and therefore the health sector must engage with other sectors to address the DoH.
The range of sectors that are influential in the creation of health and in the pathways to poor health and inequity include education, health, transport, community services and welfare; arts and culture; agriculture and markets for foods and consumable goods; politics and governments; academia; economy and taxation; local government; justice; corporate/business; sport and recreation; and built, natural, social and cultural environments.
- Health in All Policies (HiAP) is an approach that expects leadership for health and social equity from all sectors policy making.