Chapter 4 - Social Inequity, Disease & Death: SDOH Flashcards
Different Explanations of Inequality, Health & consequences
most obvious?
**materialistic approach to SODH **
- health linked to provision of basic material goods/services
- income is central
health depends on available, accessible & good quality food/water/transport/housing etc.
(2) aspects of income relevant to materialistic approach
1) income sufficiency - *buy food, shelter etc. *
2) income stability - consistent/predictable availability of money
Neomaterialistic Approach
focuses on relative distribution of material/social goods in society
- argument that once certain degree of absolute material adequacy reached..
equity & perceived equity = essential to overall health
3rd explanation for link b/w SDOH & health
explains how neo-m theory may work empirically at level of individual social-psych functioning
focuses on **relative distribution **of material/social goods in society
social capital (*access to & presence of certain social benefits) *enhances inclusion
**social inclusion **- relates to social capital
- presence of well-functioning infrastructure contributes to high levels of SI
Life Course Approach
overlaps with previous 3 but focuses on fact that impoverishment, inequity, lack of distr. policies, social exc., are exacerbated when occur among children & thru life
pathway effects - experiences set children on course (ECD)
latency effects **- **in early developmental stages & influences later life
cumulative effects - advantage/disadvantage (includes combo of previous 2)
Example of Life Course Approach
examine class-associated pre-marital/teen pregnancy
working/lower class more likely to get prego
- tend not to have adequate eco/emo/social support
- passed to child
- also less access to good food, prenatal care
Political Explanations for Inequality and Poor Health
Health inequities result from forces & decisions at global/national political & economic level
Navarro & Shi study
compared 4 types of OECD countries
**social democratic **countries characterized by extensive taxation & redistrib. policies & high rates of female engagement in labor market
- lower infant mortality rates (sensitive indicator of popn health)
- supports theory of importance of SODH to popn health
Inequality & inequity growing since ___ & justification rooted in ideology of ___
1980
neo-liberalism
main assumptions of neo-liberalism
1) markets = best & most efficient allocators of resources in production & distribution
2) societies are composed of autonomous individuals (producers & consumers) motivated mostly by material/economic means
3) competition = major vehicle for competition
Neo-liberalism
against redistribution policies bc it interferes with eco growth
- idea that everyone in society will do better if market is allowed to generate jobs as it creates wealth thru **trickle-down effect **
- assumes wealth from market will auto provide work/income for all
- based on **philosophy **that emphasizes individual rights/freedom over collective integration & wellbeing
Operating Model for SDOH
levels that impact health
Health, illness & death linked to social organization of society
broadest level - globalization & neoliberal ideology (political-economic system)
culture - degree of medicalization
social policies
social structure
individual behaviors
SDOH - Canada
history of defining health
changed with **1974 Lalonde Report **- influenced world to broaden understanding of social/env/eco causes of health/illness
(4) causes - human bio, env, lifestyle & HC organization
**1986 **- **Jake Epp **responsible for document proposing framework of health promo
also Ottawa Charter for Health Promo in 1986
SDOH explain sig differences among communities in health outcomes
(what %?)
25-55%
Inequality
significant predictor of popn health
Inequality in Japan & USA
- *Japan** - highest life expectancy despite 2x smoking rates of Canada
- cohesive society in which income equity is chief value *
**US - **high mortality rates & income inequality
- top 1% of popn control 40% of wealth
poorest 40% have 1% of wealth (1997)
Food Security
1st food bank - Edmonton (*over 25 years ago) *
2.3 million CDNs affected in **2004 **
Poverty
defn is political matter
- refers to eco position/stability of ppl with difficulty meeting basic needs
In Canada - defined as those who spend over **20% **of income on food/shelter/clothing
Employment
- also must consider stability/safety of work, salary, holidays, hours, autonomy etc.
- occupation = important predictor of health through mechanisms of income
Unemployment
rate in **2011 = 7.1% **
Education/Literacy
- increases job opportunities, health literacy, financial stability/security
- related to types of employment, income level & health behaviors, self-esteem
Housing
homeless popn growing - estimated b/w 200-300k
**absolute homelessness - **street/shelter
**hidden homeless - **in car, couch surfer
**relative homelessness - **on verge of losing shelter
- *2000 - **less than **56% **of Ab homes considered adequate
- **over 5% **unfit for human occupancy
Ab ppl **4x **more likely to live in overcrowded house
Neighborhood
characteristics have powerful/independent effect on health status
- explains large part of health gap by race in US
- poor neighborhoods linked to **higher levels of mental/physical illness & stress **
Relationship between economy & health status
many documents on this beginning with Friedrich Engels’ **The Condition of the Working Class in England - ****1845 **
when need for profit = determining principle
popn health needs = secondary importance
Commodification
Commodities = objects/activities with exchange value
– can be bought/sold (value determined by market factors such as supply & demand)
Health can be seen as a commodity
In capitalist economy, health is subject to supply & demand
- best example = buying/selling organs for transplantation
- also used to **indicate productive value of individual to society **
when corps/gov allow continuation of destructive practice to health in interest of financial benefits, **health is being commodified **
