Day 1 Session 2 Flashcards
Foundations
What are social determinants?
‘Supra-individual’ factors that influence the health of individual populations.
What are some examples of social determinants?
- social (eg status)
- economic (eg income)
- cultural (eg Norms)
- political (eg war)
- global (eg 3rd world debt)
What are the relationships between social determinants & health?
- Example: life expectancy
- Massive gap between high & low income countries
- Over time these increases are not proportional
- Modifiable
What is health inequality?
Measurable differences in health experience and health outcomes between different population groups
- According to SES, geographical area, age, disability ect.
What is health inequity?
- Differences in the opportunities of different population groups which result in unequal life chances, access to health services, nutritious food, housing ect.
- Absence of socially unjust or unfair health disparities (health inequalities)
- Doesn’t require everyone to be equal but to have the same possibilities
- social justice & fairness
What are the best interventions to do with the gradient?
Interventions need to encompass the whole gradient
- seen in under 5 mortality (Marmot & Lancet, 2007)
Is:
Younger & older Australian mortality rates
- 15-24 year old women: 26/100,000 per year
- 65-84 year old women: 2100/100,000 per year
- Inequality
Same gander, country & availability to the same services
What is the relation of inequity to inequality?
All equities are inequalities
What do we mean by the social gradient in health?
- It runs from the top to the bottom of the socioeconomic spectrum
- Seen in low, middle and high income countries
- Means that health inequities affect everyone
- Risk factors are socio-economically set standards
What type of cancer does not follow this negative gradient?
Breast Cancer
What are the three recommendations by the WHO commission on the Social Determinants of Health?
1 Improve daily living
2 Tackle the inequitable distribution of power, money and resources
3 Measure & understand the problem and assess the impact of action
Why is early life important? And what ages does this include?
Sets the scene for the rest of life
- prenatal to 8 years of age
What are 5 methods for improving daily living conditions?
1 Early Life 2 Where people live 3 Fair employment and decent work 4 Social protection policies 5 Universal Health care
What are the 6 approaches to tackling the inequitable distribution of power, money and resources?
- Health equity (in all policies, systems and programs)
- Fair financing
- Market responsibility
- Gender equity
- Political empowerment
- Good global Governance
Tackling the inequitable distribution of power, money and resources: explain Health equity in all policies, systems & programs.
1.Health equity in all policies, systems and programs
Place responsibility for action on health and health equity at the highest level of government, and ensure its coherent consideration across all policies
Adopt a social determinants framework across the policy and programmatic functions of the ministry of health and strengthen its stewardship role in supporting a social determinants approach across government.
Tackling the inequitable distribution of power, money and resources: explain fair finance.
2.Fair financing
Strengthen public finance for action on the social determinants of health (e.g. progressive taxation).
Increase international finance for health equity, and coordinate increased finance through a social determinants of health action framework. (e.g. honour existing commitments for global aid)
Allocate government resources for action on the social determinants of health.
Tackling the inequitable distribution of power, money and resources: explain marketing responsibility.
- Market responsibility
Institutionalize consideration of health and health equity impact in national and international economic agreements and policy-making (e.g. electricity pricing).
Reinforce the primary role of the state in the provision of basic services essential to health (such as water/sanitation) and the regulation of goods and services with a major impact on health (such as tobacco, alcohol, and food).
Tackling the inequitable distribution of power, money and resources: explain gender equity.
- Gender equity
Address gender biases in the structures of society – in laws and their enforcement, in the way organizations are run and interventions designed, and the way in which a country’s economic performance is measured. (e.g. legislation re discrimination on basis of sex)
Develop and finance policies and programmes that close gaps in education and skills, and that support female economic participation. (e.g. family friendly policies)
Increase investment in sexual and reproductive health services and programmes, building to universal coverage and rights
Tackling the inequitable distribution of power, money and resources: explain political empowerment & inclusion.
- Political empowerment and inclusion
Empower all groups in society through fair representation in decision-making about how society operates
Enable civil society to organize and act in a manner that promotes and realizes the political and social rights affecting health equity.
Tackling the inequitable distribution of power, money and resources: good global governance.
- Good global governance
Make health equity a global development goal, and adopt a social determinants of health framework to strengthen multilateral action on development.
Strengthen WHO leadership in global action on the social determinants of health, institutionalizing social determinants of health as a guiding principle across WHO departments and country programmes.
What is a targeted approach?
Address the health gap between the poorest and most disadvantaged in society
- but health inequities may remain as they haven’t addressed the gradient (heart of the problem)
What is a universal approach?
Focus on improving the health of all, reducing the social gradient
- but some initiatives may only be taken up with those with the most resources to do so and thus widen the health inequities
What is a place based approach? & their success?
- approach for that specific place
- Mixed evidence of effectiveness
- Need good community group support
