Determinants of health (Social, enviro & Political) Flashcards
What is the definition of a determinant in the context of health behaviour?
Determinants are causal factors; variations in these factors are systematically followed by variations in a behaviour.
What is the definition of a correlate in the context of health behaviour?
Correlates are factors associated with a behaviour, but the relationships are not necessarily causal. It’s important to note that the terms “determinants” and “correlates” are often used interchangeably despite this subtle difference.
What does “social determinants of health” mean?
Social determinants of health are the circumstances in which people are born, grow up, live, work, and age. These circumstances shape socioeconomic positions within hierarchies of power, prestige, and access to resources. Structural mechanisms like governance, education systems, labour market structures, and welfare policies create these differential social positions.
What are some of the key social determinants of health in Canada?
Key social determinants of health in Canada include:
* Indigenous Status
* Disability
* Early childhood development
* Education
* Employment and working conditions
* Food insecurity
* Health Services
* Gender
* Housing
* Income and income distribution
* Race
* Social exclusion
* Social safety net
* Unemployment and job security
What is health inequality?
Health inequality occurs when there are differences in experiences or outcomes between different populations, but these differences are not necessarily due to systemic issues or social injustice. An example is the difference in health between young and older individuals due to age, or health differences between high and low-income developed countries. Geographical location is also mentioned as a source of health inequality.
What is health inequity, and which one are the social determinants of health mostly responsible for?
Health inequities attribute the differences in health to systematic disadvantages that are potentially remediable and considered to be unequal and unfair. Social determinants of health are mostly responsible for health inequities. Examples include infant mortality rates between different countries and within countries based on maternal education, and life expectancy differences between Indigenous and non-Indigenous Australians.
What is the concept of the “Social Gradient” in health?
The social gradient in health shows that within countries, the lower an individual’s socioeconomic position, the worse their health. Conversely, the chance of good health increases as socioeconomic status also increases, often in a linear fashion. This is a global phenomenon seen in low-, middle-, and high-income countries, meaning health inequities affect everyone across the socioeconomic spectrum.
What were the key findings of the Whitehall I Study?
The Whitehall I Study, which followed male British civil servants, initially expected to find the highest risk of death from heart disease among those in the highest status jobs. However, it found a strong inverse association between job status and death rates; those in lower job status had higher death rates from heart disease.
What were the key findings and learnings from the Whitehall II Study?
The Whitehall II Study, which included both male and female non-industrial civil servants, confirmed the findings of Whitehall I. It showed that low job status is related to a higher risk not only of heart disease but also of other chronic diseases (some cancers), mental health issues (depression, suicide), sickness absence from work, and overall poorer self-reported health. We can learn that socioeconomic position has a profound impact on a wide range of health outcomes, highlighting the importance of social determinants of health. Factors like less money leading to bad diet, multiple jobs, and lack of time for leisure and physical activity contribute to this relationship.
How does income and income distribution act as a key social determinant of health?
Income and income distribution shape overall living conditions and food security. It also affects psychological functioning and influences health-related behaviours such as quality of diet, extent of physical activity, tobacco use, and excessive alcohol use. Policy implications to address income disparities in Canada include increasing minimum wages and boosting assistance levels, progressive taxation, and potentially increasing unionized workplaces.
What are the main physical environmental influences on physical activity?
The main physical environmental influences on physical activity include:
* Topography: Hills, mountains, coasts, forests, or bush
* Built environment: Buildings and roads, public open spaces and parks
* Weather and climate: Precipitation, temperature
What are the two main ways we can measure environmental determinants?
We can measure environmental determinants through:
* Subjective (Perceptions): Adult perceptions, Parent/Child perceptions
* Objective Measures: Direct observation, Geographic Information Systems (GIS), Google Earth street view
ccording to the study in Edmonton, what was the difference in children’s perception of play and physical activity in grid-like versus lollipop-style neighborhoods?
- Grid-Style: Associated with more active transportation events. Older children reported more play both at home/yard and outside home/yard.
- Lollipop-Style: Associated with more non-active transportation events. Younger children reported more play at home/yard, while older children reported less play outside home/yard. Grid style was associated with more play and physical activity in older children; Lollipop was better for younger children.
Briefly describe how we can objectively measure environmental aspects of outdoor play/activity space.
We can objectively measure environmental aspects using Geographic Information Systems (GIS) by assessing factors like:
* Cul-de-sac density
* Wooded-area
* Parks/sports fields We can also use objective measures like direct observation (walking through neighborhoods) and Google Earth street view. Other objective measures include the distance to the closest park, yard space, and the presence of recreation facilities like arenas, yoga/dance studios, etc.. Aesthetic factors like graffiti and litter can also be objectively assessed.
How does the perception of the physical environment correlate with Physical Activity (PA) in children?
For children:
* There is a positive association between the perception of recreational facilities and PA levels.
* There is a negative association between the perception of high traffic and PA.
How do objective measures of the physical environment correlate with Physical Activity (PA) in children?
There is a positive association between objective measures related to the availability of recreational facilities and sidewalks and PA in children. Traffic was not a big issue in lollipop neighborhoods, and grid-like neighborhoods were negatively associated with PA in younger kids.
How does the physical environment correlate with overall PA, walking/cycling/active transportation, and leisure/recreational PA in adults?
Based on an umbrella systematic review for adults:
* Street Connectivity: Positive association with overall PA and walking/cycling/active transportation (+)
* Walkability: Positive association with walking/cycling/active transportation (+)
* Land-use mix diversity: Positive association with walking/cycling/active transportation (+)
* Season/temperature: Positive association with overall PA (+)
What are the four relevant features of the food environment?
The four relevant features of the food environment are:
* Geographic food access: The geographic availability (proximity and number) of different types of food stores and restaurants.
* Food Availability: The actual foods that are available (proximity and amount) in someone’s neighbourhood.
* Food Affordability: The cost of foods within a defined area (per person, between types of foods).
* Food Quality: Assessments of food quality (freshness, not spoiled, not expired), which is different from nutritional quality.
How do the features of the food environment relate to diet-related outcomes, according to the Canadian evidence?
The majority of published Canadian evidence indicates that a relationship exists between geographic food access and diet-related health outcomes. This is the only food environment feature yet assessed significantly in the Canadian context. There is a relationship between living close to fast food/convenience stores/access to grocery stores, and nutritious diet. Low-income and underserved communities, as well as rural, remote, and northern communities, often have limited access to stores that sell healthy food, especially high-quality fruits and vegetables. These communities often have a higher number of convenience stores with less availability of healthy foods.
What is a policy?
A policy is a course or principle of action adopted or proposed by a government, party, business, or individual.
What are the three categories of policies?
Policies can be broken down into:
* Personal (e.g., household)
* Organizational (e.g., school)
* Public (i.e., government)
What is public policy?
Public policy is a system of laws, regulatory measures (e.g., taxes), courses of action, and social benefits concerning a given topic put into effect by government.
What are the advantages of policy change in leading to behavior change?
Policy change can be very effective in changing behaviour.
What are the disadvantages of policy change in leading to behavior change?
Disadvantages of policy change include:
* Takes time
* Governments and leaders can change
* Some behaviours are more challenging to change than others
