Health determinants Flashcards
Structural determinants influencing health outcomes
- Environmental changes
a. climate change
b. urbanisation - Sociocultural factors
a. social determinants
b. cultural blindness, safety - Geopolitical factors
a. conflict
b. displacement
c. globalisation - Historical/legal factors
a. colonisation
b. legislation and health policy
c. demographic and epidemiological shifts
Structure/agency binary
- Structural factors can restrict human agency
Social determinants
- Subset of structural determinants that affect health of COMMUNITIES/individuals
- Social support/exclusion
- Early childhood development
- Stress, addiction
- Religion, caste
- Employment
- Healthy food
- Affordable and reliable transport
Mediators
- Bridge the gap b/w structural determinants and health outcomes
Include:
- Changes in basic needs, behaviour, healthcare access
- Exposure to hazards
- Impact on psychosocial wellbeing and physiology
Upstream factors and interventions
Upstream factors
- Social determinants
- Structural determinants
Upstream interventions
- GENERALLY LESS COST-EFFECTIVE
- Addressing social and structural determinants
- Addressing health systems (4 Sās)
- Preventative medicine (vaccines)
Downstream factors and interventions
Downstream factors
- Health outcomes/indicators, burden of diseases, diseases distribution
Downstream intervention
- GENERALLY MORE COST-EFFECTIVE
- Therapeutic interventions, medicine, behaviour change programs
Whitehall 1
- Increased life expectancy
- Decreased rates of CVD
in HIGHLY RANKED civil servants (compared to those lower in the social hierarchy) - 18,000 British MALE servants
- Aged 20-64
Whitehall 2
- Confirmed stratification of health status across many variables according to employment grade
- Correlation mediated by
a) perceived control
b) status
c) social support - Social determinants = DIRECT IMPACT ON HEALTH OUTCOMES
- 32nd year of data collection (FOLLOW UP ONGOING)
- 10,000 participants, both males & females
Began in 1985
