L3 - Determinants of oral health, the public health approach

Question 1

describe the four components of the Dahlgren and Whitehead model

Answer 1

• general socio-economic, cultural and environmental conditions
• living and working conditions
• social and community networks
• individual lifestyle factors

Question 2

describe the upstream model of health and what it can be useful for

Answer 2

• this model is concerned that we are focusing on just rescuing the people downstream who are in the river. need to think about hat is going on upstream to cause all of the people to be in the stream in the first place
• useful to work through problems and think about contributing factors
• its mostly easier to see downstream determinants, but there could be bigger forces at work upstream
• the environment could also be something that shifts their ability

Question 3

how are the health and social problems distributed across countries?

Answer 3

the more inequal the country, the worse the health and social problems
- income inequalities relate to health inequalities
- the more inequal, the more problems

Question 4

define determinants of health (WHO definition)

Answer 4

the range of personal, social, economic and environmental factors which determine the health status of individuals or populations - WHO

Question 5

what are the components of the UN + CIDA + Bopp and Bopp model of determinants of health

Answer 5

UN:
- social: social development
- economic: economic development
- ecological: environmental protection
- social + economic = equitable
- social + ecological = bearable
- economic + ecological = viable
- all three make like sustainable
CIDA:
- cultural diversity
- political: participation and sustainability

Question 6

what is colonisation, what does it result in a loss of and what are its intergeneration effects?

Answer 6

Dominant group imposes: political, social, economic, psychological and spiritual ways on colonised group

Results in loss of: culture, language, land, status, power, health

Intergernerational effects:
- low levels of access and participation in society’s mainstream
- low economic wellbeing
- high levels of poor indicators… health, education, welfare etc

Question 7

describe/draw out the social determinants framework

Answer 7

Structural determinants (political and economic drivers):
socio-economic and political context
- macro economic policies
- social and welfare policies
- political autonomy
- historical/colonial
- globalisation

Intermediary determinants (circumstances and risk for oral disease):
socioeconomic position:
- social class
- gender
- ethnicity
- occupation
- income

material and social circumstances:
- living and working conditions
- food security
- social capital
behaviour and biological factors:
- age, genetics
- inflammatory processes
- infections
psychological factors:
- stress
- perceived control
- social support
health services:
- quality of care
- appropriate access
- evidence based preventative orientation

Outcomes:
- oral health inequalities
- social gradient

Question 8

how does social advantage or disadvantage affect health through the life course?

Answer 8

• the effects of social advantage or disadvantage accumulate through out lives
• the effect of disadvantage on health can compound over time
• hypothesis tested in dunedin study

Social origins:
- growing up in low SES conditions leads to poorer adult health regardless of adult SES
- upward mobility: rising in the SS hierarchy leads to better adult health
- downward mobility: falling in the SES hierarchy leads to poorer adult health

Question 9

what are the CSDH recommendations to close the gap in inequity?

Answer 9

1. improve daily living conditions
2. tackle the unequal distribution of power, money and resources
3. measure and understand the problem and assess the impact of action

Question 10

what is lifestyle drift?

Answer 10

public health practice ‘drifts’ to focusing on individual lifestyle factors because that’s easier

Question 11

what are the four components of the public health approach?

Answer 11

1. surveillance: what is the problem?
   - systematic collection: magnitude, scope, characteristics, consequences
   - define the problem + epidemiology
   - the study of the occurrence: who, what, when, where, how?
   - of states: illness, injury, death, and the determinants
   - in specified populations: NOT individuals, charactaristics
2. Identify risk and protective factors: what are the causes?
   - causes, correlation, risk factors, modifiable?
   - what puts ppl at risk?
   - risk factors and causal path
   - contributing risk factors
   - determinants of health
   - conversely, what protects ppl?
3. develop and implement interventions: what works for whom?
   - design, implement, evaluate interventions
   - given what we know abt the risk factors, what strategies could we use to prevent negative outcome?
   - can use upstream/downstream model
4. implementation: scaling up effective policy and programmes
   - wide range of settings, policy, cost effectiveness?
   - implement change to address the upstream factors: policy, organsiational/structural, fiscal