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NURS 201 > LEC 2: Social Determinants of Health > Flashcards

LEC 2: Social Determinants of Health Flashcards

1
Q

Whitehall Studies

A

Major influence on SDH and health inequality research done by Sir Michael Marmot at UCL

Follow up work is still going on today

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2
Q

When was Whitehall I conducted?

A

Whitehall I studies started in 1967 to 1977 with men only

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3
Q

When was Whitehall II conducted?

A

Whitehall II studies started in 1985 to 1988 and included men and women

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4
Q

What did the Prospective Cohort Study look at?

A

Prospective cohort study looked at thousands of UK civil servants to examine health effects of stress and work

  • Lower pay grade (class of work)= hight mortality
  • Status and perceived inequality negatively impact on health
  • Stress of social environment and inequality is a key factor
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5
Q

What are the four considerations used when developing the SDH model?

A
  1. Holistic perpective
  2. Life cours perspective
  3. System-wide
  4. goal
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6
Q

SDH Model Development: Holistic Perspective

A

All aspects of person and society

- Physical, mental, spiritual, social, environmental

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7
Q

SDH Model Development: Life Cours Perspective

A

Life long impacts on health

- Not just length of life but quality of life as well

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8
Q

SDH Model Development: System-Wide

A

All sectors have an influence on health

- “Horizontal” or diagonal: programming across sectors

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9
Q

SDH Model Development: Goal

A

Break down “silos” of service delivery and embed health into all aspects of policy and programming

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10
Q

What are SDH?

A

The SDH are the conditions that people grow, live, work, and age in
- There are different models that include different factors

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11
Q

What have the SDH shown within people?

A

The effects of SDH have been shown to have stronger effects on the health of Canadians than those associated with behaviours such as diet, exercise, tobacco, and excessive alcohol use

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12
Q

What are the 13 SDH in the Mikkonen & Raphael model?

A
  1. Income and Income Distribution
  2. Education
  3. Unemployment and Job Security
  4. Employment and Working Conditions
  5. Early Childhood Development
  6. Food Insecurity
  7. Housing
  8. Social Exclusion
  9. Health Services
  10. Gender
  11. Aboriginal Status
  12. Race
  13. Disability
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13
Q

SDH: Income and Income Distribution

A

Level of income shapes living conditions, health related behaviours, psychological functioning, and social engagement

More equal income distribution is one of the best predictors of health of a society

Income is not just about having money, it is about the ability to have control and discretion over life circumstances

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14
Q

The Evidence: Income and Income Distribution

A

More low-income Canadians die earlier or suffer from more illnesses regardless of age, sex, race, and place of residence

Each step up the income ladder Canadians reported having less sickness, longer life expectancy, and improved health

Lowe income predisposes people to social deprivation, it is more difficult for one to engage in cultural, educational, and recreational activities

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15
Q

SDH: Education

A

Health status improves with increasing levels of education and is closely tied to socioeconomic status

Education makes it easier to enact change, presents more opportunities, and increases capacity to promote one’s health

Equips people with knowledge and skills for problem solving, accessing information, securing employments etc.

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16
Q

The Evidence: Education

A

Those with low literacy skills are more likely to be unemployed, poor, and to suffer from poorer health and premature death rates than those with higher levels of literacy

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17
Q

SDH: Unemployment & Job Security

A

Unemployment, underemployment, stressful, and/or unsafe work environments have been associated with poor health and reduced life expectancy

Jobe insecurity has been rising in Canada along with the number of Canadians reporting part-time work

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18
Q

The Evidence: Unemployment Job Security

A

Part-work is associated with more intense work life, decreased job security and income, and class division

Insecure employment often consits of intense work and non-standard hours

Insecure employment is associated with higher rates of stress, body pains, and high risk injury

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19
Q

SDH: Employment & Working Conditions

A

Employment security, physical conditions at work, work pace, and stress, working hours, and opportunities for self-expression and individual development shape health outcomes

A person’s work provided a sense of identity and purpose, social interactions, and opportunities for personal growth

Regulations and policies have been implemented to universally protect Canadian employees, but there are still many factors that shape health outcomes

  • Work-related injury, disability, and death still occur
  • High-stress jobs still occur
  • Work hours over 40 hours per week still occur
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20
Q

The Evidence: Employment & Working Conditions

A

High stress jobs predispose people to high BP, cardiovascular disease, and the development of physical and psychological difficulties

30% of Canadians feel their work puts their health and safety at risk

21
Q

SDH: Early Childhood Development

A

Early child development affects brain development, school readiness, and health in later life

Early childhood experiences have strong immediate effects and long-lasting biological, psychological, and social effects on health

22
Q

What are the three developmental stages in child development?

A
  1. Pathway effects
  2. Cumulative effects
  3. The first 2000 days of life (conception to age 5)
23
Q

Early Childhood Development: Pathway Effects

A

When a child is exposed to risk factors but does not immediately show health effects, rather health issues are seen latin in life

24
Q

Early Childhood Development: Cumulative Effects

A

The longer children live under material and social deprivation conditions, the more likely they are to show adverse health outcomes and developmental effects

25
Q

Early Childhood Development: The first 2000 Days of Life

A

The first 2000 days of life are considered the most important for brain development

Cumulative stress during the first 2000 days especially caused by extreme poverty, neglect, abuse, or severe maternal depression can weaken the architecture of the developing brain with long term consequences for learning behaviour, and physical and mental health

26
Q

SDH: Food Insecurity

A

Inadequate diet in either quality or quantity

Dietary deficiencies are associated with an increased likelihood of chronic disease and difficulties managing them

Important to know that income level may not be the best assessment of food insecurity; better to determine if one’s income meets their needs as this accounts for other financial demands in their lives

27
Q

The Evidence: Food Insecurity

A

9% (1.1 million) Canadian households experience food insecurity

Aboriginal households are more likely to experience food insecurity than non-Aboriginal households

Food insecure households were 80% more likely to report diabetes, 60% more likely to report high blood pressure, and 70% more likely to report food allergies than those with sufficient foods

28
Q

SDH: Housing

A

Poor quality housing and homelessness have been shown to be independent causes of adverse health outcomes

Unaffordable housing is >30% of one’s total income spent on rent

Canada is a signatory to multiple international human rights agreements agreeing to the provision of shelter

29
Q

What are the impacts of Canada’s housing crisis?

A
  • Premature death
  • Poor health
  • Increased emergency room visits
  • Hospital occupancy
  • Increased cost on public health care system overall
  • Economic losses due to loss of workers
30
Q

SDH: Social Exclusion

A

Denying specific groups of people from participating in aspects of Canadian life

Structural conditions marginalize different groups and limit access to social, cultural, and economic resources

Aboriginal peoples, recent immigrants, women, people with disabilities are more likely to experience social exclusion

31
Q

What are the four aspects of social exclusion?

A
  1. Denial of participation in civil affairs: Systemic forms of discrimination prevent people from participation
  2. Denial of social goods: Healthcare, housing, education, income security
  3. Social production: Lack of opportunity to participate and contribute to cultural activities
  4. Economic exclusion: Inability or difficulty accessing opportunities for paid work
32
Q

SDH: Health Services

A

Universal health care protects the health of all citizens and spread health costs across a society as a whole

Services are ideally designed to maintain, promote, and restore health and to prevent disease. However, access to these services can be limited even within Canada

Each province is responsible in providing all medically necessary services but there is much variation across the provinces given that Canada Health Act does not provide a list of services that should be insured

33
Q

The Evidence: Health Services

A

In Canada medicare covers only 70% of total health expenses, the rest is covered out of pocket or by private insurance companies

Dental plans are available to only 26% of low-income workers

Low income earners are 60% less likely tp get a needed test or treatment due to cost compared to average and high income earners

34
Q

SDH: Aboriginal Status

A

Aboriginal Canadians have faced a long history of colonization continuing into multiple aspects of today’s society

35
Q

The Evidence: Aboriginal Status

A

The average income for Aboriginal Canadians is considerably lower the average income for non-Aboriginal Canadians
- 58% lower for Aboriginal men and 75% lower for Aboriginal women

Aboriginal Canadians living off reserve are 4x more likely to experience food insecurity than non-Aboriginal Canadians

Life expectancies for Aboriginal people are 5-14 years less than non-Aboriginal Canadians

36
Q

SDH: Gender

A

Women experience more adverse determinants of health

Unpaid work, lower wages, gender-based discrimination

Women experience more long-term disability and chronic disease than men

The social constructs of gender ascribe society-determined roles, personality traits, attitudes, behaviours, values, and influences

37
Q

SDH: Race

A

Canadians of colour experience higher rates of unemployment and lower income than Canadians of European descent

Increased in low-economic status affected immigrant in all age and education groups (including university)

38
Q

What are the many forms that racism can occur?

A
  • Institutionalized racism
  • Personally mediated racism
  • Internalized racism
39
Q

Institutionalized Racism

A

The structural conditions confided into institutions and governace

40
Q

Personally Mediated Racism

A

Prejudice and discrimination including lack of respect, suspicion, devaluation, scapegoating, and dehumanization

41
Q

SDH: Disability

A

Society should provide Canadians with disabilities the necessary supports and opportunities to engage in Canadian Life

42
Q

The Evidence: Disability

A

People with disabilities are less likely to be employed and when employed they often earn less

  • 12.4% of Canadians report disabilities
  • 40% of those with disabilities are not in the Canadian labour force and rely on Canada’s scarce social assistance
43
Q

What can RNs do to help people with SDH?

A

Understand the impact of the SDH on health status

Learn about the client’s situation

Consider the SDH in their treatment and follow-up plans

Know what community and health resources are available

44
Q

How do we implement SDHs globally?

A

Through the Millennium Development Goals (2000-2015)

- Drawing from SDHs and Whitehall social inequity work

45
Q

MDGs: What are the 8 goals for the world by 2015?

A 
Poverty
Education
Women's empowerment
Child mortality 
Maternal health 
HIV/AIDS & malaria diseases
Environmental sustainability
Global partnerships
46
Q

What are Sustainable Development Goals (2015-2030)

A

Move 2015 from MDGs to SDGs

  • Mainly due to criticism over “missing” ares of MDGs
  • SDGs are more precise goals/ indicators
  • Allows countries to be able to pick and choose issues to measure progress
  • 17 SGDs in 3 main areas
47
Q

What was missing from MDGs?

A
  • Housing
  • Water/ sanitation
  • Hunger
  • Energy/ climate change
  • Governance
48
Q

What are the three main areas in SDGs?

A
  1. Economic
  2. Social
  3. Environmental

NURS 201 (21 decks)

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