Lecture 1 - Social and structural determinants of health Flashcards
What is health?
-WHO: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity
- Physically can be optimal, but physical health alone is not enough to be considered healthy. Also, need mental health such as not suffering from anxiety
- Health is a resource for everyday life. Good health allows you to fully participate in society and allows you to pursue your personal goals
What is social well-being?
- Social well-being is a sense of belonging to a community and contributing to society through having positive interactions with other people and with local communities and social institutions (inclusion in society). It gives people a sense of meaning and purpose.
- Have trust in society, that you believe in your government, participating in social institutions (e.g. church)
Define health disparity
- Health disparity: differences in health status between different population groups (e.g. men and women immigrants vs non-immigrants; rich and poor)
- Unfair differences can often be prevented (cannot prevent differences such as genetics - not considered unfair)
What are diet-related chronic diseases attributed to? What are the symptoms and consequences?
- Diet-related chronic diseases are attributed to too much sodium, too much saturated fat, too much sugar, too few whole grains and too few vegetables and fruits
- Diet-related chronic diseases include hypertension, coronary artery disease, cancer, obesity, and type 2 diabetes
- People with diet-related chronic diseases face a range of negative consequences, which include lower quality of life and premature death
- Individuals with diet-related chronic diseases are an economic burden on the healthcare system
Who are most likely to have diet-related chronic diseases?
- People with the lowest socioeconomic status and disproportionately high rates of hospitalization and deaths due to chronic disease
- Need to consider what factors lead to increased health risk
Prevalence of obesity among adults
- The prevalence of obesity among adults who have not completed high school is twice that of those with a university degree
- The prevalence of obesity among people who are permanently unable to work is 1.6x that of people who have a job
Define health inequity
The unfair disparity in health status between groups due to avoidable differences in social, economic, environmental or healthcare resources between different groups of people
What are the causes of health inequities?
- Social determinants of health and structural determinants are the cause of health inequities
Because differences in health are unfair and avoidable it is a _______________________
Social injustice
- Health inequities are the result of social injustice, e.g. educational inequality, racial discrimination
What are determinants of health?
- The determinants of health are the broad range of factors that determine individual and population health
- Genetics
- Age
- Gender
- Personal lifestyle practices (lead to…)
- Life conditions and circumstances
Life conditions and circumstances are from?
- An individual’s lifestyle ‘choices’ (e.g. diet, activity levels, alcohol and tobacco use) are heavily structured by conditions and circumstances in their life
- This implies free will and choice but not everyone has resources available to them. Need to remember this when counselling individuals
What contributes to health?
- Environment and life mainly contribute to your health. Need to be aware of these
- Health care and biology contribute though less so
- With health care it doesn’t matter if you treat someone if their environment and life isn’t conducive to health
What are social determinants of health?
- the conditions in which people are born, grow, live, work, and age that influence health in positive and negative ways:
- Income = Major driver
- Education
- Employment
- Food Insecurity (can you afford the food you want to eat?)
- Housing (crowded home, move often, security)
- Early childhood development
- Social inclusion and non-discrimination
- Health services (available, culturally safe)
What is the primary driver of SDoH?
- Income
- Income is an exceedingly good predictor of health and mortality from a variety of diseases
- Income is a better predictor of health than weight or physical activity
- People with lower income levels report higher prevalence of diet-related chronic diseases than those in higher socioeconomic status groups
Why is low income a primary driver?
- Low income leads to material and social deprivation
- The lower the income, the less likely individuals and families are able to afford the basic prerequisites of health such as food, clothing, housing, and water
- Income also affects health by determining the degree of control people have over life circumstances and, hence, their capacity to take action (low income means choices are taken out of your control)
What is material and social deprivation in the context of Canada?
- Certain goods are needed to survive in society. - Consumption goods and activities where most people would have them. Vehicle, cellphone, credit card, participation in sports, internet, school activities = materials needed today
- In Canada for the most part peoples basic needs are at least met, so these other things are important. In different societies it can mean different things
How does low-income lead to social exclusion?
Low income contributes to social exclusion by making it harder to participate in cultural, educational, and recreational activities
How does social exclusion impact social support networks?
People experiencing social exclusion may lack social support networks. E.g. have to move around a lot and limited time to engage with the community
How can victim blaming occur when an individual is obese?
- People tend to blame the person for being obese when in reality they may not have a choice
- Creates a disease stigma
- Can create fat shaming
- Don’t acknowledge SDoH
What does linked lives in regards to the life course perspective mean?
- The lives of family members are interconnected. Families transmit advantage or disadvantage (e.g. if your parents are poor you have a greater likelihood of being poor and so do your children)
- Upward Social Mobility
Explain how structures, social determinants of health and health disparities are all interconnected
- Structures such as policies, economic systems, and social hierarchies like racism can all impact social determinants of health related to poverty and inequality
- These then can cause health disparities and health outcomes
Explain the difference between an upstream and downstream approach
- A Downstream approach provides care to those already injured or sick and is therefore reactive. It includes medical interventions and clinical care.
- An upstream approach focuses on improving conditions before they happen. It is more of a community impact. Tactics include laws, policies and regulations that create community conditions supporting health for all people. It is proactive. Looks at structural determinants. Fewer people downstream that need help by focusing here
- Midstream approaches address individuals social needs as well as includes patient screening questions, social workers, community health workers, organizations to provide direct assistance. Looks at social determinants.
