Lecture 3: Social Determinants of Health

Question 1

what are some socioeconomic indicators for maori compared to non-maori?

Answer 1

Maori are more likely to be unemployed, have a personal income less than $10,000, receive income support, live in a household without telecommunications, live in a household without motor vehicle access, live in rented accomodation and have household crowding compared to non-maori.

Maori are less likely to live in a household with internet access and complete school with level 2 certificate or higher compared to non-maori

Question 2

how has income changed as a social determinant over time for different ethnicities?

Answer 2

In the lare 1980s structural reforms caused an increase in unemployment rates especially is Mari and Pacific. This lead to a decrease in income for all groups but especially in Maori and Pacific.

By the early 90s, income for Maori, Pacific and European was recovered, but Maori and Pacific did not recover as much as European.

The european income didn’t decrease as much due to the reforms, their income was always the highest and also increased the most overtime.

deliberate policy choices created these trends.

Question 3

how has income changed overtime in the different decile boundaries?

Answer 3

The lower percentiles were most affected by the structural reforms in the 1980’s which resulted in a reduction in after household cost disposable incomes. those in higher incomes weren’t affected as much

people with lower household incomes have had almost no increase in income overtime

people with higher household incomes have higher increase in income overtime

Question 4

why is housing important as a social determinant of health?

Answer 4

• warm dry well ventilated housing is good for health
• cold, damp housing is associated with increased acute illnesses such as respiratory, worse asthma, increased health service use, more time off work/school
• studies of insulating homes shows houses are warmer and drier. there are also improvements in health, reduced health service utilisation, reduce expenditure on heating
• need to consider rental housing quality and leaky homes as well
• crowded housing is linked to infectious diseases and stress
• homelessness is a problem (41,000 homeless in 2013)
• housing affordability is getting worse. higher mortages also lead to higher rent costs
• availability of heating a house is also an issue

Question 5

how is electricity costs a social determinant?

Answer 5

data was adjusted for difference in value of the dollar

• residential heating costs have increased a lot since 1974-2013
• in 1988 it was very lose cost compared to what it was in 2010
• using electricity is gradually becoming more expensive.

Question 6

how is household fuel as a social determinant?

Answer 6

• Decile 1 (least deprived) spends 7.5% of their income on power in 1988 to 13-14% in 2010. meaning that a larger portion of their income is spent on power compared to decile 10 (most deprived)

This increase didn’t happen in higher deciles. This leads to more chances of adverse health effects due to spending less on heating the house.

Question 7

what is the NZDep 13?

Answer 7

• a small area geographic measure
• at least 100 persons usually resident
• 82 small areas withheld because too few people in the small area for some of the variables (<20)
• 2013 census of population and dwellings
• eight variables

Question 8

what were the findings of the NZDep 13?

Answer 8

decile 10 = most deprived
decile 1 = least deprived

if everything was equal, 10% of maori and non-maori would live in each decile

BUT

23.5% Maori live in decile 10 but only 6.8% non-Maori
3.8% Maori live in decile 1 but 11.6% non-Maori
over 50% of Maori live in deciles 8-10

Question 9

how does mortality differ by ethnicity and deprivation?

Answer 9

• Male mortality is higher than female mortality overall
• Maori males and females have higher mortality than non-maori males and non-maori females.
• mortality rates increase with deprivation. decile 1 has least mortality rates for maori and non-maori whole decile 10 have highest mortality for maori and non-maori
• however the gradient of change is steeper for maori men and maori women compared to non-maori men and non-maori women

Question 10

what is colonisation and indigenous historical trauma? how does it affect Maori?

Answer 10

Historical trauma
- cumulative trauma through emotional and psychological wounding originating from group trauma experiences. e.g. colonisation

• experiences are transmitted between generations by the structures enforced by the dominant systems and through stories
• colonisation and historical trauma causes high levels of collective distress which is transalted multi-generationally.
• leads to dysfunctional and self-destructive behaviours e.g. anxiety, depression and suicide,
• stress from one generation can alter the health and wellbeing outcomes of descendant generations, especially if the initial cause of the distress, such as land loss following colonisation, remains in place
• the primary aspect of trauma resulting from colonisation is a result of the subjugation of a population by a dominant groups and requires 4 elements:
• overwhelming physical and psychological violence, segregation or displacement, economic deprivation and cultural disposession

Question 11

how does land loss and cultural well-being affect Maori?

Answer 11

Iwi that retained a greater proportion of their land, especially in 1890 or 1910 now have:

• higher rates of te reo proficiency
• place greater importance on involvement in Maori culture
• more likely to have visited an ancestral marae over the previous year
• less likely to find it hard getting support with Maori cultural practices

Question 12

how does land confiscation impact maori health?

Answer 12

Iwi that was subject to land confiscation during the Raupatu have a higher smoking rate than in an iwi for whom confiscation did not occur

Question 13

how does te reo impact maori health?

Answer 13

knowledge of te Reo is protective against the progression of pre-diabetes

Question 14

what is the difference between racism and discrimination?

Answer 14

racism is an organised system that categorises racial/ethnic groups and structures opportunity, leading to inequities in societal goods and resources and a racialised social order

discrimination is a behavioural manifestation of racism. it is differential treatment on the basis of race/ethnicity that disadvantages an ethnic group

Question 15

what are the types of racism?

Answer 15

• institutionalised/systemic racism
• personally mediated/interpersonal racism
• internalised racism

Question 16

what is institutionalised racism?

Answer 16

• differential access to the goods, services, and opportunities of society by ‘race’ or ethnicity
• inaction in the face of need
• manifests in material conditions and in access to power

Question 17

what is personally mediated racism?

Answer 17

• includes prejudice and discrimination
• prejudice - differential assumptions about the abilites, motives and intentions of others according to their race/ethnicty
• discrimination - differential actions toward others by race based on those assumptions
• they are explicit, intentional and/or unconscious, automatic (implicit bias)

Question 18

what is internalised racism?

Answer 18

• acceptance by members of stigmatised races/ethnic groups of negatice messages about their own abilities and intrinsic worth
  e. g. the white man’s ice is colder

Question 19

how does racism impact on health?

Answer 19

• differential exposure to determinants of health (e.g. socioeconomic, environmental and behavioural)
• differential access to and quality of health services
• direct effects of racism such as trauma and stress

Racial climate:

• internalised racism influences health behaviours such as smoking, substance abuse
• institutionalised racism influences socioeconomic states and access to health care
• personally-mediated racism leads to differential treatment and stress
• all of these lead to poorer health outcomes