Lecture 7 Flashcards
What is a social determinant of health?
A set of factors that act together to influence the health of individuals and communities
-influence health is either +/-
What is the social gradient?
Increase income-> better health
Decrease income-> poorer health
What are the main 8 social determinants of health?
- Income and its distribution
- Education
- Unemployment and job insecurity
- Employment and working conditions
- Early childhood development
- Food insecurity
- Housing
- Social exclusion
What are the 6 other SDs?
Social safety network Healths ervices Aboriginal Status Gender Race Disability
Why is income the most important determinant of health?
It allows. access to other SDOH
- can get better education, food, housing recreational activities
- low income leads to material deprivation and social exclusion
What happens when you increase and decrease income?
Increase-> longer life and decrease. rates of suicide
Decrease-> increase rates of CVD and diabetes
What is income inequality?
The extent to which income is distributed unevenly in a country
What does income inequality lead to?
A weaker economy and poorer health for everyone -greater the distant in income the poorer quality of like and more people are affected by this unequal distribution
What happens in more equal societies?
Life expectancy, child well being, literacy and trust are all BETTER
Infant mortality, obesity, teenage pregnancy, homicide, incidence of mental illness are all LOWER
-society as a whole suffers when there is inequality
What does higher education lead to?
Better health
- Correlated with other SDOH (better jobs, working conditions)
- Facilitates civic engagement
- Increases overall literacy and enhance ability to improve health though individual action
- Provides more opportunities for individuals if their employment situation suddenly changes
What does employment provide?
Income
Sense of identity
Structure day to day life
What does unemployment lead to?
Leads to material and social deprication
Psychological stress
Adoption of health threatening coping behaviours (smoking etc)
What is job insecurity?
Par time/temporary, precarious employment
- numbere of these jobs have increased
- involves non standard working hours
- hard to manage transportation and child care
- Increases physiological and psychological stress
- Negative effects on personal reealtionships, children behaviours
Why is employment and working conditions a SDOH?
Those most vulnerable to poor health outcomes experience adverse working conditions
for employment and working conditions what are the factors that shape health outcomes?
Employment security
Physical conditions at work
Work pace and stress
Working hours and degree of control over time
Opportunities for self expressions and individual development
Why is early childhood development a SDOH?
Early childhood experiences predicted health in later life
-poor maternal diet, parental risk behaviours, stress
The longer children live under conditions of material and social deprivation the more liegely they are to show adverse health and development outcomes
- incompetence and emotional immaturity
- sense of inefficacy
What is the most common reason for food insecurity?
Poverty
-simply don’t have the money to buy the best food
What can food insecurity lead to?
Nutritional inadequacies
Chronic
Diseases
Low birth weight (developmentally delayed, cycle continues)
-these conditions cost more to treated manage than would be needed to prevent them through food security
What were the result of the study that looked at ~67,000 individuals in Ontario with regards to annual health care costs and food security?
23% higher (marginal food security)
49% higher (moderates food insecurityy)
121% higher (severe food insecurity)
-these were independent of other SDOH
What is the Paradox of hunger and obesity?
Hunger and obesity can exist in the same families and the same individuals
What research is there for the Paradox of hunger and obesity?
The need to maximize caloric intake (max cals for min price)
Tradeoff between food quantity and quality
Overeating when food is available
How does food insecurity relate to quantitative, qualitative. psychological and social?
Quantitative
-not enough food
Qualitative
-reliance on inexpensive non nutritious food
Psych
-Stress associated with trying to meet daily needes
Social
-getting food in socially unacceptable ways
How are food banks helpful?
Given poverty a public profile
Transportation network for surplus food
Satisfies present and urgent needs
How are food banks harmful?
Acceptance of poverty
Government inaction
Food banks have become institutionalized
What are the 3 steps in the food security continuum?
- Efficiency strategies (give charity)
- food bank
- soup kitchen
- breakfast prog - Transitional strategies (build capacity)
- Community gardens & kitchens
- Soceial enterprises - Redesigne Strategies (address root cause)
- poverty
- housing
- food systems
When does community food security exist?
When all residents obtain a safe personally acceptable nutritious diet through a sustainable food system that maximizes health choices, community self reliance and equal access for everyone
Why is housing a SDOH?
Poor quality leads to increased risk of many health problems
High housing costs= less money for food
Creates stress and unhealthy means of coping
Aboriginals on reserves lack clean wear and basic sanitation
What is the early death rate for homeless individuals in Canada?
8-10x greater to die of early age
What is social exclusion associated with?
Poor health
What are some examples of social exclusion?
Lack of access to emergency child care when single parents work
Senior living along, unable to leave house
Immigrant who do not speak English and do not have family here
Teenagers who feel they don’t fit in
What factors can contribute to a high level of stress?
Low income Poor housing Food insecurity Inadequate working conditions Insecure employment Discrimination Lack of supportive relationships Social Isolation Mistrust of others
In terms of stress and illness, what are the physiological and psychological responses to stress?
Phys: chronic stress->more vulnerability to CVD, immune system diseases, Type 2 diabetes
Psych: Poor living conditions-> feeling of shame, anxiety, h9opelessness, adoption of unhealthy coping behaviours
What is the health gradient?
Individually oriented preventative action
Pushing health hazards
While overcoming barriers
Why would investing in social services reduce some of the impact of SDOH?
Governments should spend less on healthcare and more on social programs such as:
- ECE
- Income assistance
- Affordable child Care
- Subsidize/affordable housing
What happens if we were to spend 1 cent more on social services?
1 cent more spent on social services for every 1 dollar spent on health would:
- increase life expecancy by 5%
- decrease mortality by 3%
What is the difference between equality, equity and structural?
Equality: give everyone same resources
Equity: Give access to same opportunities
Structural: Remove or alter barriers
What is the real measure of an economy?
How well the typical family is doing
income, saving, debt, quality of life
What are things the government can do to support families?
Invest in education, tech and infrastructure
Increase employment-> higher tax revenues cause more people will be paying
Tax bad things like pollution instead of good things like work and savings
Make everyone pay their taxes, including large corporations
Why is the promotion of home cooked family meals a solution to SDOH?
Promoted as a solution to many problems
Usually moms responsibility however:
- most moms work outside the home
- many single parents are moms
- many moms feel like failures for not providing nutritious family meals
- poor parents experience chronic stress
How can we eve beyond the kitchen in terms of the home?
Keeping food in perspective
- dinner time alone cannot make children happy, healthy and well adjusted
- Encourage home cooking if possible but font demonize people for suing convenience foods once in a while
- recognize the diversity of peoples food experiences
How can we eve beyond the kitchen in terms of the community?
Share the work
-community kitchens and suppers
How can we eve beyond the kitchen in terms of listening?
Ask community members what THEY want
What works in one community may not work in another
How can we eve beyond the kitchen in terms of the nation?
Make food a human right
- fix structural inequalities to address root causes
- most effective strategy is to reduce poverty
Support the workers who feed us
-though the whole foodchain
Support families
-paid fam leave, sick and vacation leave. Subsidized preschool, universal health care
