PPHC 16: Special Topics – Why are some individuals sicker than others?

Question 1

What is inequality?

Answer 1

unequal access to opportunities

Question 2

What is equality?

Answer 2

evenly distributed tools and assistance

Question 3

What is equity?

Answer 3

custom tools that identify and address inequality

Question 4

What is justice?

Answer 4

fixing the system to offer equal access to both tools and opportunities

Question 5

What is health inequity?

Answer 5

• the unfair and avoidable differences in health status seen within and between countries
• health inequalities that are unfair or unjust and modifiable

Question 6

How are health inequities different from health inequalities?

Answer 6

they are unfair and avoidable differences in health

Question 7

What are the main determinants of health?

Answer 7

• income and social status
• employment and working conditions
• education and literacy
• childhood experiences
• physical environments
• social supports and coping skills
• healthy behaviours
• access to health services
• biology and genetic endowment
• gender
• culture
• race/racism

(all these factors are interconnected and play a role in not only who gets sick, but also how sick they get)

Question 8

What are social determinants of health?

Answer 8

non-medical factors that influence health outcomes

• the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life – these forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems

Question 9

What are the main social determinants of health?

Answer 9

• income and income distribution
• education
• unemployment and job security
• employment and working conditions
• early childhood development
• food insecurity
• housing
• social exclusion/inclusion
• social safety network
• health services
• indigenous ancestry
• gender
• race
• disability

Question 10

SDOH

Income and Income Distribution

Answer 10

• level of income shapes overall living conditions, affects psychological functioning, and influences health-related behaviours
• major predictor for socioeconomic status (SES) – an economic and sociological combined total measure of a person’s work experience and of an individual’s or family’s economic access to resources and social position in relation to others

Question 11

SDOH

Education

Answer 11

• higher educational attainment can lead to improved health
• education shapes employment opportunities
• having higher education can decrease likelihood of unemployment

Question 12

SDOH

Unemployment and Job Security

Answer 12

• unemployment can cause material and social deprivation and increases risk of poverty
• individuals struggling with job insecurity may be forced to work in poor conditions with non-standard hours
• increased likelihood of stress, injury, and bodily harm

Question 13

SDOH

Employment and Working Conditions

Answer 13

• working conditions are important to consider – think of the amount of time we spend in our workplaces
• people who are already vulnerable to poor health outcomes due to lower income and education are also most likely to experience adverse working conditions

Question 14

SDOH

Early Childhood Development

Answer 14

• latency effects: describe how early childhood experiences predispose children to either good or poor health regardless of later life circumstances
• cumulative effects: the longer a person is exposed to negative factors the worse off their health will be
• pathway effects: early experiences set the stage for future experiences which will in turn shape subsequent experiences

Question 15

SDOH

Food Insecurity

Answer 15

the inability to acquire or consume an adequate diet quality or quantity of food in socially accepted ways, or the uncertainty that one will be able to do so

Question 16

SDOH

Housing

Answer 16

• homes and health: poor-income houses are subject to poor ventilation, over-crowding, improper food storage and waste disposal, lead paint, unsafe railings and wires
• neighbourhood and health: research has found that where you live will determine your health, weight, mental health, children’s readiness for school, likeliness of starting to smoke, heart disease, and more – consider food deserts, safety, access to parks and sidewalks

Question 17

SDOH

Social Exclusion/Inclusion

Answer 17

• social capital: those features of social structures (level of trust and norms) which act a resource to individuals and facilitate collective action
• social exclusion: includes both economic hardship and marginalization from community life – stems from lack of power

Question 18

SDOH

Social Safety Network

Answer 18

social safety nets provide non-contributory assistance existing to improve lives of vulnerable families and individuals experiencing poverty and destitution

• Employment Insurance, Canada Pension Plan, Canada Child Benefit, the Canada Workers’ Benefit

Question 19

SDOH

Health Services

Answer 19

• Canada Health Act (1984) requires provinces provide all “medically necessary” services on a universal basis – all residents are provided access to public health-care insurance on equal terms and conditions
• main purpose of a universal health care system is to protect the health of citizens and spread health costs across the whole society – who has access to care, is it easier for some people to access health services than others
• uncovered services – eyecare, dental care, some pharmaceuticals, alternative health practitioners

Question 20

SDOH

Indigenous Ancestry

Answer 20

• health of Indigenous peoples in Canada is linked to their history of colonialization
• colonial legislation and policies have real-world effects resulting in poorer health outcomes
• eurocentric attitudes reflected in Canadian society
• lack of access to health services

Question 21

SDOH

Gender

Answer 21

• gender roles in society dictate how we’re expected to act, speak, dress, groom, and conduct ourselves
• implications on health linked to gender roles and norms, wage gaps, and increased discrimination
• impact on health behaviours – consider masculinity and attitudes of ‘toughing it out’

Question 22

SDOH

Race

Answer 22

• institutionalized racism: concerned with societal structures of society and may be codified in institutions of practice, law, and governmental inaction in the face of need
• personally mediated racism: prejudice and discrimination, and can manifest itself as lack of respect, suspicion, devaluation, scapegoating, and dehumanization
• internalized racism: those who are stigmatized accept these messages about their own abilities and intrinsic lack of worth

Question 23

SDOH

Disability

Answer 23

• often seen in medical terms without recognizing the social relevance
• consider whether society is willing to provide persons with disabilities with the supports and opportunities necessary to participate in life
• exacerbated by and linked to gender, unemployment, and income

Question 24

What are the Whitehall studies?

Answer 24

demonstrated the social gradient of health for income – phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged

• can be seen in any of the SDOH
• implications for policy and health

Question 25

What are the 3 levels of cause of SDOHs?

Answer 25

• proximal: behaviours, capabilities, attitudes, direct biological threats to health
• intermediate: relationships, social contexts
• distal: cultural, political, infrastructural

Question 26

What is the upstream approach in health?

Answer 26

seeks to improve fundamental social and economic structures in order to decrease barriers and improve supports that allow people to achieve their full health potential

• goal: mitigating the causes-of-causes
• requires looking at SDOH to address and prevent health inequities

Question 27

What is the midstream approach in health?

Answer 27

seek to reduce exposure to hazards by improving material working and living conditions, or to reduce risk by promoting healthy behaviours

• goal: change the causes

Question 28

What is the downstream approach in health?

Answer 28

seek to increase equitable access, at an individual or family level, to health and social services

• goal: change the effects of the causes

Question 29

Describe SDOH in research.

Answer 29

• documented to impact our health
• policy implications of findings
• how can we use this information to improve population and public health

Question 30

What are implications for practice for SDOH?

Answer 30

• ongoing relationship between pharmacists and patients – Better understanding of other factors that might be influencing a person’s health (ie. SDOH)
• pharmacists can play a role in influencing outcomes associated with SDOH through effective screening and intervention methods
• can connect patients with community-based organizations to help address their specific needs