Social and Structural Determinants of Health

Question 1

Describe social determinants of health

Answer 1

Conditions in which people are born, grow, live, work, and age, including the health system which are shaped by the distribution of money, power, and resources at global, national, and local levels – WHO

An individuals place in society such as income, education, or employment

Experiences of discrimination, racism and historical trauma are important SDH

Question 2

What are the conditions in which people are born, grow, live, work, and age, including the health system which are shaped by the distribution of money, power, and resources at global, national, and local levels?

Answer 2

Social determinants of health

Question 3

What are the individual social determinants of health?

Answer 3

o Income and income distribution
o Education
o Unemployment and job security
o Employment and working conditions
o Early childhood development
o Food insecurity
o Housing
o Social exclusion
o Social safety net
o Health services
o Indigenous status
o Gender
o Race
o Disability

Question 4

Why are SDOH of importance to healthcare workers?

Answer 4

o We can advocate for patients by pushing for politics and policies that positively affect SDH
o Properly addressed, SDH enhance health and diminish persistent disparities in health

Question 5

Other than SDH, what can impact health outcomes at the individual level?

Answer 5

Biology and genetic endowment

Specifically genes, epigenetics, and early brain development

Question 6

How can our genes affect our health?

Answer 6

o Thought to predispose and individual to certain health conditions
o May manifest themselves when the individual is exposed to certain socioeconomic or environmental factors

Question 7

What are epigenetics?

Answer 7

o Study of heritable changes in gene expression (phenotype) that do not involve changes to the underlying DNA sequence, which in turn affect how cells read the genes
o Demonstrates genes alone may not be sufficient to determine health status

Question 8

What biological process is significantly influenced by the attachments formed during childhood? What can if effect?

Answer 8

Early development of the brain

Plays a crucial role in shaping a person’s long-term capacity to cope with stress and navigate conflicts

Question 9

What is demography?

Answer 9

Study of populations, including
 Size, density
 Fertility, growth
 Age distribution, mortality
 Migration, geography
 Vital statistics

Question 10

What are sociodemographic indicators?

Answer 10

MEMORY: FAIL to get demos

Family environments

Aging
 Rising proportion of the population is >65 y/o

Immigration
 Permanent residents or landed immigrants
 Increasing rates is changing overall ethnicity as more coming from non-European countries

Language

Question 11

What are socioeconomic indicators?

Answer 11

MEMORY: money LIED

L - literacy and education
I - income
E - employment and working conditions
D - deficient housing/homelessness

Question 12

How does socioeconomic indicators affect health both directly and indirectly

Answer 12

Directly – affects access to what we need for good health

Indirectly – correlated with things like living in unsafe neighbourhoods and experiencing poor working conditions

Question 13

What is included in the physical environment?

Answer 13

physical, biological, chemical, and radiological factors found in food, water, soil, indoor and outdoor air, the built environment, and animal and insect vectors.

Question 14

What are some concerns with the physical environment related to agricultural exposure?

Answer 14

Techniques to achieve economies of scale
Genetic technology
Antibiotics
Accidents

Question 15

What are some concerns with the physical environment related to outdoor air quality?

Answer 15

o Impacts on pulmonary, cardiovascular, and neurological systems
o Estimated 14 400 deaths in Canada every year attributable to air pollution

Question 16

While emphasis continues to be placed on modifiable risk factors, there is increasing recognition that the _____________ affects their ability and motivation to change their behaviour and lifestyle

Answer 16

social and economic environment in which individuals live and work

Question 17

What are examples of preventative health practices?

Answer 17

Immunization

Preventative sexual health practices

Injury prevention practices
o Use of protective equipment/devices
o Distracted driving
o Driving under the influence

Question 18

What are barriers to diet and nutrition as a modifiable risk factor?

Answer 18

• Food environments
• Food insecurity

Question 19

What is physical literacy?

Answer 19

o The motivation, confidence, physical competence, knowledge, and understanding to value and take responsibility for engagement in physical activities for life

Question 20

Which individuals are more likely to have a higher BMI?

Answer 20

o Lower income
o Lower education
o Lower-grade occupations

Question 21

The rise in obesity and overweight has been linked to what some call the “nutrition ________”

Answer 21

transition

Question 22

What significantly contributes to reducing inequities in access to healthcare within the population?

Answer 22

Universal health insurance

Question 23

What is complementary medicine?

Answer 23

o Range of services offered outside of the traditional health care system
o Used alongside conventional medical treatments

Question 24

What is alternative medicine?

Answer 24

o Used instead of conventional treatment

Question 25

Describe proximal determinants of health. What is included? What does inequity give rise to in this stratum?

Answer 25

The upper branches/leaves of the tree

Affect the health of the individual directly (could be considered downstream)

Conditions that have direct impact on mental, physical, emotional, or spiritual health

Disadvantage and inequity within this stratum give rise to all manner of physical, emotional, mental, spiritual, and social challenges

Includes
o Social support networks
o Education and literacy
o Early childhood development
o Gender
o Culture
o Employment
o Working conditions and occupational health
o Income and social status

Question 26

Which level of determinants of health are conditions that have direct impact on mental, physical, emotional, or spiritual health?

Answer 26

Proximal determinants of health

Question 27

Describe intermediate determinates of health. What is included in this level?

Answer 27

The trunk of the tree

Facilitate or hinder health through systems that connect proximal and structural determinants

Systems of care and can include relationships and treatment within those systems

Considered the origin of proximal determinants
o I.e. poverty and smoking are rooted in broader social systems

Includes
o Health promotion and care
o Education and justice
o Social supports
o Labour markets
o Government
o Kinship networks
o Language
o Ceremonies
o Access to health services

Question 28

Which level of determinants of health facilitate or hinder health through systems that connect proximal and structural determinants?

Answer 28

Intermediate DOH

Question 29

Describe the structurral determinatnts of health.

Answer 29

The roots of the tree

Also called distal determinants of health

Structural determinants of health are the interplay of historical, political, ideological, economical, social foundations.

Have the most extensive impact on health, they are challenging to address because they encompass the environment in which intermediate and proximal determinants exist

Question 30

Which level of determinants of health affects the individual directly?

Answer 30

Proximal DOH

Question 31

Which level of determinants of health includes gender, culture, employment, and education?

Answer 31

Proximal DOH

Question 32

Which level of determinants of health includes systems of care (including health) and can include relationships and treatment within those systems?

Answer 32

Intermediate DOH

Question 33

Which level of determinants of health includes health promotion and healthcare, social supports, and ceremonies?

Answer 33

Intermediate DOH

Question 34

Which level of determinants of health are the interplay of historical, political, ideological, economical, social foundations?

Answer 34

Structural DOH

Question 35

Which level of determinants of health generate social stratification?

Answer 35

Structural DOH

Question 36

What are the mechanisms of structural determinants of health?

Answer 36

o Values, beliefs, worldviews, culture, and norms
o Governance
o Laws, policies, regulations, and budgets
o Institutional practices
o Have the capacity to maintain or change status quo

Question 37

When evaluating social structures and power in the ecosystem that influences health, what are Lukes’s 3 “faces of power”?

Answer 37

MEMORY: AID in getting power

Agenda setting power - who can access decision making and what issues are being considered by decision-making bodies

Invisible power in - shaping information, beliefs, and worldviews about social norms

Decision making power - exercising influence over decisions to achieve a particular outcome

Question 38

What does the WHO Commission on SDOH Framework allow us to understand?

Answer 38

causal mechanisms that drive health disparities and realistically evaluate potential interventions, it is essential to understand the operation of power across various aspects of economic, social, and political dynamics

Question 39

The WHO Commission on SDOH Framework looks like 3 columns on two bases. What is on the left 2 columns and the left base they are connected to?

Answer 39

Base is structural determinants/ social determinants of health inequities

The far left column is the socioeconomic and political context and includes
- governance
- macroeconomic policies
- social policies
- public policies (health, education)
- cultural and societal views

The middle column on the same left base is the socioeconomic position and includes
- social class, gender, ethnicity, racism
- education
- occupation
- income

Question 40

The WHO Commission on SDOH Framework looks like 3 columns on two bases. What is on the right columns and base?

Answer 40

Right base is the intermediary determinants/social determinants of health

The right column includes
-material circumstances
-behavioural and biological factors
-psychosocial factors