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Social Determinants of Health > Social Determinants of Health > Flashcards

Social Determinants of Health Flashcards

1
Q

Social Determinants of Health

A

the economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole” (Raphael, 3)

  • Include material and social environments, and are not always (or usually) directly within our control
  • Differ from a traditional focus on individual characteristics and behaviours
  • “social determinants of health also determine the extent to which a person possesses the physical, social and personal resources to identify and achieve personal aspirations, satisfy our needs, and cope with our environments (Raphael, 3).
  • E.g. Food, housing, employment, education, health systems, pollution, racism, sexism etc.
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2
Q

1845: Friedrich Engels

A
  • Material living conditions, day to day stress and adoption of health-threatening behaviour contribute
  • Poor housing, clothing, diet and lack of sanitation leads to infections, diseases and early death among working class English
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3
Q

1885: Rudolph Virchow

A
  • ‘Father of Modern Pathology’

- Health-threatening living conditions as rooted in public policy

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4
Q

1974: New Perspectives on the Health of Canadians

A

-human biology, lifestyle, and health care organizations as determinants of health

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5
Q

1979: The Political Economy of Health:

A
  • “social determinants of health” coined

- Income, resource distribution stress from unemployment and insecure employment

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6
Q

1992: The Health Divide (UK)

A
  • Lowest employment group shows greater likelihood of various diseases, and premature death from illness or injury; despite universal health care system
  • Focus on poverty and the clustering of indicators together
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7
Q

1980: the Black Report (UK)

A
  • Lowest employment group shows greater likelihood of various diseases, and premature death from illness or injury; despite universal health care system
  • Focus on poverty and the clustering of indicators together
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8
Q

1986: Canadian Public Health Association Action Statement for Health Promotion in Canada

A

-Advocating for healthy public policies as the single best strategy to affect the determinants of health

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9
Q

1986: Achieving Health for All a Framework for Health Promotion (Canada)

A

-Need to reduce inequities between income groups; policies to promote income security, employment, education, housing, business, agriculture, transportation and technology

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10
Q

1998: Taking Action on Population Health: a Position Paper

A

-Paper for Health Promotion and Programs Branch Staff (Canada)

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11
Q

2000: Canadian Public Health Association Action Plan

A

-Poverty as having a profound influence on health and needs to be reduced

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12
Q

2003: WHO Social Determinants of Health: the Solid Facts

A

-Explain how nations differ in overall population health

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13
Q

THE GAP BETWEEN KNOWLEDGE AND POLICY

A
  • Despite knowledge of their importance since the 1800s, social determinants have been obscured by an emphasis on biomedical factors and individual behaviour
  • This knowledge has not always translated into practice: Canadian public health policy tends to favour individual, behaviour-based approaches
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14
Q

In the 1970s…

A

the term “social determinants of health” was conceived, and since then a growing body of research has demonstrated their importance

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15
Q

KEY QUESTIONS FROM THE SDOH PERSPECTIVE

A
  1. What are the social factors (e.g. income, education, employment conditions etc.) that shape health and that help explain health inequalities?
  2. What are the societal forces (e.g. economic, social and political) that shape the quality and distribution of these factors?
  3. What is it about Canada’s (or global) economic and political systems that make addressing the social determinants of health through public policy so difficult?
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16
Q

World Health Organization (Ottawa Charter for Health Promotion):

A

-“prerequisites for health” include peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice and equity

17
Q

Rainbow Model of Health (1992):

A

-“living and working conditions arch” includes agriculture and food production, education, work environment, unemployment, water and sanitation, health care services and housing as contributors to health

18
Q

Health Canada:

A
  • various determinants, some (not all) of which are social determinants:
  • income, social status, physical and social environments, biology and genetic endowment, personal health practices and coping skills, healthy child development, health services, gender and culture
19
Q

CDC:

A

-Socioeconomic status, transportation, housing, access to services, discrimination by social grouping (e.g. race, gender class and social or environmental stressors

20
Q

British Working Group:

A

-social gradient (class), stress, early life, social exclusion, work, unemployment, social support, addiction, food, transport

21
Q

THE SOCIAL DETERMINANTS OF HEALTH FRAMEWORK

A
  • Indigenous ancestry
  • Disability
  • Early life
  • Education
  • Employment and working conditions
  • Food security
  • Gender
  • Geography
  • Health care services
  • Housing
  • Immigrant status
  • Income and its distribution
22
Q

THE SOCIAL DETERMINANTS OF HEALTH FRAMEWORK FROM THE YORK UNIVERSITY CONFERENCE

A
  • Includes social location (gender, race, Indigenous ancestry) as indictors of power, influence, and access to economic and social resources
  • Includes social safety net, increasingly recognized as important determinant
23
Q

Framework of the York University Conference based four criteria:

A
  • All of these social determinants of Health are important to the health of Canadians
  • All of these social determinants are understandable to Canadians
  • All of these social determinants of health have clear policy relevance to Canadian decision makers and citizens
  • All social determinants of health are especially timely and relevant
24
Q

Key Themes in Social Determinants of Health

A
  • empirical evidence to support SDoH
  • mechanisms and pathways by which SDoH’s effect health
  • importance of the life course perspective
  • role of public policy and policy environments
  • politics and political ideology
25
Q

Theme #1: EMPIRICAL EVIDENCE OF THE IMPORTANCE OF SOCIAL DETERMINANTS OF HEALTH

A

•Asks what the empirical evidence tells us about the quality and distribution of various social determinants
•How does the quality and distribution of various social determinants explain?
-Improvements in health among Canadians
-Persistent differences in health outcomes among Canadians
-Differences in overall health between Canada and other nations

26
Q

Theme #2: PATHWAYS BY WHICH SOCIAL DETERMINANTS OF HEALTH INFLUENCE HEALTH

A
  • Not only what social determinants of health are correlated with outcomes and indicators, but how they affect health; what is the nature of the relationship
  • Understandings pathways is crucial for interventions
27
Q

Cultural/Behavioural Perspectives → situates the problem in individual choices

A
  • E.g. does this person smoke? Do they exercise? What is their diet like?
  • These choices are seen as factors primarily or solely responsible for someone developing or dying from diseases
28
Q

Materialist/Structuralist Perspective → situates the problem in material conditions

A

-In part asks how our choices are determined or influenced by material contexts

29
Q

Materialist

A

-How do living conditions shape health?

30
Q

Neo-Materialist

A
  • Not only how do living conditions affect health, but how do these living conditions come about?
  • What affects the quality and the distribution of social determinants?
31
Q

Psychosocial Comparison

A

-How comparing ourselves and our lives to others affects our health and well-being

32
Q

Theme #3: THE IMPORTANCE OF A LIFE-COURSE PERSPECTIVE

A
  • Acknowledge and recognize that living conditions experienced at one point in our lives affects our health throughout our lives
  • Avoid the ahistorical approach often associated within individualized, behaviour-centered approaches
  • Lasting impact of childhood living conditions in particular (poverty; trauma)
33
Q

Theme #4: THE ROLE OF PUBLIC POLICY AND POLICY ENVIRONMENTS

A

-In asking how social determinants come about, public policy has a crucial role
-SDoH do not exist in a vacuum – they are largely the result of various policy
decisions
-E.g. if working conditions are a social determinant, then employment regulations play a key role
-Policy context in Canada has changed over time
-Post WWII era – support and development of a strong welfare state
-1970s-present neoliberalism and dismantling of welfare state

34
Q

Theme #5: POLITICS, POLITICAL IDEOLOGY AND SDOH

A
  • What is the role of political ideology in producing policy contexts that shape social determinants?
  • Helps explain why, despite evidence of their importance, there is resistance to acting to improve social determinants of health
  • For instance, what do we believe is the appropriate role of the state?
  • Who is seen as deserving of help/support from the state?
  • Who holds power to influence government policy?
35
Q

Post WWII welfare state

A

possible because state was understood as having a responsibility to care for citizens

36
Q

Post 1970s neoliberal state

A

state understood and ensuring freedom; individuals responsible for own well-being

37
Q

Politics, Political Ideology & SDoH

A

Living Conditions (material and social)-> Access to Power and Resources (and Ideology)-> Influence Public Policy-> Social and Economic Structures

38
Q

Social Determinants are depoliticized when…

A

the focus returns to identifying communities or individuals ‘at risk’ and seeking to change their health behaviour, rather than addressing

a) environments (social, political, economic etc.)
b) the factors that shape our environments

Social Determinants of Health (15 decks)

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