Social Determinants of Health

Question 1

Socioeconomic determinants of health inequalities within countries

Answer 1

(1) Diet
o	Access to food
o	Education
o	Food culture (Jensen and Miller)
o	Time it takes to prepare healthy food

(2) Stress
o Biological pathways linking stress to health outcomes, e.g.:
- Hormone (im)balances
- Inflammation

(3) Access to healthcare
o Rural vs. urban
o Income
o “Inverse care law”: healthcare tends to be organized in such a way that the places that need healthcare the least tend to have the most and the best healthcare facilities (e.g., affluent areas of New York)

(4) Stigmatization of aspects of one’s identity

Question 2

Inequalities in Health: Report of a Research Working Group (1980)

Answer 2

1. Artefact – argument that way in which data was being measured over time had changed (REJECTED as an explanation for health inequalities)
2. Genetics – people in poorer sociological conditions more likely to marry others in poorer sociological conditions (REJECTED)
3. Social selection – those with health conditions may end up in lower paying jobs (not found to be a main driver of socioeconomic health inequalities)
4. Healthcare – access (plausible?)
5. Behavior – diet, etc. (plausible?)
6. Material deprivation – experience of being poor (found to be primary driver of health inequalities)

Question 3

Michael Marmot

Answer 3

‘Health and longevity are intimately related to [relative] position in the social hierarchy’ (Marmot, 2004)

Relative position in the social hierarchy, rather than absolute wealth, is what matters in determining health inequalities

Question 4

Captain John Graunt

Answer 4

Started publishing causes of death in London in the 15th century

Used socio-epidemiological tools to demonstrate that people die of different things, and at differing rates

Question 5

‘Lives on the Line’

Answer 5

Shows life expectancies in London by tube station—health inequalities evident even within a city

Question 6

Within a country, there exist inequalities between social groups, such as by…

Answer 6

o Area of residence
o Sex
o Education
o Wealth quintile