Social determinants of health

Question 1

According to WHO, what is health?

Answer 1

Health is defined by the WHO as a state of complete physical, mental and social well-being and not simply the absence of disease or infirmity (WHO, 2014).

Question 2

What is the social model of health?

Answer 2

The social model of health highlights social, cultural, political, economic, environmental influences for health and wellbeing.
No such thing as ‘normal’ health or disease- health is that which is in line with a rule for a particular cultural or social group.

Question 3

What are the social determinants of health?

Answer 3

‘The social conditions in which people live powerfully influence their chances to be healthy. Indeed factors such as
• poverty,
• food insecurity
• social exclusion and discrimination,
• poor housing
• unhealthy early childhood conditions and
• low occupational status
are important determinants of most diseases, deaths and health inequalities between and within countries.’

Question 4

What are the social determinants of health?(Contd.)

Answer 4

Social determinants operate at different levels…. •Structural issues, such as socioeconomic policies or income inequality, are often termed ‘upstream’ factors. •While ‘downstream’ factors like smoking or stress operate at an individual level –and can be influenced by upstream factors.
•Addressing the social determinants of health suggests ‘going beyond the immediate causes of disease’ and placing a stronger focus on upstream factors.

Question 5

Why are social determinants important?

Answer 5

• Health care is responsible for less than half of our health.
• The biggest contributor to our health & to health inequalities is ‘the wider determinants of health’, i.e. those factors that are not health care, behaviours or genetics.

Question 6

What is Health Inequality?

Answer 6

Differences in the health status between different population groups e.g. differences in mobility between elderly people and younger populations.

Question 7

What is Health Inequity?

Answer 7

Arise from the uneven distribution of resources that are unnecessary and avoidable, as well as unjust and unfair

Question 8

The Black Report (1980), identified four explanations for health inequalities- what were they?

Answer 8

1.Materialist e.g. poverty, deprivation2.Behavioural e.g. lifestyle3.Artefact e.g. how inequalities are measured4.Social selection -health determines social class and not vice versa. It concluded that although all the explanations have a role to play, that materialist explanations accounted more for health inequalities

Question 9

What is poverty?

Answer 9

• Absolute poverty –this generally denotes a poverty level relative to a fixed standard of living, rather than the rest of the population.
• Relative poverty –this compares each household’s income to the median income of their country, where those with less than 60% of the median income are classified as poor.

Question 10

What is deprivation?

Answer 10

• Material deprivation is when an individual is not able to afford certain possessions most people take for granted, or are unable to replace worn out items.
• Area deprivation “may summarise an area’s potential for health risk from ecological concentration of poverty, unemployment, economic disinvestment, and social disorganisation“

Question 11

What did the Acheson Report (1998) discover?

Answer 11

It concluded that while social determinants affect people’s health across their lives, the early years are a particularly important stage of life, where poor socio-economic circumstances have lasting effects.

Question 12

What is the life course theory?

Answer 12

Barker hypothesis- Low growth rates in utero and during infancy are associated withpremature mortality in adulthood.
Fetal undernutrition leads to disproportionate fetalgrowth:programmes later CHD, impaired glucose tolerance, lipid metabolism

Question 13

What did the Marmot Review find in regards to Health inequalities as a social gradient?

Answer 13

• Sir Michael Marmot (Marmot Review 2010) identified a social gradient of health inequalities, which means that health inequities run from the top to bottom of the socioeconomic spectrum and affect everyone.
• This is a global phenomenon, seen in low, middle and high income countries.

Question 14

What can doctors do to tackle social determinants of health?

Answer 14

Doctors can use their position and their expertise to…
•advocate for change•promote the generation of research, especially on the efficacy of prevention measures
•use clinical tools including social prescribing and brief interventions
•work within communities, for example, by commissioning measures including health promotion and ill-health prevention that will affect changes to the social determinants