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Year 3 - Public Health > Social Determinants of Health > Flashcards

Social Determinants of Health Flashcards

1
Q

Define social determinants of Health

A

Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks

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2
Q

What is epidemiology concerned with

A

understanding the causes of disease and illness; and the way in which multiple factors interact with each other to cause illness and how to prevent it

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3
Q

What are the two broad categories that determine health and the third broad category

A

Two main

  • The biological determinants
  • The social determinants

Third broad category
- the environmental, ecological or planetary determinants of health

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4
Q

What are conceptual frameworks

A

Conceptual frameworks are useful tools for helping to describe concepts or complex relationships in a simple manner

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5
Q

What do public health frameworks aim to do

A

that aim to describe the complex interaction between the many different factors that influence the health of individuals or populations.

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6
Q

What framework did Dahlgren and Whitehead come up with

A
  • Rainbow framework
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7
Q

What is the rainbow framework

A
  • framework reveals a mix of social and biolgoical factors that cut across multiple sectors (e.g. agriculture, education, housing, and healthcare) which operate a multiple levels from the individual to the conditions of society
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8
Q

What does the barton and grant framework propose

A
  • More detailed and complex
  • includes specific mention of the global ecosystem including climate change and biodiversity
  • makes specific reference to politics and makes a distinction between the natural and built environments
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9
Q

Describe the social susceptibility and vulnerability to HIV/AIDS infection (Barnett, whiteside, and decosas) framework

A 
Distal determinants 
Determinants 
Macroenvironment 
- wealth
- income distribution 
- culture 
- religion

Microenvironment

  • mobility
  • urbanisation
  • access to healthcare
  • levels of violence

Behaviour

  • rate of partner change
  • prevalence of concurrent partners
  • sexual missing patterns
  • sexual practices and condom use
Biology 
- virus subtypes 
- stage of infection 
- presence of other STDs 
- gender 
Proximal determinants

distal internventions
Macro-environment
- governance

Micro-environment
- women’s rights and status

Behaviour

  • breastfeeding
  • communications about behaviour change
  • condom promotion and marketing
Biology 
- circumcision 
- STD treatment 
- blood safety 
- ART during pregnancy 
Proximal interventions
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10
Q

describe the UNICEF pathway that is used to descirbe child malnutrition and mortality

A

Basic causes

  • economic structure
  • political and ideological superstructure
  • resources control: human, economic, and organizational

Underlying causes

  • insufficient household food
  • inadequate maternal/child care
  • insufficient health services/unhealthy environment

Immediate causes

  • inadequate dietary intake
  • disease

Manifestations
- malnutrition/death

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11
Q

What are the important features of the UNICEIF pathway that is used to descirbe child malnutrition and mortality

A
  • distinction between immediate, underlying (or intermediate) and basic causes
  • highlights the political and ideological superstructure and the economic structure as the factors that determine how resources are controlled and distributed across society which influences the way communities and households are exposed to the underlying and immediate causes of child malnutrition and mortality
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12
Q

what can be viewed as a social determinant of health

A

Anything that is created or produced by human society can be viewed as a social determinant of health if it plays some part in promoting and protecting health, or increasing the risk of illness, disease or injury

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13
Q

What is health inequalities the result of

A
  • social structures
  • social systems
  • processes that most people would consider unfair or unjust
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14
Q

What are health inequities

A

Health inequalities that are systemic, unfair and reversible are usually referred to as health inequities

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15
Q

What was included in the 1978 Alma Ata Declaration

A
  • The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.
  • The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.
  • Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace
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16
Q

What are the dominant determinants of health and those that play a smaller role

A

Dominant determinants of health

  • total ecology
  • societal/social characterstics

Smaller roles

  • access to healthcare
  • indvidual behaviours
  • genetic/biological factors
17
Q

what are system maps used for

A

System maps or causal loop models are often used to improve insight into the underlying structure of complex issues.

18
Q

What is the obesity system map

A

Our obesity system map was designed as a conceptual representation of the interdependencies of relevant variables that currently determine the energy balance of an individual or group of people in the UK

19
Q

What is the obesity system map made up of

A
  • large number of determinants or variables
  • some variables are straightofward and measurable while others are psychological, cultural or enviornment that are difficult to quantify
  • has an energy balance (energy intake versus energy expenditure)
20
Q

what drives energy balance in the obesity system map

A
  • core balancing loop = combination fo two overlapping balancing loops - biolgical in nature and revolve around the activity of body weight maintenance - this loop embodies the underlying homeostatic control system which regulates body weight
  • a reinforcing loop = core balancing loop may be overridden if the people increase the time and effort they give acquiring and conserving energy
  • A conscious control loop - third balancing loop is superimposed on the core and lock in loops - cognitively driven effort that reflects the ability of humans to make decisions which can override biological, social or cultural factors
21
Q

what varables does the core balancing loop link (obesity system map)

A
  • level of avaliable energy
  • importance of physical need
  • effort to acquire energy
  • effort to preserve energy
22
Q

what does the reinforcing loop link (obesity system map)

A

a reinforcing loop or ‘lock-in’ linking both ‘effort to acquire energy’ and ‘effort to preserve energy’ positively to ‘strength of lock-in to accumulate energy’. A strong lock-in, in its turn, reinforces both the ‘effort to acquire energy’ and the ‘tendency to preserve energy’. This reinforcing loop effectively bypasses the role of the ‘importance of physical need’ variable from the core balancing loop.

23
Q

What does the third balancing loop (consiocus control) do (obesity system map)

A

The variable ‘conscious control of accumulation’ is negatively driven by the ‘importance of physical need’. When, in a situation of energy abundance, the importance of physical need for energy decreases, the conscious control of accumulation should increase to keep the system in balance. As conscious control increases, the ‘strength of lock-in to acquire energy’ is decreased, as is the effort to acquire and preserve energy.

24
Q

What are the 7 key subsystems or themes of the obesity system map

A
  • the physiology cluster
  • individual activity cluster
  • physical activity environment cluster
  • food consumption cluster
  • individual psychology cluster
  • social psychology cluster
25
Q

Describe the 7 key subsytems or themes of the obesity system map

A

• The physiology cluster contains a mix of biological variables e.g. genetic predisposition to obesity, level of satiety and resting metabolic rate. It also contains an important reinforcing loop that endeavours to maintain the appropriate body composition from one generation to another.

• The individual activity cluster consists of variables such as an individual’s or group’s ‘level of recreational, domestic, occupational and transport activity’, ‘parental modelling of activity’ and ‘learned activity patterns’. The links between the variable ‘level of physical activity’ and the ‘level of fitness’ indicate that a
particular level of fitness is required to engage in physical activity – the higher the level of fitness, the easier it is to engage in physical activity, and vice versa.

  • The physical activity environment cluster includes variables that may facilitate or obstruct physical activity such as ‘cost of physical exercise’, ‘perceived danger in the environment’ and ‘walkability of the living environment’. It also includes variables that reflect cultural values associated with activity patterns, such as ‘reliance on labour-saving devices’.
  • The food consumption cluster includes many characteristics of the food market in which consumers operate and reflects the health characteristics of food products, such as the level of food abundance and variety, the nutritional quality of food and drink, the energy density of food, and portion size.
  • The food production cluster includes many drivers of the food industry such as ‘pressure for growth and profitability’, ‘market price of food’, ‘cost of ingredients’ and ‘effort to increase efficiency of production’. It also includes variables reflecting the wider social and economic situation in the UK, such as ‘purchasing power’ and ‘societal pressure to consume’.
  • The individual psychology cluster contains variables that describe a number of psychological attributes from ‘self-esteem’ and ‘stress’ to ‘demand for indulgence’ and ‘level of food literacy’. It also contains variables related to the kind of parenting style prevalent in families with children: ‘level of parental control’ and ‘level of children’s control of diet’.
  • The social psychology cluster captures variables that have influence at the societal level, such as ‘education’, ‘media availability and consumption’ and ‘TV watching’. It also includes variables related to societal attitudes to weight such as ‘social acceptability of fatness’ and ‘importance of ideal body-size image’
26
Q

What are the four key variables of the energy baalnce engine

A
  • the level of primary appetite control in the brain – reinforces the dominance of the system to regulate biological appetite over energy expenditure within the physiology cluster of the map
  • the force of dietary habits that keeps individuals or groups from adopting healthier alternatives – represents the accumulated consequences of multiple variables within the food cluster of the map, from the energy density of food to the portion size.
  • the level of physical activity – dominates other energy expenditure mechanisms that are less easily modified within the activity area of the map
  • the level of psychological ambivalence experienced by individuals, groups or organisations in making lifestyle choices – symbolises the convergence of many motivations and social drivers on individual, family, group and societal behaviours within the psychological areas of the map.
27
Q

What is the core engine surrounded by (foresight obesity system map)

A
  • the level of primary appetite control
  • the force of dietary habits
  • the level of physical activity
  • the level of psychological ambivalence
28
Q

What were the 6 recommendations in Marmots fair society

A
  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure healthy standard of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill health preventions
29
Q

What gives rise to inequities

A

Unfair economic arrangements, poor social policies and bad governments are responsible to inequities that give rise to avoidable inequalities in health

30
Q

What do bigger income gaps lead to deteriorations in

A

Health

  • Drug abuse
  • Infant mortality
  • Life expectancy
  • Mental illness
  • Obesity

Social relations

  • Child conflict
  • Homicide
  • Imprisonment
  • Social capital
  • Trust

Human capital

  • Child wellbeing
  • High school drop outs
  • Math and literacy scores
  • Social mobility
  • Teenage births

Year 3 - Public Health (12 decks)

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