Social determinants of health and Health as a social construct

Question 1

Deprivation and health

Answer 1

People living in areas with the highest socio-economic deprivation have:

• lowest life expectancy at birth
• highest death rates from most conditions
• higher rates of teenage pregnancy
• higher levels of unhealthy lifestyles

Question 2

5 original theories linking socioeconomic deprivation and poor health

Answer 2

1) Measurement error (discredited)
2) Social selection- health determines socioeconomic status (not significant)
3) Behavioural/cultural- poor health behaviours
4) Psychosocial- stress creates biological changes
5) Material- direct effects of poverty

Question 3

2 new theories linking socioeconomic deprivation and poor health

Answer 3

1) Importance of area context- physical environment, availability of goods and facilities, social capital
2) Role of lifecourse- biological and social pathways between childhood and adulthood that accumulate risk for health, behaviours and social circumstances

Question 4

WHO definition of health

Answer 4

A complete state of physical, mental and social wellbeing and not merely the absence of disease and infirmity.

Question 5

WHO definition of mental health

Answer 5

A state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his own community.

Question 6

Marinker’s 3 levels (1975)

Answer 6

1) Disease- a pathological process, deviating from the norm
2) Illness- a personal feeling of being unhealthy
3) Sickness- a social role

Question 7

Disease definitions

Answer 7

• International Classification of Diseases (ICD-10)

- Diagnostic and Statistical Manual of Mental Disorders (DSM-V)

Question 8

Traditional theories of health and disease

Answer 8

• Germ theory/pathogenic medicine

- Biomedical model

Question 9

Health as a social construct

Answer 9

The concepts of health and illness mean different things to different people, so they cannot be objective, scientific, absolute facts. Social construction means that disease categories are not created independently from social or moral forces.

Question 10

Medicalisation

Answer 10

A process by which non-medical problems become defined and treated as medical problems. Occurs on international, conceptual and institutional levels.

Question 11

Iatrogenesis

Answer 11

The causation of an illness or injury by any form of medical care. Categories are:

• medical incompetence
• cascade iatrogenesis
• social iatrogenesis
• structural iatrogenesis

Question 12

Medicalisation of madness

Answer 12

• behaviour and emotions under moral/religious/clinical gaze
• power of incarceration and hospitalisation
• hard to define what is ‘normal’
• consequences of labelling and psychiatric categorisation=loss of autonomy, depersonalisation, powerlessness
• self-surveillance, assumptions and monitoring

Question 13

The birth of the clinic (Foucault 1973)

Answer 13

• new forms of knowledge lead to new ways of constructing disease
• shift from hospital based medicine to ‘surveillance’ medicine ie. public health and primary care
• shift from disease located in the body to the psychosocial space
• current emphasis on lifestyle factors and health promotion

Question 14

Feminist critique

Answer 14

Medicine as an instrument of patriarchy:

• medicalisation of women’s reproduction and childbirth
• obstetrics as a male-dominated profession
• stigma around a mother’s choices ie. breastfeeding
• role of the midwife and health visitor