Social Determinants of Health and Primary Health Care Flashcards
Define gender as a health determinant
- Historical roots embedded in the patriarchal subordination and control of cis-women and the erasure of all other non-conforming gender identities
- All people are subject to the health effects of gender but some individuals are more affected than others
Describe the inequities between genders in the workplace
- Ghettoization of cis-women in part-time, lower-waged work with limited or no benefits
- Under-representation of cis-women in leadership positions in the workplace
- Income gap between cis-men and cis-women continues to sit at 20% for comparable work
- Disproportionate burden of unpaid care-giving work carried out by cis-women (children, parents, members of the community) *The double day
- Under-representation of cis-women in research
What are some of the health consequences when considering health as a health determinant?
–Delay in diagnosis of conditions whose symptomology differ from that of cis-men
–Physical/emotional/psychological/social toll of care-giving
–Higher burden of chronic illness and impairment in the latter stages of life
Define transphobia according to Transpulse
“an ‘irrational fear of, aversion to, or discrimination against people whose gendered identities, appearances, or behaviours deviate from societal norms.’ This includes transgender, transsexual, transitioned, transgender, and gender-queer people, as well as some two-spirit people. Transphobia exists within a context of cisnormativity, the expectation that all people are- and should be- cisgender, or non-trans. Transphobia includes acts of exclusion, discrimination, and violence, as well as attitudes that trans people may themselves internalize”
What are some manifestations of transphobia?
• Familial/social rejection during transition process
• Employment & housing discrimination
• Discrimination within the educational system
• Physical/spiritual/psychological/sexual violence
• Institutional erasure in health care–Informational erasure (research, information, training)
–Cis-normative forms/documents/waiting rooms
–Rigid adherence to fixed sex-designations on identification
–Unarticulated anatomically-based eligibility criteria
–Outwardly hostile care environments
What are the consequences of transphobia on health?
•Poorer nutrition, traumatic injuries, exposure to environmental hazards
•Persistent stress
•Cascade of mental health/addictions issues
•Fear of seeking out health care services
–Lack of regular primary care
–Non-prescribed use of transition-related medications
–Low rates of participation in disease screening
What are some Indigenous-specific health determinants?
- Self-determination
- Spirituality
- Culture and Tradition
- Relationship with the Land
- History of Colonialism- Truth and Reconciliation
- Intersectionality of SDH (gender, race, socio-economic status, housing, food security, health services and social support)
- *Freedom from violence against women
Describe some key points and events that occured in the history of colonialism
- Policy of physical, biological, and cultural genocide of Indigenous peoples in Canada
- Land occupation & seizure
- Creation of geographically isolated and confined communities
- Implementation of residential school system to achieve ‘assimilation’
- Destruction of Indigenous forms of self-governance
- Disqualification of women from holding council positions
- Persecution of spiritual leaders
What are the consequences in today that colonialism has imposed for Indigenous peoples?
–Limited employment opportunities in many communities
–Inadequate housing/infrastructure in many communities
–Inadequate health care and education in many communities
–Extremely high cost of living
–Limited availability of healthy food
–Environmental pollution
–Profound intergenerational trauma
–Deeply entrenched, racist cultural representations of Indigenous Peoples within Canadian society
What are some systemic and institutionalized forms of discrimination against Indigenous people?
- Employment
- Housing
- Health care
What are some health-related consequences of colonialism?
- Cascade of mental health issues/addictions
- High rates of suicide
- High rates of domestic violence secondary to intergenerational trauma
- High levels of stress, nutritional deficiencies, traumatic injuries, infectious disease, chronic illness
What are some of the barriers and/or tensions in clinical practice when trying to assess for SDOH?
–Not knowing how to ask about SDH or what to do about them once finding out
–Feelings of helplessness/powerlessness
–Argument that making an impact on the SDH requires broad intersectoral action and whole of government approaches
–Impact on quality of life for individuals/communities through resource mobilization as well as advocacy
–Ethical/professional imperative
What are some ways to assess for SDOH?
•Ask clients about potential social challenges in a sensitive and culturally acceptable way
–“Do you ever have difficulty making ends meet at the end of the month?”
–The Clear Toolkit
•Social prescribing
–Connecting patients with various support resources within and beyond the health system
–Educating about and advocating for access to programs/benefits
What is the The Alma-Ata Declaration of 1978: Primary Health Care (‘Health for All’)
Recognition of the close relationship between health and social-economic development, and the social responsibility of governments
•Desire to focus on ‘upstream’ interventions to promote health and prevent occurrence of disease/injuries
What are the aims and focus of primary health care?
- A principle-based, comprehensive approach to health
- Aim is to improve health of populations across the continuum of care and across the lifespan
- Emphasizes both macro, meso, and micro strategies for achieving health
- Acknowledges the broader conditions that determine health, the importance of promoting ‘healthy lifestyles’ to prevent injury and disease, and the value of ongoing care for people with chronic conditions
