The Social Determinants of Health

Question 1

According to WHO, what is health?

Answer 1

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity (World Health Organization, 1948).

Question 2

What is health considered?

Answer 2

Health is an individual right and a social justice issue. It is also a public good.

Question 3

What is the responsibility of the government?

Answer 3

Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.

Question 4

Other then the WHO, where are other examples of where a definition of health is stated?

Answer 4

the United Nations Universal Declaration of Human Rights (1948),

the International Covenant on Economic, Social and Cultural Rights (1966),

and the Ottawa Charter for Health Promotion (1986).

Question 5

What is a fundamental right of every human being?

Answer 5

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

Question 6

What is a priority for the whole of society?

Answer 6

Governments have a responsibility for the health of their peoples. Health is a priority for the whole of society.

Question 7

Factors Determining Health

What factors are quite important on health and well being?

Answer 7

Clinical care is less important than many people think whereas socioeconomic factors and the physical environment are quite influential on health and well-being.

Question 8

Factors Determining Health

What factors are less important on health and well being than people think?

Answer 8

Genetic characteristics are also less significant than many people think.

Question 9

Factors Determining Health

Whether people are healthy or not, is determined by what?

Answer 9

Whether people are healthy or not, is determined by their circumstances and environment – the social, economic and environmental conditions which affect the health of the population.

Question 10

Why frame health in terms of societal conditions?

Answer 10

Societal conditions have a direct impact on health, accounting for an impact of 30-50% or more on levels of the populations’ health.

Question 11

WHAT ARE THE Social Determinants of Health?

Answer 11

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

Question 12

WHAT ARE THE Social Determinants of Health:

What are social determinants of health responsible for?

Answer 12

The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

Question 13

How are the social determinants of health? How do they range?

Answer 13

The social determinants of health are multi-layered and range from societal to individual factors.

Question 14

Why do the social determinants of health matter?

Answer 14

The social determinants of health matter because they set the conditions for the health of individuals, communities and populations, and if the social determinants of health are not distributed fairly, they can lead to health inequities.

Question 15

All of these factors are what we refer to collectively as the social determinants of health:

Answer 15

Agriculture and food production

Education

Working environment

Living and working conditions

Unemployment

Water and sanitation

Healthcare services

Housing

Question 16

THE Social Determinants of Health

Dahlgren and Whitehead’s model:

Answer 16

Dahlgren and Whitehead’s model maps the relationship between the individual, their environment and disease.

Question 17

THE Social Determinants of Health

Dahlgren and Whitehead’s model:

Answer 17

Individuals are at the centre with a set of given genes. Surrounding them are influences on health that can be modified.

Question 18

THE Social Determinants of Health:

What is a widely cited model of the main determinants of health?

Answer 18

The Dahlgren and Whitehead social determinants of health framework is a widely cited model of the main determinants of health, and a recognized framework which identifies the range of social determinants

Question 19

THE Social Determinants of Health:

What is the first layer of Dahlgren and Whitehead determinants of health framework?

Answer 19

The first layer is personal behaviour and ways of living that can promote or damage health (e.g. choice to smoke or not). Individuals are affected by friendship patterns and the norms of their community.

Question 20

THE Social Determinants of Health:

What is the second layer of Dahlgren and Whitehead determinants of health framework?

Answer 20

The next layer is social and community influences, which provide mutual support for members of the community in unfavourable conditions but they can also fail to provide support or have a negative effect.

Question 21

THE Social Determinants of Health:

What is the third layer of Dahlgren and Whitehead determinants of health framework?

Answer 21

The third layer includes structural factors: housing, working conditions, access to services and provision of essential facilities. The fourth layer captures the broader political, cultural and environmental conditions in which all these other factors occur.

Question 22

THE Social Determinants of Health

What is important to know about many of the determinants of health?

Answer 22

Importantly, many of the determinants of health lie outside of the control of the health care system – so the health sector does not have control of these determinants.

Question 23

Social Determinants of Health Conceptual Frameworks include:

Answer 23

Global Commission on SDH (2008)

PAHO Equity Commission (2019)

Dahlgren& Whitehead(1991)

Question 24

Social Determinants of Health Conceptual Frameworks include:

Global Commission on Social Determinants of Health Conceptual Framework (2008): What does it illustrate?

Answer 24

Illustrates how the socioeconomic and political context, including governance, policy and cultural and societal values, has a role in determining the position of an individual in society.

Question 25

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

In this model, there are two categories of social determinants -

Answer 25

Structural determinants:

Intermediary determinants:

Question 26

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

Structural determinants include what?

What kind of interaction do these groups have?

Answer 26

two main components;

1. Socioeconomic and political context:
2. Socioeconomic position:

These two groups have a reciprocal interaction and can be affected by each other.

Question 27

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

Structural determinants include: Socioeconomic and political context-

Answer 27

consists of components of governance, macroeconomic and social policy, public policy, social culture, and values;

Question 28

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

Structural determinants include: Socioeconomic position:

Answer 28

such as education, occupation, income, social class, ethnicity/race and gender.

Question 29

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

Intermediary determinants include:

Answer 29

including environmental condition, psychosocial factors, behavioural factors, biological factors, and health system.

Question 30

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

In this model, bridging the structural and intermediary determinants are concepts…

Answer 30

In this model, bridging the structural and intermediary determinants are concepts of social cohesion and social capital mentioned as a cross-cutting determinant, and the structural factors affect health and well-being through affecting on intermediate factors, and the likelihood of exposure to health-compromising conditions.

Question 31

Global Commission on Social Determinants of Health Conceptual Framework (2008)

Global Commission on Social Determinants of Health Conceptual Framework (2008):

In this model, bridging the structural and intermediary determinants are concepts of social cohesion and social capital mentioned as a cross-cutting determinant, and the structural factors affect health and well-being through affecting on intermediate factors, and the likelihood of exposure to health-compromising conditions. What is an example? What does this mean?

Answer 31

Illnesses caused by poor living conditions can then circle back to the structural determinants if, for example, a person experiences a loss of employment or income, thereby lowering his or her socioeconomic status.

Therefore, there is constant feedback and interaction across the different levels of determinants.

Question 32

PAHO Conceptual Framework on Social Determinants of Health and Health Equity (2019)

In the PAHO framework there is greater emphasis on what?

Answer 32

In the PAHO framework there is greater emphasis on structural racism, colonialism, and importance of relationships to land.

There is also greater emphasis on the environment and climate change; there is a more explicit focus on human rights; and greater emphasis on inequities according to gender, ethnicity, sexual orientation, life stage, and disability.

Question 33

PAHO Conceptual Framework on Social Determinants of Health and Health Equity (2019)

What does the PAHO Equity Commission recognise?

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Answer 33

The PAHO Equity Commission also recognizes the interrelations between these, with emphasis on leading a dignified life as a desired outcome – aligned with greater health equity. In addition, it highlights governance for health equity as critical for taking action on the social determinants of health.

Question 34

Action recommendations

Global Commission on SDH (2008)

Answer 34

–3 overarching recommendations

Question 35

Action recommendations

PAHO Equity Commission (2019) –

Answer 35

PAHO Equity Commission (2019) –
12 recommendations

Question 36

Priority recommendations: The Global Commission

The World Health Organization’s Commission on Social Determinants of Health final report (2008) contains three overarching recommendations -

Answer 36

1. Improve daily living conditions:the circumstances in which people are born, grow, live, work, and age
2. Tackle the inequitable distribution of power, money and resources:the structural drivers of those conditions of daily life – globally, nationally, and locally
3. Measure and understand the problem and assess the impact of action: expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health