Week 2 - Class 1 (SD & Health Determinants)

Question 1

What are the social determinants of health?

Answer 1

“the economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole… and determine the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment”

• strengths-based

Question 2

Where did the SD of Health come from? What did it culminate in?

Answer 2

• mid-1990s Canadian society and health policies resulted in an increase in social and economic inequalities and health disparities

Culminated in the Toronto Charter on SD of Health

• identified 12 SD
• interrelated and influence each other

Question 3

What are key determinants of health? Why are they important to know?

Answer 3

• Income and social status
• Social support networks
• Education and literacy
• Employment/Working conditions
• Social environments
• Physical environments
• Personal health practices and coping skills
• Healthy child development
• Biology and development
• Health services
• Gender
• Culture

To know the patient and what is relevant to them to provide the best care for that individual

Question 4

What is the greatest determinant of health? What does it influence? What is it associated with?

How does this inequality arise?

Answer 4

Income & Social Status

• Poverty is the largest influence over health and influences most of the other determinants
• Associated with chronic health problems

Arises through things like policy
- Ex. Tax and economic policies, gender, race, education, etc.

Question 5

What is absolute poverty vs. relative poverty? Describe each.

Answer 5

Absolute: is a condition where household income is below a necessary level to maintain basic living standards (food, shelter, housing).
Relative: A condition where household income is a certain percentage below median incomes.
- Absolute has a profound effect on health status and tends to stay the same.
- Relative takes a toll on children and tends to track up/down with fluctuations in conditions of the economy

Question 6

Is there a relationship between household income and emotional/behavioural problems in children? Why or why not?

Answer 6

Yes

- However, we do not understand why.

Question 7

Why does income effect health? Provide examples.

Answer 7

Limits choices and works against desirable changes in behaviour
- Ex. Shelter, food, warmth, social life, psychological stress

Question 8

Why is teaching someone about “best diet choices” who suffers from a lack of income meaningless?

Answer 8

Because if that person has no basic necessities (i.e. heat, housing, etc.), “best diet choices” are not a priority for them

Question 9

What is social support networks linked to?

Answer 9

Positive health outcomes

Question 10

What does social exclusion deny and what does it result in?

Who is mainly effected? Why?

Answer 10

Denies individuals opportunity to participate in normal activities of society and results in poorer health outcomes and increases vulnerability to disease

Indigenous & people of colour - 2x likely to live in poverty, and 2x likely to be unemployed
- It marginalizes and isolates people, physically and psychologically

Question 11

How does education and literacy affect health?

Answer 11

It influences health directly and indirectly

Opportunity vs. Privilege
- A chance vs. a given

Question 12

How does employment and working conditions have an affect health?

How does being employed benefit ones health vs being unemployed? Who does unemployment affect more?

Answer 12

Affects physical, mental, and social health

Employment: Financial resources, sense of identify and purpose, social contacts, opportunities for personal growth

Unemployment: Material and social deprivation, health threatening coping behaviours, psychological stress, physical and mental health problems - chronic stress
- Men because they work harder jobs, outdoors, contaminants, exposure

Question 13

What percentage of women is the career work force?

Answer 13

90%

Question 14

What is another form burdens can come in? Give an example.

Answer 14

Behaviours

- Substance abuse/misuse

Question 15

How does the physical environment affect ones health?

Answer 15

Individuals need affordable, suitable, and adequate housing… Cheaper rent is often in less-desirable areas and sometimes amongst poorly situated resources (i.e. bus routes, industrial plants, grocery stores)
- Ex. Usually in town there is a “bad part of town” and it is usually the East

Question 16

How does biological and genetic factors affect health? Why?

Answer 16

Hereditary is strongly influenced by the social and physical environment
- People do not have control of what is passed down to them

Question 17

What is a strong determinant of health?

Answer 17

Age

Question 18

How do individual health practices and coping skills affect health? Provide examples.

Answer 18

It helps people face challenges without resorting to risk behaviours
- Risk Behaviours: Physical inactivity, poor nutrition, substance abuse, etc.

Question 19

How does food insecurity impact health? What are the stats of food insecurity? What is food insecurity associated with? What should you consider when educating PT’s about diet?

Answer 19

Limited or uncertain availability of nutritious food

• Unable to afford
• Lack of transportation

1/10 report food insecurity (2005)

Associated with multiple chronic conditions (i.e. distress, depression, etc.)

Need to be considerate of what the PT has access to and what is manageable for the PT.

Question 20

What determinants influence child development?

What are the prime years of influence of a childs lifelong health?

What are 3 necessary conditions?

Answer 20

All determinants

Conception to 6y

1) Equitable income
2) Effective parents and families
3) Supportive community environments

Question 21

Describe health services in Canada:

• Statistics
• Types of care

Answer 21

25% of the populations health status is attributed to health care services

• Primary Care
• Hopsital Care
• Long term care
• Public Health services
• Community/home care

Question 22

How is gender a SD of health?

How does this affect individuals?

Answer 22

Gender-based social roles

• Girls are taught to be nice, want/bear children - stressed when they cannot conceive or do not want children
• Boys are taught to be tough, not express emotions
• Sex-specific health concerns

When individuals cannot fulfill gender roles they suffer health consequences

Question 23

How do culture & ethnic factors affect health?

What influences cultural & ethnic factors?

Answer 23

Dominant culture governs health care - this may exert itself strongly and any difference is denied/not welcomed

• Biomedical model might not be what all PT’s wants (i.e. naturopathy)
• Language barriers
• Interaction with health care system
• Participation in prevention/health promotion programs
• Access to health info
• Understanding health and illness

Question 24

How do social environments influence health? What provides a supportive society that reduces or avoids many potential risks to good health?

Answer 24

Values and norms of the society influence health and well-being of a population
- Social stability, recognition of diversity, safety, good working relationships, cohesive communities

Question 25

How do we achieve health promotion?

Answer 25

1) Health education
2) Health screening
3) Disease prevention

• Integrated

Question 26

What is health promotion?

Answer 26

“The process of enabling people to increase control over, and improve, their health” (WHO, 1986)

“Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action” (Nutbeam, (1998)

• Health promotion addresses health issues in context
• Health promotion supports a holistic approach
• Health promotion requires a long-term perspective
• Health promotion is multi-sectoral
• Health promotion draws on knowledge from social, economic, political, environmental, medical, and nursing sciences

Question 27

What are the prerequisites

for health?

Answer 27

The Ottawa Charter for HP

• Peace
• Shelter
• Education
• Food
• Income
• Stable ecosystem
• Sustainable resources
• Social justice
• Equity

Question 28

Why is HP important?

Answer 28

Built into our professional philosophy

Creates conditions that sustain health and address broader social/economic conditions that affect a populations health

Nurses have a loud voice to promote social change to improve health

Question 29

What is the concept of HP based on / core beliefs?

Answer 29

1) Social Justice - Fair distribution of society’s benefits and responsibilities, focus on eliminating root causes of inequities (CNA, 2010)
2) Equity - Fair distribution of resources of health

Question 30

What is the first level of disease prevention? Provide an example.

Answer 30

1) Primary - Looks at education to make informed, healthy choices
- Preventing illness or injury
- Promotes health through the identification of potential risk factors
- Mobilization of policy and public awareness to avoid injury or illness

Ex. Tanning - Intervene before PT engages in that behaviour

• Sit out of sun in shade
• Sunscreen
• Hat

Question 31

What is the second level of disease prevention? Provide an example.

Answer 31

2) Secondary - Early identification and treatment to stop or mitigate or slow progression of a disease

Ex. Prostate cancer

• What an he do?
• Knows he has a family history
• Can seek out annual prostate exam and blood work

Question 32

What is the third level of disease prevention? Provide an example.

Answer 32

3) Tertiary Prevention
- Injury already occurred or advanced disease, goal is to prevent further harm and restore maximum function
- Max. quality of life and meet self-identified goals

Ex. Spinal cord injury

• Person already has injury
• Sitting all day = skin breakdown occurs but cannot sense it bc of injury
• Tertiary = goal is to prevent this further compromise by having PT change positions throughout the dat

Question 33

What is upstream vs. downstream approaches to promoting health? Provide an example.

Answer 33

Upstream

• Prevention and promotion strategies focused on policy intervention
• PHC that focuses on well-being by addressing and taking actions on the root causes of disease and injury

Downstream

• Focused on individual treatment or cure
• Acute care services

Ex. Emergency department is constantly overflowing with PT who are actually no emergencies

• Downstream Approach: New device model that triages PT from emergencies and non-emergencies then treat PT accordingly
• Upstream Approach? Asks why are these PT even here? May doctors are closed or shortage of after hours so people have to come to emerge bc cannot wait until doctors open. Shelters are closed and more PT come in the winter for shelter.