What Influences Health? Flashcards
what do people typically think impacts health the most?
they believe these have the greatest infleunce on health outcomes:
- personal habits (exercise, diet)
- medical treatment (access to doctors, nurses, health care practitioners)
how has the importance of SDOH changed over the years?
over the last 15-20 years, the significance of SDOH has been increasingly recognized in public health and medicine
- SDOH is being recognized as primary causes of ill/good health
- more journals have been published that include the term “social determinants of health”
what has been the main cause responsible for the decrease in mortality?
advances in medical care were NOT responsible for dramatic declines in mortality
- - studies have showed improved living conditions have historically had a greater impact on health than medical care
- research found that mortality rates dropped steadily decades before the availability of modern medicine and modalities (ex: antibiotics, vaccines, ICUs)
- rather, the decline in mortality could be attributed to overall improvements in living conditions (ex: better nutrition, sanitation, housing and water)
–> socioeconomic factors (wealth, income, education) strongly correlates with health outcomes!
what are SDOH?
- “the conditions in which people are born, grow, live, work and age” and “the fundamental drivers of these conditions”
- the non-medical factors
what makes Canadians sick?
- 50% your life (ex: income, education, housing, gender, race etc)
- 25% health care (ex: access to health care, wait time)
- 15% your biology (ex: biology and genetics)
- 10% your environment (ex: air quality, civic infrastructure)
what are upstream determinants?
- upstream determinants are the underlying, root causes, and influence health from the source
- they are “fundamental drivers” of the conditions that produce health or illness
- includes policies, systemic factors, social norms
what are downstream determinants?
- downstream determinants are the apparent, immediate health effects of upstream determinants
- includes individual health behaviours, direct health outcomes
what are the best types of health interventions?
- focusing on the upstream, fundamental causes can present more opportunities to sustainably improve health and reduce disparities
- addressing upstream determinants is crucial for long-term health improvements and reducing inequalities
- it allows for preventative actions on root causes rather than reactive management
- interventions that only target downstream determinants may have limited effectiveness because upstream determinants will continue to trigger the chain of causal events leadings to adverse health outcomes
what are upstream solutions?
upstream interventions focus on systemic changes
- policies
- economic reform
ex: stop environmental degradation
what are downstream solutions?
downstream interventions address immediate health disparities
- healthcare access
- direct aid programs
ex: peer navigator in hospital
what is an example of upstream/downstream determinants?
- people living beside a river who depend on it for drinking water
- many of these people become ill/sick from drinking the water that ha been contaminated by toxic chemicals released into the river from a factory upstream
- drinking the contaminated water is the most proximate or downstream cause of the illness but the fundamental (less evident) cause is the dumping of toxic chemicals upstream
- a downstream solution would be to get residents to buy bottled water or filters to treat the water. however, their poorer neighbors may not be able to afford that, so they continue to get sick = widened disparities
- an upstream solution would be to focus on the source of contamination, which i ending the factory’s dumping of pollutants = more equitable impacts on people’s health
what is the framework for upstream and downstream determinants of health?
UPSTREAM –> DOWNSTREAM
power and social values –> access to resources and opportunities –> health harming or health-promoting factors –> biological mechanisms –> health and health disparities
- power structures (laws, values, policies) determine who has access to key economic and social resources needed to be healthy
- these resources and opportunities can then determine who experience health-harming or health-promoting conditions
- in turn, it directly triggers the biological mechanisms that ultimately result in good or poor health
*upstream triggers everything else!
what are examples of power and social values in SDOH framework?
- established systems (political, economic, educational, healthcare, criminal justice)
- policies, laws and entrenched practices
- minimum wage and unemployment benefits
- systemic and structural racism
examples of resources and opportunities in SDOH framework?
- income (earnings from employment, investments etc)
- wealth (accumulated assets)
- education (attainment or schooling)
examples of health-harming or health-promoting factors in SDOH framework?
- quality of school
- environmental hazards/exposure
- housing conditions
- quality of neighbourhood
- health related behaviours (diet, activity, smoking)
examples of biological mechanisms in SDOH framework?
- inflammation
- immune dysfunction
- epigenetic
- altered metabolism
is health spending associated with better health outcomes?
NO
- the United States currently spend the most on healthcare out of all nations however, they have consistently ranked the at or near the bottom of key measures of health
- reveals that spending more on healthcare doesn’t improve health outcomes
what is the relationship between life expectancy and health expenditure in the US?
- despite higher healthcare spending, America’s health outcomes worse compared to other wealthy/developed countries.
–> there are a lot of wasted resources in the USA
–> the U.S healthcare system is for-profit (no universal healthcare) while CAN is non-for-profit
what is a ‘structural issue’ in a society?
- is a problem that arises from the way a society is organized/built
- this is considered “systemic”
example: the superior health status of wealthy, white Americans suggests that “structural issues” are at play
what did the study results of “disparities in the incidence of breast cancer mortality” show?
- the incidence (# of cases) of breast cancer is slightly lower among African American women than white women, but mortality rates are far worse!
- the five-year survival rate was 10% higher among white women (91% vs 80%)
- disparities due to: late screening, late stage detection, access barriers
what did the results of the ACCURE study show?
- ACCURE study implemented customized interventions (patient/peer navigator) to help black patients overcome obstacles to cancer treatments
- prior to study, 80% of black women completed treatment however, after the study, over 90% completed treatment
- the gap between white and black women finishing treatment disappeared!
what were the findings of the SDOH study during COVID-19 in Waterloo?
the study highlighted how racialized people suffer from disproportionate health outcomes.
- COVID-19 cases were 2-3 times higher among visible miniorities and Black individuals
- proportion of cases among people in households of 5 or more is 1.5 times higher (crowded housing)
- proportion of cases among those with non-official childhood language (non-english, non-french) was 2 times higher
what factors influence health?
- income and wealth
- education
- living and working conditions
- stress levels
- access to healthcare
- neighbourhood conditions
- housing quality and environmental exposures
what is the requirement to be a determinants of health disparity?
- a given risk factor must be more prevalent among disadvantaged group(s) or have a greater effect on the disadvantaged group compared to advantaged groups
- health disparities arise from disparities in exposure, vulnerabilities and consequences
what is health equity?
health equity involves ensuring everyone has an equal opportunity to be as healthy as possible by distributing resources according to need
* not everyone has the same building blocks to health
* equity ensures everyone has an equal starting place
what is health inequity?
- differences in health outcomes that can be controlled for but societies have chosen to ignore
- a disparity exists but it doesn’t have to (we can intervene and make it better)
disparities vs. inequities
- disparities are measurable, statistical health differences between 2 populations
- inequities are unjust and preventable health differences (structural issues in society causing the issue)
what does health disparities mean?
- the differences in health among more or less socially advantaged groups of people
- entails worsened health outcomes affecting disadvantaged populations (marginalized, excluded or oppressed)
- due to racial/ethnic group, disability, gender, immigration status etc.
how can health disparities be reduced?
POLICIES are necessary for improving overall health outcomes:
- address both upstream and downstream determinants
- policies to reduce economic inequality and strengthen social cohesion
- enhance public awareness and advocate for systemic changes
what are the challenges in addressing SDOH and health disparities?
- there is little consensus on the effective ways to address upstream social factors to improve health and health disparities (where, when and how to intervene)
- the relationships between upstream factors and health are complex and hard to study/identify priorities for intervention
- funding for research and programs is rarely adequate and tend to focus on diseases rather than causal factors
what is the rate limiting step in eliminating health disparities?
LACK OF POLITICAL WILL to allocate the necessary resources and overcome obstacles to coordinated action across different sectors (health, education, housing)
- also reflects political and ideological disagreements and different social values
what is discrimmination?
unfair treatment based on membership in specific social groups including gender, LGBTQ+ status, poverty, disability, race, ethnicity, and national origin
what are economic resources?
- wealth (accumulated assets like real estate, savings and investments) and income (earnings during a given period)
*wealth is a more comprehensive measure of long-term economic resources
what are excluded groups?
- women
- LGBTQ individuals
- people of colour
- those living in poverty
- religious minorities
- people with disabilities
*all these groups often have limited access to health-supporting opportunities and services
health vs. healthcare
- health refers to physical and mental well being
- healthcare includes services provided by health professionals to prevent or treat illness
how are equity and equality different?
- equity = providing based on one’s needs (more/less) to achieve success
- equality = give everyone exactly the same thing regardless of need
what are social factors?
- the non medical factors like policies, social forces and economic resources that influence healthy
- these elements can significantly affect biological and environmental properties
what does social advantage/disadvantage mean?
one’s acceptance in society, relative power, money and reputation
what does inclusion/exclusion mean?
- inclusion involves full participation in society and its benefits
- exclusion and marginalization restrict access to resources and opportunities, subsequently harming historically marginalized groups
how is racism a social determinant of health?
- chronic stress from racism causes biological impacts (inflammation, immune dysfunction)
- systemic racism shapes access to health resources (ex: indigenous people experience racism in healthcare = more likely to receive poor care)
what is the most important indicator of health
INCOME –> predicts and influence other determinants (food security, housing, education)
