Course:Social Determinants of Health

The Social Determinants of Health encompass the economic and social effects on health, which not only affect individuals but also entire communities. The social determinants of health can be seen as the resources that should be provided for by the society in which one lives.

Social Determinants

These resources include, but are not limited to

• Income
• Conditions of childhood
• Food security and quality
• Availability of education
• Quality of education
• Housing
• Unemployment and employment security
• Working conditions
• Social services
• Health care services
• Gender
• Stress
• Aboriginal status

Dennis Raphael.

These social determinants have been found to have more effects on health then what we commonly associate to negatively effect health, which are lifestyle choices like smoking, using alcohol or drugs, not eating healthy or getting enough exercise. Focus on lifestyle choice and health behaviours actually works to make social determinants appear less important, which keeps enabling the government to not address the situation by putting more money into social welfare programs and better infrastructure for people who experience poverty. It also blames victims for their poor health by not engaging in 'health promoting behaviours', which does not take into consideration that many health behaviours require individuals to already be in a position where they can spend money on nutritious foods or have time to exercise. Noncompliance to medical treatments is used to blame victims of poverty for further health problems. Though it has been shown that when financial assistance is given noncompliance decreases, as people are able to better afford transportation to appointments or the cost of medication (p. famer) It creates a cyclical dynamic in which people are getting diseases associated with these social determinants and but they are also remaining ill and unable to get necessary treatments because of the same social determinants.

History

Friedrich Engels was a social scientist who studied how poor housing, diet and insufficient sanitation directly lead to infections and diseases(dennis raphael). The majority of these deaths were taking place among the lower and working class. Rudolf Virchow linked poor health due to living conditions to public policy, emphasizing politics role in discourse about the health. In 1980 the Black Report, a UK publication reported those living in the lowest-employment level had a greater likelihood of developing a range of diseases and dying prematurely.The term Social Determinants of Health was first used in the 1996 volume of Health and Social Organization: Towards a Health Policy for the 21st Century. (‪David Blane‬, ‪Eric Brunner‬, ‪Richard Wilkinson.)

Empirical Evidence

Rodger's was the first to do a international cross-section analysis looking at the link between income inequality and health. He relates this to countries that have greater income inequality also showing rates of lower life expectancy. (Rodgers GB) Further studies indicate that income levels across the lifespan is an independent predictor of who eventually gets diseases 23 percent of excess premature years of life lost can be attributed to income differences heart disease and stroke are most related to income differences among Canadians. (Dennis Raphael) A 20 year gap in the life expectany between the most and least advantaged populations in the USA. (Michael Marmot)

Life Course

The life course perspective emphasizes the accumulated effects of experience on health across the entire lifespan. Health begins during gestation, meaning that the mothers health and her position due to the social determinants of health could have future health effects on the child. "Early child development follows, in which the circumstances of the physical and emotional environment impact not only children's current health, but sets the groundwork for future vulnerabilities and resiliencies."

Intersectionality

It is important to view the social determinants of health in conjunction with an intersectional approach. Intersectionality is the theory that emphasizes lived experience and narrative by looking at how different systems of oppression work together to effect an individuals social location. This could be a consideration of that one is a woman while also a immigrant, while also a single mother who also has low education. Intersectionality also looks at the systems of domination which has created the process of ‘othering’ some individuals and normalizing these differences. It does not view systems of power in isolation because these systems, racism, colonialism, sexism, ablelism, homophobia function through one another. (Rita kaur dhamoon)

Aboriginal Status

Aboriginal status creates a social location in which one is more at risk of experiencing the negative health effects associated with social determinants. Social determinants for Aboriginal peoples also includes historical and political contexts as well as community infrastructure especially in regards to those living on reservations. There is a problem of overcrowding in homes as housing is unaffordable, this causes stress within households which effects health. Overcrowding also contributes to the spreading illnesses and diseases. Many houses lack properly ventilation, which results in mold problems and subsequently asthma and difficulties with lungs. Those living in remote areas do not have adequate access of affordable and nutritional food. There are also poor sanitation, waste management and water supplies which all drastically effect health. Living in rural areas sometimes leads to fewer opportunities for an education, this results in social exclusion, lack of job opportunities, shame and perpetuates poverty (Reading & Wien). The health care system is linked for many First Nations people to the severe abuse that took place in residential schools. The health care system also does not take into consideration First Nations traditional practices of healing and many do not seek help for the health care system because they feel excluded by it (Browne & Fiske). Despite these systems of exclusion and well documented poor living conditions, there still exists a movement that looks toward genetics and race to account for health disparities between Aboriginal and non-Aboringinals. An example of this is the statistically higher rates of diabetes for Aboriginals, which has attempted to be explained by the thirty gene hypothesis. Though it was found that once predictor variables such as education and income where included as variables to explain who gets diabetes, Aboriginal status lost all its significance.<Margery="">

References

Brown, J. A., Fisk, J. First nations women's Encounters with mainstream health care services. Western Journal of Nursing Research. 2001;23, 126-147

Farmer, P. Pathologies of power: Health, human rights, and the new war on the poor. Health, Healing, and Social Justice. University of California Press. 2003; 139-159

Margery F. Racializing narrative: Obesity, diabetes and the "Aboriginal" thrift genotype. Social science & medicine. 1982; 62(12), 2988 - 2997

Raphael, D. Social determinants of health: An overview of key issues and themes. Social determinants of health: Canadian perspectives 2nd ed. Canadian Scholar's Press. 2009; 2-19

Reading, C., Wien, R. Health inequalities and social determinants of health of Aboriginal people's health. National collaborating centre for Aboriginal health. 2009.

Rodgers, GB. Income and inequality as determinants of mortality: an international cross-section analysis. International Journal of Epidemiology. 1979;33:343–351