Lecture 2 - Social Determinants of Health PDF

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Social Determinants of Health and how Geography plays a role...

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Lecture 2: Social Determinants of Health (SDH) 

Conventional Model of Health and Disease o In our culture, and in Western medicine, we mostly rely on a biomedical model of health and disease o Individual characteristics are seen as the most important aspect in relation to biomedical model o Individual behaviors are also seen as important as determinants of health o If individuals are healthy, it’s strictly because of their life choices 

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You are solely responsible for your individual health

Shift Away from the Conventional Model o Four Seminal events that contributed to the shift: 

Ottawa Charter was the one to begin talking about exposures to disease and health

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What are SDH? o Circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness o Encompasses every single type of an individual’s life o Made up of every single experience an individual goes through till that point of their life o Many things can be associated with people’s health in all kinds of way 

Food, Access to water, economy structure, income inequality

o Framework having a holistic perspective in people’s lives 

Social Determinants of Framework

o Structural factors 

Individual cannot make significant changes to these structures on their own

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Have little to no control over

o Combination of structural and intermediary factors contribute to health o All these factors together have an influence on socioeconomic position 

People’s social class are a result of all these combined

o Intermediary factors 

Some products that emanate from broad level

o These two groups of factors that are constantly in a feedback loop of each other leading to outcomes in different points of time 

Why do we study SDH? o To understand why different types of diseases are more or less prevalent at a given point in time or overtime in certain groups or populations 

Why is one group impacted by some conditions relative to others

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Understanding why will help to provide solutions how to minimize or eliminate these realities

o To understand how to reduce health inequities by improving social conditions and reducing social inequalities  

Equitable social policy = good health policy

Education and life expectancy o Canadians with less than high school education live 11.3 years less than university graduates

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Material deprivation and low life expectancy o Canadians living in areas with both high social and material deprivation live 5.9 years less than those in areas with less deprivations o Locations is also connected to this

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Realities of minority health experiences in Canada o Reported use of health services by these groups is less frequent compared to others o Their poor health outcomes persists and may be getting worse (e.g. infectious diseases)

Unpacking Racism and Health 

Life Course perspective o Everyone’s health status is a result of an accumulation of several conditions over their life course o Contemporaneous relationship 

Unable to tell because you measure them at the same time, which is responsible for one another 

Playing video games makes me happy: which results in which?

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Life course perspective eliminates this because you track from long time till now and helps explain what is the cause and what is the effect

o Early exposure to adverse social and environmental conditions impact lifelong health behaviors 

Negative experiences in childhood have negative impacts later on in life

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This increases our understandings of health outcomes

o Allows us to incorporate several experiences from certain people’s distant past o Most dominant explanation for health disparities within populations especially along ethnic race 

Structural perspective o Health policy and health institutions 

Minority groups have not been the focus in Canada

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Disproportionately impacted by health policies

o Mistrust of health care spaces due to historical events including Tuskegee syphilis experiment o Ethnic minorities face more barriers accessing essential ‘health-enabling’ resources o Black and Brown representation in institutions and policy environments are missing, which leads to negative experiences from racisms of all sorts which overall harm their health Levels of Racism 

Institutionalized o Differential access to the goods, services, and opportunities of society, by “race”

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High school streaming (Ontario and Alberta)

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Mass incarceration of Black and Aboriginal population (US and Canada)

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Slavery, Jim Crow laws, Redlining

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Residential segregation has pervasive adverse effects on health

Personally-mediated

o Differential assumption about the abilities, motives, and intents of others, by “race” o Differential actions based on those assumptions o Prejudice and discrimination o Implicit bias o Hate crimes, Police brutality etc. 

Internalized Racism

The Cliff analogy: Addressing Health Disparities 

Exposure is different, so is access to health care o Which leads to differences in quality of care

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The preventative part will save some people and prevent some significant damage but some people will still fall through to the bottom

How does Racism affect health? 

Psychological and Physiological impact o Can be direct sometimes o Experience of discrimination can result in severe outcomes o Poor housing o Absence of recreational spaces

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Access to SES resources

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Epigenetics o Many terrible experiences have many gene expressions that can be passed on to future generations

o These gene expressions are not the result of changes in DNA per say, but result of interactions that have come from people and their environment 

ALL THESE FACTORS THEN CONTRIBUTE TO PEOPLE’S WELLBEING

What can we do to address the social determinants of equity? 

Amplify the voices of racial groups

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Civic engagement/positive defiance

Interventions based on SDH (more details in PowerPoint) 

Healthcare system-based interventions o Nurse-family partnership program o Medical-legal partnership

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Non-healthcare system-based interventions o Improving neighborhood conditions o Additional income and health o Early childhood academic enrichment o Civil rights and health...