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UNIT 1: COURSE INTRODUCTION TO THE SOCIAL DETERMINANTS OF HEALTH ❖ ❖

Raphael, D. (2016) Chapter 1, Key Issues and Themes. In D. Raphael (Ed.), The Social Determinants of Health: Canadian Perspectives (pages 2-24). Toronto, ON: Canadian Scholar’s. Raphael, D. (2016) Chapter 2, Living Conditions and Health. In D. Raphael (Ed.), The Social Determinants of Health: Canadian Perspectives ( pages 32-50). Toronto, ON: Canadian Scholar’s.

REQUIRED MEDIA FILES:

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Public Health Academy. (2017, June 25). The Social Determinants of Health – An introduction.[ Video]. Youtube. https://www.youtube.com/watch?v=8PH4JYfF4Ns (6 mins) TED. (2009, July). Becky Blanton: The year I was homeless. [Video] https://www.ted.com/talks/becky_blanton_the_year_i_was_homeless?language=en (7 minutes) TED. (2013, December 3). Bee Orsini: The unexpected face of homelessness. [Video]. Youtube.

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https://www.youtube.com/watch?v=w18ZuellVts (12 minutes) The Power of Empathy (Brene Brown) h  ttps://vimeo.com/165917210 (3 minutes)

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KEY CONCEPTS:Social and structural determinants of health, socioeconomic position,

societal forces and factors, control/choice, power KEY TERMS:Social determinants of health, structural determinants of health, equity (vs.

equality), toxic stress CHAPTER ONE ● The concept of social determinants of health is an illustration of how thinking is moved beyond a medical model and lifestyle approaches to understanding health and the means by which it is maintained ● Medical model ⇒ seen as a machine run well or not at all which signals repair ● Free of illness = healthy ● Infected with pathogens or afflicted with system or organ malfunctioning disease results in illness ● Remedies ⇒ medical or curative care ⇒ administered by doctors or nurses ● Diseases arise from unhealthy choices ⇒ remedies include education exhortations for individuals to change behaviours and even environmental adjustments ● Biomedical and behavioural indicators are rather poor indicators of health status as compared to living conditions, government spending research etc ● Living conditions = primary determinants SOCIAL DETERMINANTS KEY ISSUES AND THEMES ● Social determinants of health are social and economical conditions that shape the health of individuals, communities and jurisdictions as a whole

● Social determinants of health are the primary determinants weather a person stays healthy or becomes ill ⇒ narrow definition of health ● Determine the extent to which a person possess resources ● All about quantity and quality of resources provided to members ⇒ quality and distribution are key players amongst populations ● Resources include: conditions as a child, income, education/literacy, food, housing, employment, work conditions, income ○ Lack of = biomedical and behavioural risk factors such as increased BMI, increased BP, drug use etc ● Requires political, economical, and social forces AN HISTORICAL PERSPECTIVE ON DETERMINANTS ● Friedrich Engeles studied how⇒ poor housing clothing diet and lack of sanitization directly led to the infections and diseases associated with early death among working class people in england ○ Material living conditions, day to day stress and adoption of health threatening behaviours are primary contributions to social class differences ● Rudolph Virchow identified how⇒ health threatening living conditions were rooted in public policy making and emphasized the role that politics play in promoting and preventing( issues never disappeared) ○ Over last 40 years less emphasis on biomedical and behavioural approaches to health promotion and prevention British Contributions ● Health differences occurred in a stepwise progression across the socioeconomic range ● Universally accessible health care = after WWII Canadian Contributions ● Theorized relationships between economic and social conditions of health ● New perspective on the health of canadians identified human biology, environment, lifestyle and health care organization as determinants ● Achieving health for all ⇒ framework for health promotion outlined reducing inequalities between income groups was an important goal in policy ● Factors outside of healthcare systems significantly impact health( income, social status, social support networks, education, employment, work, environments, genetics, personal health practices, coping, development, services, gender and culture ● CPHA= Canadian Public Health Association

● The study of social determinants deals with a. What are the societal factors (income, education, employment) that shape health and help explain inequalities b. What are the societal forces (economic, social, political) that shape the quality and distribution of these factors c. What is it about canada's economic and political system that make addressing the social determinants through policy so hard What are social determinants ● Attempts to identify specific exposures that different socioeconomic groups came to experience Current Concepts ● There are contemporary approaches to social determinants ● Prerequisites for health = peace, shelter education, food, income, stable ecosystem, sustainable resources, social justice and equity ○ Concerned with structural aspects of society organization and distribution of economic and social resources ● Social class health gradient = more grounded in everyday experience of living and policy making structures and avoids potential problem of irrelevance ● From 12 to 16 determinants ○ Some are social locations in that they refer to aspects of one's personal identity such as indigenous ancestry, disability, gender immigrastion and race ■ Social locations are indicators of power and influence ● 4 criteria to identify Social determinants ○ First criteria⇒ be consistent with most existing formulations of the social determinants of health and associated with an existing empirical literature as to its relevance to health. ALL are important ○ Second Criteria ==>be consistent wit lay/public understandings of the factors that influence health and well being ○ Third criteria⇒ clearly be aligned with existing government policy activity/structures and policy frameworks ○ Fourth criteria⇒ be an area of either active policy or policy inactivity that has provoked sustained criticism ■ Social determinants List ● Indigenous ancestry ● Disability ● Early life ● Education ● Employment and work conditions

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Food security Gender Geography Services Housing immigrant status Income and distribution Race Social safety net Social exclusion unemployment and employment security

CURRENT THEMES ● 5 themes ○ Empirical evidence concerning SD ■ Volume concerned on how SD shape health ■ Quality and distribution of SD of health to which exposed explains ● Improvements in health over 100 past years ● Persistent differences in outcomes ● Differences in overall health among canadians and other developed nations ○ 10- 15% increase in longevity since 1900 due to improvements ○ Vaccines are major driver to decreased mortality ○ There has been an improvement in behaviours ○ Much of the volume is concerned with the present State and distribution of the the SD of health and how they shape the health outcomes of Canadians ○ Income = SD= indicator of quality of life ○ Heart disease and stroke most prevalent ○ Developing vs non developing have differences due to lack of necessities for basic life ○ Mechanisms and pathways that influence SD ■ Theoretical of how3 frameworks ⇒ materialist, neo-materialist,psychosocial ○ The importance of a life course perspective ○ The role of public policy environments play in determining quality within jurisdictions ○ Political ideology roles in shaping state ● Income influences health most directly through access to material resources

CHAPTER TWO: LIVING CONDITIONS AND HEALTH Individual approaches ● Individual perspective limits analysis of health risks to individual biomedical and behavioural risk factors for disease ● For biomedical indicators this is associated with screening for physiological and medical risk factors ● Carry assumptions that it is primary cause to issues ● Biomedical and behavioural play a minor role as compared to SD of health ● Biomedical and behavioural risk factors are heavily structured by SD that people experience ● Individualism assumes that the current social system provides sufficient and equal opportunity for individuals to move within social system according to their abilities ● Poverty results from the individuals failure to seize the opportunity to work sufficiently⇒ not a reflection of inadequacies and inequalities within the social order Social determinants of health and living conditions ● Reflection of the organization of society and how society distributes economic and social resources

● Figure 2.1 SD of Health (Brunner and Marmots Model) ○ Social structure is a catch all for organization of society and how it distributes access to actual material and resources ○ Makes little mention of political, economic and social forces that shape how a society's social structure comes about ○ Has 3 primary pathways ■ 1st direct link between social structure material factors and health outcomes ■ 2nd social structure shapes social and work environments to create psychological responses that- operating through brain mechanisms-determine health outcomes ■ 3rd sees these same environments creating life,genes and culture contribute to processes at all levels ● Social structure has a direct influence upon early life

● Linear model do not take in complexity Materialist explanation ● The social structure is characterized by finely graded scale of advantage and disadvantages with individuals differing in terms of length and level of their exposure to a particular factor and in terms of the number of factors to which they are exposed ● Income Potential=is the accomodation skills and educational experiences in childhood that are important determinants of employability and income capacity.Education is seen as the key mediator in this Association being strongly influenced by Family circumstances in childhood and is the Central determinant of an individual's income in adulthood ● Health capital=The accumulation of her resources are physical and psychosocial inherited and acquired during the early stages of Life which determine current health and future potential( page 97 ) ○ Willingness to cooperate with each other for a wider benefit ● 2ns component living conditions determine the presence or absence of health threatening stress ○ Fight or flight reaction evolved as a means of dealing with sudden and dangerous threats in the environment ○ Body is activated to respond to these immediate threats ⇒ sympathetic and parasympathetic nervous system neuroendocrine and metabolic ○ Continuous stress= chronic= weaker immune system Life Course Model ● There are 3 types of health effects that have relevance for a life course perspective⇒ latent pathway and cumulative ○ Latent effects are biological or developmental early life experiences that influence health later ■ Impact sensitive periods ○ Pathway effects⇒ experiences that set individuals on trajectories that influence health wellbeing and competence over life ○ Cumulative effects⇒ represents the accumulation of these advantages or disadvantages over time, this involves the combination of latent and pathway effects Neo-material

● Shares a concern with materialist approaches about how health outcome come to be associated with living and working conditions over the lifespan but extends the analysis to explicitly consider how these health advantaging or threatening living conditions come to be ● Focus is on how a society allocated economic and social resources among the population ● Generally distribute income and wealth more equitably also spend more on social infrastructure ● Direct attention to both effects of experiencing varying living and working conditions(materialist) and identifying the societal forces that determine the quality and distribution of these living and working conditions (neo materialist) Social comparison ● Presented as a competing explanation to the materialist framework ● In this material and social conditions of life are downplayed in favour of the view that individual placement in the social hierarchy and social distance explain differences in outcome ● Health Outcomes = shaped by citizens interpretations of their standings ● Widening and strengthening of hierarchy weakens social cohesion The Social Determinants of Health – An introduction. [ Video]. Youtube. h  ttps://www.youtube.com/watch?v=8PH4JYfF4Ns (6 mins ➔ ➔

Health is variable across populations groups 2015 life expectancy varied in developed and non developed

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Health influenced by social status = increases money increased life Migrants⇒ diseases risks behaviour diff ◆ Health influenced by determinant ● who , age sex, work, beahviours , grow, born, live , systems, cuture, c ● Money power resources ● Health inequities= Complex interactions, many levels Frame word WHO⇒ 2 broad categories⇒ structural and intermediary (material circumstances and psychosocial , behav, biological)

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TED. (2009, July). Becky Blanton: The year I was homeless. [Video] https://www.ted.com/talks/becky_blanton_the_year_i_was_homeless?language=en (7 minutes) ➔

Society equates living in a permanent structure even a shack with having value as a person

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Negatives impact reality Homlessness is an attitude not a lifestyle People will go to the extremes to keep things they want ⇒ her pet People are stigmatized and are seen as invisible ⇒ engage encourage and offer hope to them

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TED. (2013, December 3). Bee Orsini: The unexpected face of homelessness. [Video]. Youtube. https://www.youtube.com/watch?v=w18ZuellVts (12 minutes) ➔ ➔

People assume things when they see homeless ⇒ shoe story Labeled as a hobo

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Described as certain ways druggies, smelly etc Language judgments and attitude are key players Develop deeper understandings to respond Stereotyping images⇒ leads to lack of help

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Carry labels and shame of a homeless person ◆ Someone is experiencing homlessness

The Power of Empathy (Brene Brown) h  ttps://vimeo.com/165917210 (3 minutes) ➔

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Empathy ⇒ fuels connection ● It's a choice ● Hey it's okay ik how it's like... Sympathy ⇒ dives disconnection ● Ouuu its bad ● Want food ● Don't silver line

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Empathy

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I think i'm falling apart well at least u have one

Perspective taking Staying out of judgement Recognizing emotion communicating emotion Feeling with ppl ● We try to make things better ● Rarely is a response going to make it better, connection is what will...