CNUR240 Week 2 - Social Determinants of Health (PDF)

Week 2 The ecological perspective is a valuable framework for promoting health within communities, emphasizing the interaction between individuals and their physical and social environments. This approach is based on the understanding that public health and well- being are influenced...

Week 2 The ecological perspective is a valuable framework for promoting health within communities, emphasizing the interaction between individuals and their physical and social environments. This approach is based on the understanding that public health and well- being are influenced not only by individual behaviours but also by broader social, economic, and environmental contexts. Empirical evidence demonstrates that impoverished individuals suffer more illnesses, disabilities, and shorter life expectancies, and have a poorer quality of life compared to affluent individuals. These disparities are strongly linked to structural factors such as age, gender, race, ethnicity, income, education, employment, housing, food security, social inclusion, and living and working conditions. These factors, known as the social determinants of health, are often beyond any individual's ability to change. This module employs the ecological perspective to discuss the concept of social determinants of health and to highlight health disparities among vulnerable, at-risk, and marginalized populations. It will illustrate that these conditions are preventable and explore approaches to reducing health disparities. Additionally, we will examine upstream and downstream thinking in the context of health promotion. Topics Ecological perspective Social determinants of health Health inequity Social justice Upstream thinking Ottawa charter and health promotion Learning Objectives By successfully completing this module, you should be able to: Reflect critically on concepts of health, health inequality, health equity, and social justice. Consider critically current health inequities and disparities in relation to populations who are more vulnerable to being marginalized, and/or at-risk in Canada. Examine critically the concept of the social determinants of health from differing perspectives. Demonstrate familiarity with similarities and differences regarding community, public health, and health promotion perspectives in relation to reducing social inequities in health in the work towards social justice for all. Required 1. Lind, C., & Baptiste, L. (2020). Health promotion. Chapter 8 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen- Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall (pp. 137–167). * Note-1: Concepts of thinking upstream vs. downstream (p.140). Resources 1. What makes us get sick? Look upstream, (18:13) Dr. Manchanda. 2. Social determinants of health (9:20) – A discussion of social determinants of health. 3. What it is Health Equity? (3:34) Health Equity Institute. A discussion of social determinants of health, health equity, with a focus on social justice (being political). Key terms Health disparities Health Equities Social determinants of health Upstream thinking Setting the Context Research indicates that in all countries, poorer people have more illness and shorter life expectancies than the rich (CNA, 2005, p. 1). “The issues of inequalities in health is not confined to the problem of the poorest of the poor… it’s socially graded… across the whole of society… solutions have to be social across the whole of society.” (Marmot, 2009, p. 24; V; CRC for Aboriginal Health, 2008 – Prof. Sir Michael Marmot) Canada One of its distinctive features is being a multicultural country meaning it includes a diverse ethnic, racial and cultural population Generally high standard of living Promise of universal access to high quality healthcare Commitment to equity and access to health and opportunity Realities Research Statistics indicate:  Racial minorities receive lower quality healthcare due to systemic racism. Low-income neighbourhoods have limited access to healthy food and safe recreational areas, leading to higher rates of obesity and related diseases. Canadians in the bottom SES quintile are 5 times more likely to rate their health as fair or poor than people in the highest income quintiles. Aboriginal peoples are twice as likely to report fair or poor health status than non-Aboriginal with the same income levels. People living in Canada’s northern remote communities have the lowest disability-free life expectancy and the lowest life expectancy. Canada: Specific sub-populations suffer a burden of illness and distress greater than others (“Marginalized Vulnerable &/or at-Risk Populations”)  Aboriginal peoples  The poor  LGBTQ2S: Lesbian, Gay, Bisexuals, Transgendered, Queer, 2 Spirits  Immigrants  The homeless  The elderly  Refugees  Children and youth  The disabled  People with low literacy  Women  People-stigmatized conditions (HIV, mental health) Critical Questions In a country with so many opportunities: How does this happen as it does? How do we explain these conditions? What analysis/theoretical perspectives might help us to understand/know/see/do? What action plans are needed? When? Where? Who should be involved in working for healthy social change? How will we evaluate the work/assess the effectiveness? Health Disparities vs. Health Inequities: What Is the Difference? Health Disparities Differences in health outcomes and access to healthcare services between different population groups. These differences can be observed along various lines, including race, ethnicity, socioeconomic status, gender, geographic location, and other demographic factors. Examples: Men generally have higher rates of certain cancers compared to women. Rural populations might have higher rates of certain health conditions due to geographic isolation. Health Inequities Health inequities are a subset of health disparities that are specifically considered to be unfair, unjust, and avoidable. These inequities are rooted in social, economic, and political factors and often stem from systemic issues like discrimination and unequal distribution of resources. Examples: Racial minorities receive lower quality healthcare due to systemic racism. Low-income neighbourhoods have limited access to healthy food and safe recreational areas, leading to higher rates of obesity and related diseases. How Can Disparities Be Addressed? Compare our health system and health disparities to other countries; e.g., Sweden and the United Kingdom (UK) where health disparities are less prevalent. Analyze how it is possible to address health disparities more appropriately in some countries versus other countries. Examine how health disparities are measured, by whom, and for what purposes. Investigate promising initiatives that have an evaluative component in their work. Develop health promoting research initiatives with the purpose of improving the health conditions and health services for people who are socially excluded, marginalized, and/or at risk for health disparities.  Analyze current health policies. Work with others to advocate for and/or develop “healthy” policy options. Work with those who are most often burdened with health disparities to learn about their lives, their needs and their perspectives and continue to work with them throughout the whole process of working towards “healthy” social change. What Are Health Determinants? Health Determinants Factors that influence health. It includes not only people’s genetics and life-styles but also, where they are born, live, work, and age. The main determinants of health include: Income and social status Employment and working conditions Education and literacy Childhood experiences Physical environments Social supports and coping skills Healthy behaviours Access to health services Biology and genetic endowment Gender Culture Race/racism Social Determinants of Health Refers to social, economic and political factors that are subsets of health determinants. Lifestyles also are influenced by people’s socioeconomic position. Income and income distribution Education Unemployment and job security Employment and working conditions Early childhood development Food insecurity Housing Social exclusion Social safety network Health services Indigenous status Gender Race Disability Upstream thinking in nursing represents a proactive approach to healthcare that aims to address the root causes of health issues before they escalate into significant problems. This concept prioritizes prevention and health promotion by identifying and addressing the social, environmental, and economic determinants of health. By tackling these underlying factors, nurses can reduce the incidence of illness, enhance overall well-being, and foster healthier communities. This approach encourages a shift from reactive, treatment-focused care to a more holistic, preventative perspective in nursing practice. Key Point Public health and community services aim to work upstream… (build skills, confidence, and increase prevention through support and social change)… illness services work downstream (diagnosis, treatment and support after a crisis). Thinking “Upstream” Means making smarter decisions based on long-term thinking. Creating the conditions for all people to enjoy true health – complete physical, mental, and social well-being? And what better measure of its success than the health of those people? Upstream thinking seeks to generate a new frame of thinking. Focuses on decisions that will make the most impact on the quality of our lives. So, how do we create this? Critical question! Connect individuals and partner organizations.  Establish common goals. Use common language. Aid in creating a public demand for policies and actions consistent with the new frame. Module Summary In summary, the ecological perspective is crucial for effectively promoting health across diverse communities. It supports a holistic approach that acknowledges the complexity of human behaviour and the multiple factors that influence health. The social determinants of health are the conditions in which people are born, grow, live, work, and age, including the health system. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels, which are influenced by policy choices. The social determinants of health are primarily responsible for health inequities – the unfair and avoidable differences in health status observed within and between countries. Although public health, community health, and health promotion approaches can all enhance population health, health promotion is the most effective strategy for reducing health inequalities. The health promotion approach empowers populations to gain greater control over their health and values advocacy, equity, and social justice. By integrating efforts across various domains of influence, public health initiatives can achieve more substantial and enduring improvements in community health outcomes. This perspective encourages addressing not only immediate health issues but also the underlying social structures and policies contributing to those issues.