Social Determinants of Health POH705 Week 2 PDF

Social Determinants of Health POH705 School of Occupational and Public Health Toronto Metropolitan University Week 2 1 Lesson Objectives To review the social determinants of health and their impac...

Social Determinants of Health POH705 School of Occupational and Public Health Toronto Metropolitan University Week 2 1 Lesson Objectives To review the social determinants of health and their impact on the Canadian population To understand how the various social determinants shape access to opportunities to be healthy 2 How Healthy Are Canadians? Quite healthy, relatively speaking Canada ranks among the top and middle third performers among OECD member states for most health indicators Canadians are living longer with increased life expectancy, decreasing morbidity and mortality rates Canada is currently rated 6th out of 30 countries on the OECD 3  How Healthy Are Canadians? Areas of Concern: particularly with an aging population Cardiovascular and Chronic Respiratory Disease Cancer Diabetes More than 1 in 5 Canadian adults live with one of these chronic diseases Public Health Agency of Canada (2017, March 8). How Healthy are Canadians? [Education and awareness]. 4 https://www.canada.ca/en/public-health/services/publications/healthy-living/how-healthy-canadians.html  How Healthy Are Canadians? The ‘____healthy immigrant effect____': Most recent immigrants are in __good____ health (better than Canadian-born) although it ___declines_____ as their years in Canada increase Why do we see this pattern? Salami B, Olukotun M, Vastani M, et alImmigrant child health in Canada: a scoping review BMJ Global Health 2022;7:e008189. Elshahat, S., Moffat, T., & Newbold, K. B. (2022). Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A5 Systematic Critical Review. Journal of immigrant and minority health, 24(6), 1564–1579. https://doi.org/10.1007/s10903-021-01313-5  Healthy Immigrant Effect Immigration selection: the process of selecting who immigrates is more likely to favour __healthy_____ adults Cultural factors: The habits (diet, lifestyle, behaviours) assumed from country-of-origin are associated with __better____ health _Resilience__________: Newcomers often have the motivation/determination to seek out the country’s resources for good health 6 Sources: Farré, L. (2016): https://doi.org/10.1007/s00148-015-0578-4; Elshahat, S., Moffat, T., & Newbold, K. B. (2022). : https://doi.org/10.1007/s10903-021-01313-5; Kyriakos S Markides, et al (2019): https://doi.org/10.1093/geront/gny136  How Healthy Are Canadians? The current infant mortality is 3.9 infant deaths per 1,000 live births 7 w4.hrsdc.gc.ca/[email protected]?iid=2  Life Expectancy by Province Government of Canada, S. C. (2021, April 13). Life expectancy and other elements of the complete life table, three-year estimates, Canada, all provinces except Prince Edward Island. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310011401 8  Life Expectancies among G7 Countries G7: Life expectancy by country 2022. (n.d.). Statista. Retrieved August 27, 2023, from https://www.statista.com/statistics/1372668/g7-country-life- 9 expectancy  Chronic Disease Prevalence in Canada 10 Source: https://www150.statcan.gc.ca/n1/pub/82-570-x/2023001/section1-eng.htm What shapes health? Health status can be determined by multiple inter-related factors Some factors may have an independent effect or they may be interacting with other variables Example of Coronary Heart Disease (CHD): physiological factors (age, sex, fam history) lifestyle factors (smoking, physical activity) environmental factors (Access to healthy food, neighbourhood build environment) social factors (social support for coping w stress) 11  Social Determinants of Health “The social determinants of health are the __medical_____________ factors that influence health outcomes. They are the ___conditions_________ in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.” 12 https://www.who.int/health-topics/social-determinants-of-health#tab=tab_  Health Equity “Equity is the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual orientation). Health is a fundamental human right. Health equity is achieved when everyone can attain their full potential for health and well-being.” Source: https://www.who.int/health-topics/health-equity#tab=tab_1 13 Health Equity All groups do not have the same _____opportunities______________ to achieve good health Health equity is achieved when barriers that may impede an individual from reaching their full health potential are reduced or eliminated. Population patterns exist for MORBIDITY and/or MORTALITY Not just one variable affecting health, but 14 SDOH FRAMEWORKS 15 Key Determinant 1 Income and Social Status Some argue this is the most important determinant Premise Income determines living conditions such as safe housing and ability to buy sufficient good food The healthiest populations are those in societies which are prosperous and have an equitable distribution of wealth 16  Canada has relatively high poverty levels Source: https://www.statcan.gc.ca/en/topics-start/poverty WHO, 2003 17  Canada's Poverty Levels: By Province 18 https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021009/98-200-X2021009-eng.cfm https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-of ficer-reports-state-public-health-canada/2016-health-status-canadians/page-4-how-h ealthy-are-we-life-expectancy-birth.html#p4 19 Income and Social Status: Supporting Facts Low-income Canadians are more likely to _die_____ earlier and to suffer more ___illnesses_________ than Canadians with higher incomes, regardless of age, sex, race and residence Men in the wealthiest of neighbourhoods in Canada live on average more than 5 years longer than men in the poorest of neighborhoods (3 yrs for women) ___Distribution______________ of income in a given society may be a more important determinant of health than the total amount of income earned by society members 20 How would we factor in 'income and social status' to health education/promotion? Identifying vulnerable pop Understanding unique access issues for vulnerable populations Advocating to government agencies Health literacy 21 Key Determinant 2 Social Support Network Important in helping people to Solve problems Deal with adversity Maintain a ________sense of control__________over life circumstances The caring and respect that occurs in social relationships, and the resulting sense of satisfaction and well-being, seem to act as a buffer against health problems 22 https://www.canada.ca/en/ public-health/services/ publications/healthy-living/ 23 measuring-positive-mental- Social Support Network: Supporting Facts For both men and women, the more _______social contacts_________ people have, the lower their premature death rates Low availability of _______emotional support_________ and low social participation were associated with all- cause mortality Coping with stress and having control boost the immune and nervous systems’ responses that keep us healthy 24 How would we factor in 'social support networks' to health education and promotion? Identifying health education settings that align with existing social support networks Helps to understand how people access information, and who they are talking to Creating groups that support the dissemination of health information- Using interactive tools that create networks261 25 Key Determinant 3 Education and Literacy Closely tied to socioeconomic status Equips people with knowledge and skills for problem solving, and helps provide a sense of control and mastery over life circumstances 26 Education and Literacy: Supporting Facts People with higher levels of education: Have better access to healthy ____physical environments_______________ Are better able to prepare their children for school Tend to smoke less Tend to be more physically active Tend to have access to healthier foods 27 Highest Level of Completed Education in Canada: 2006 vs 2016 Statistics Canada (2017) Education in Canada: Key results from the 2016 Census. Government of Canada. https://www150.statcan.gc.ca/n1/daily-quotidien/171129/dq171129a-eng.htm 28 Education and Literacy: Supporting Facts Self-reported health is lower among those with education less than high school compared to university graduates Number of ___lost workdays___________is higher among those with lower levels of education Men living in neighbourhoods with the highest educational levels had a LE 3.7 years higher than that of men living in neighbourhoods with the lowest educational levels. For women, the corresponding difference was 2.3 years 29  Education and Literacy: Supporting Facts The prevalence of ___smoking_________ among adults with less education than high school is nearly 4 times that of university graduates ____Heavy drinking____________ prevalence is lowest among university graduates and similar across other education groups. People who have a higher economic status are more likely to have a post-secondary educations and opportunities Being well-educated is associated with Greater understanding of the implications of unhealthy behaviour Increased ability to navigate the healthcare system (which contributes to better health outcomes) Cusick, J. (n.d.). Overview of all 12 Social Determinants of Health (SDOH). Retrieved September 11, 2023, from 30 https://opentextbc.ca/peersupport/chapter/overview-of-all-12-social-determinants-of-health-sdoh/ How would we factor in 'education and literacy' to health education and promotion? Messaging (use of infographic, less text) Mode of delivery Promote health literacy Consider educational backgrounds in program design etc 31 Key Determinant 4 Employment and Work Conditions Premise People who have ___more control___ over their work circumstances and fewer stressful demands are healthier and often live longer Work influences many aspects of life that affect health Income/social status Workplace hazard Healthcare access Housing Economic security, and more 32  Occupation Type and Life Expectancy Deeg, D. J. H., De Tavernier, W., & de Breij, S. (2021). Occupation-Based Life Expectancy: Actuarial Fairness in 33 Determining Statutory Retirement Age. Frontiers in Sociology, 6. Metropolitan Employment Rates WHO, 2003 34  Employment and Work Conditions: Supporting Facts __Precarious______ work: uncertain or unstable types of work, typically no regular schedule and no work benefits. Linked to a decrease in mental and physical health Injuries: Physically demanding jobs pose mental and physical health risks Unemployment: Associated with a reduced __life expectancy________ and health problems compared to employed status Many Canadians (especially women) spend almost as many hours engaged in unpaid work, such as doing housework and caring for children or older relatives 35 Work as a Key Social Determinant of Health: The Case for Including Work in All Health Data Collections | Blogs | CDC. (2023, February 16). How would we factor in 'employment and work conditions' to health education and promotion? Work places as potential health education settings: - Ti implement healthy practices and policies - TO disseminate info Identifying specificrisk factors to target messaging 36 Key Determinant 5 Social Environments Premise Social ____stability____, recognition of diversity, safety, good working relationships and ___cohesive_______ communities provide a supportive society that reduces many potential health risks Social or community responses can improve coping strategies and foster health 37 Key Determinant 5 Social Environments Social environment can include: Interactions with family, friends, coworkers, others in the community Social institutions/settings: workplace, schools, community centers 38  Sense of Belonging 39 https://www160.statcan.gc.ca/society-societe/local-community-collectivite-locale-eng.htm  Sense of Belonging In 2021 and 2022, almost half of people (47%) in Canada reported having a strong sense of belonging to their community __Lower_____ among young people aged 15 to 34, and among LGBTQ2S+ Lower among people experiencing social and economic challenges _Higher______ among rural compared to urban residents __Higher_____ among some racialized groups (i.e., South Asian, Filipino, Arab, Black) 40 https://www150.statcan.gc.ca/n1/en/daily-quotidien/220819/dq220819b-eng.pdf?st=tusQG7U5  Sense of Belonging Painter, C. V (2013, June). Sense of Belonging: Literature Review. Government of Canada Immigration, Citizenship and 41 Refugees. https://www.canada.ca/en/immigration-refugees-citizenship/corporate/reports-statistics/research/sense-belonging-literature- review.html  Social Environments: Supporting Facts Psychosocial factors affect physical health Social environments can either __create_____ or _mitigate______ stress Turning on stress responses diverts energy from bodily processes important for long term health If these conditions last for long periods, individuals can become more vulnerable to various health conditions 42 Volume Source: Natalia Bobba-Alves, Robert-Paul Juster, Martin Picard, The energetic cost of allostasis and allostatic load, Psychoneuroendocrinology, 146, 2022, ISSN 0306-4530, https://doi.org/10.1016/j.psyneuen.2022.105951  Social Environments: Supporting Facts Stress from social situations, including family violence, has a devastating effect on health in both the short and long term Discrimination, stigmatization, and marginalization are experienced in social contexts Negative impacts on mental health Can impact access to resources and information for taking care of physical health (i.e., culturally- appropriate services) 43 Bendavid, E., et al P. (2021): https://doi.org/10.1016/S0140-6736(21)00131-8 ; A.P. Gray, W. Cote (2019), https://doi.org/10.1016/j.puhe.2018.12.003 Key Determinant 6 Physical Environments Premise At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects i.e., cancer, birth defects, respiratory illness, gastrointestinal ailments 44  Physical Environments: Supporting Facts __Air pollution____________, including exposure to second-hand tobacco smoke, has a significant association with health Link between hospital admissions for respiratory illness in the summer months and air quality Access to good water quality is imperative to health 150 million people have been exposed to arsenic contaminated water globally, which poses serious health risks such as carcinogenic effects, cardiac failure, and hypertension 45 Adeloju, S. B., Khan, S., & Patti, A. F. (2021). Arsenic Contamination of Groundwater and Its Implications for Drinking Water Quality and Human Health in Under-Developed Countries and Remote Communities—A Review. Applied Sciences, 11(4), 1926-. https://doi.org/10.3390/app11041926  Physical Environments: Supporting Facts The recent increase in processed __food____ production and consumption has been associated with obesity and other non-communicable diseases Soil quality can affect human health Directly through skin contact, ingestion, inhalation Indirectly through consumption of plants and microbial activity of the soil affecting ecosystems 46 Dinu, M., & Martini, D. (2023). Ultra-Processed Foods, Diet Quality and Human Health. Nutrients, 15(13), 2890. https://doi.org/10.3390/nu15132890 Li, G., Sun, G. ‐X, Ren, Y., Luo, X. ‐S, & Zhu, Y. ‐G. (2018). Urban soil and human health: a review. European Journal of Soil Science, 69(1), 196–215. Urban Planning and Health What makes a healthy city? - Pedestrian walkways - Bike lanes - Separating neighborhoods from industrial operations - Greenspaces - Public Transit 47 Environmental Inequalities Distribution of __pollution_____ (air, land, water) tends to be highest in the least desirable residential areas Who is most vulnerable? Children Outdoor workers Low-income and racialized communities Impacts on health outcomes E.g., childhood asthma, safety, cancer rates 48 Physical Environments: Supporting Facts The prevalence of core housing need among Canadians in the lowest income group was nearly 7.5 times as high as among Canadians in the highest income group Recent immigrants report a prevalence of core housing need twice that of non-immigrants 49 https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-repo 50 rts-state-public-health-canada/2016-health-status-canadians/page-11-what-influencing-health- housing.html#p11 How would we factor in 'social and physical environments' to health education and promotion? Recognizing the importanc eof community organizations, volunteering etc Improving built envrionmnt to enable better health for communities at large. (i.e. advocating forgreen spaces) 51 Key Determinant 7 Personal Health Practices and Coping Skills Premise Influenced by social, economic, and environmental factors Impacts lifestyle choice through at least five areas: Personal life skills Stress Culture Social relationships and belonging Sense of control 52 https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-heal th-canada/2016-health-status-canadians/page-13-what-influencing-health-physical-activity.html#p13 53 - Only tobacco smoking - Higher among males at all age groups Government of Canada, S. C. (2019, June 25). Smoking 2018. https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00006-eng.htm 54  Higher among males at all age groups Declining trend w age Government of Canada, S. C. (2019, June 25). Heavy Drinking, 2018. https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00007-eng.htm Supporting Facts Multiple risk-taking behaviours (i.e., alcohol/drug use, driving, etc.) are higher among young people, especially young __men___ Poor _diet____ linked to some of the major causes of death, including cancer and coronary heart disease Effective coping skills enable people to be self- reliant, solve problems and make informed choices that enhance health A strong socioeconomic gradient is evident for healthy behaviours (e.g., smoking, diet, physical activity, alcohol consumption) 56 Key Determinant 8 Healthy Child Development Premise Evidence on the effects of early experiences on brain development, __school readiness____ Consensus about early child development as a powerful determinant of health 57 Paternal Income Correlates with Newborn Birth Weight Azhar, Bably & Monirujjaman, Md & Islam, Kazi & Alam, Md Jahangir & Afrin, Sadia & Abdullah-Al-Shoeb, Mohammad 58 & Hossain, Md. (2013). Maternal Socio-demographic factors and anthropometric characteristics related to infant birth weight. J Pharm Biomed Sci.. 2013. 788-797.. Healthy Child Development: Supporting Facts Experiences from conception to age 6 have the most important influence of any time in the life cycle on the brain's development Positive stimulation and __attachment_____ early in life improves learning, behaviour and health into adulthood Tobacco and alcohol use during pregnancy can lead to poor birth outcomes 59 Supporting Facts Infants and children who are neglected or abused are at higher risk for _injuries______, and a number of behavioural, social and cognitive problems later in life There is a strong relationship between __income_____ level of the mother and the baby's birth weight Mothers at each step up the __income_____ scale have babies with higher birth weights, on average, than those on the step below The proportion of children with developmental vulnerability is twice as high for those living in materially and socially deprived neighbourhoods 60 61 Key Determinant 9 Biology and Genetics Premise Two-fold: Genetic endowment appears to predispose certain individuals to particular diseases or health problems Genetic endowment provides an inherited predisposition to a wide range of individual responses that affect health status 62 Biology and Genetics: Supporting Facts Genetic endowment may play a role in personality development, intelligence levels, and a person's mental health Aging is not synonymous with poor health Education and lifelong learning can help ___compensate______ for cognitive losses that occur with age Importance of physical activity 63 Key Determinant 10 Health Services Premise Health services are designed to __maintain_____ and __promote_____ health, to prevent disease, and to restore health for populations Includes treatment, management, and prevention 64  Health Services: Supporting Facts Health promotion, surveillance and immunization activities have proven to be beneficial The average hospital stay has decreased, which has put an increased financial, physical and emotional burdens on families, especially women Many low and moderate income Canadians have limited or no access to eye care, dentistry, mental health counseling and prescription drugs Access to care varies by jurisdiction 65 Key Determinant 11 Gender and Sex Premise Refers to our gender identity, socially- constructed roles, personality traits, attitudes, behaviours, values, relative power and influence of both sexes Sex: “refers to a set of biological attributes in humans and animals” ex. chromosomes, gene expression, hormone levels, reproductive organs 66 Life expectancy at birth in Canada from 2011 to 2021, by sex JR – Please update 67 Gender: Supporting Facts Differences in health outcomes Women ____live longer_____ than men, but are more likely to suffer from depression, stress overload (often due to efforts to balance work and family life), chronic conditions such as arthritis and allergies, injuries and death resulting from domestic violence 68  Gender: Supporting Facts Differences in __lifestyle______/healthy behaviours E.g., smoking, drinking, types of sedentary activities Differences in _health seeking_______-seeking behaviour E.g., likelihood to visit a doctor or engage in medical intervention, seek support from peers (i.e., coping strategies) Most health research (until recently) has focused on male subjects Concerning as health findings cannot always be extrapolated across genders (i.e., cardiac health) 69 Key Determinant 12 Culture Premise Some people may face additional health risks due to dominant cultural values that contribute to Perpetuating marginalization or stigmatization Loss or devaluation of language and culture Lack of access to culturally appropriate health care and services Culture typically _intersects______ with other SDOH Culture can also be a _protective__ factor Linked to social support and positive health practices 70 Culture: Supporting Facts Impacts of ___colonizations________ Legacy of discrimination and historical trauma have had consequences for intergenerational transmission of health risks Infant mortality rates among Indigenous populations much higher than other Canadian populations Prevalence of major chronic diseases, including diabetes, heart problems, cancer hypertension and arthritis/rheumatism, is significantly higher Indigenous Peoples living in northern and 71 Some First Nations reserves don't have clean drinking water 72 Source: https://www.youtube.com/watch?v=ibWLCYknpNc Culture: Supporting Facts Health inequalities Can lead to internalized stress Differential access to information and care Can result from not having culturally appropriate resources I.e., language, beliefs, value systems, acknowledging varying attitudes to health Culture as a protective factor Many cultures have healthy practices (i.e., diet, social cohesion) that has immense benefits for health Can __mitigate_____ some of the other SDOH such as low income 73 How would we factor in 'gender' and 'culture' to health education and promotion? Language Diverse representation in messaging and images Targeted interventions and info for vulnerable groups 74  Discussion Question For which determinant of health do you think health education has the largest role? 75 Talking about SDOH How do we translate the topic to the public? How do we make it easy to understand and meaningful? 76 Messaging guides 1- __Scientific______ phrasing is not well understood 2- Connect it with messages they already _believe__ 3- Use one strong and compelling fact 4- Identify the problem, but offer __solutions_____ 5- Incorporate the role of personal responsibility 6- Mix traditional conservative values with progressive ones 7 – Focus broadly on how SDOH affects everyone 77 Key References on Health Impacts of SDOH Mandatory readings: What Makes Canadians Healthy or Unhealthy? http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#st atus Key Health Inequalities in Canada: A National Portrait https://www.canada.ca/en/public-health/services/publications/science-rese arch-data/key-health-inequalities-canada-national-portrait-executive-summ ary.html Optional readings: Health Status of Canadians 2016: Report from the Chief Public Health Officer of Canada https://www.canada.ca/en/public-health/corporate/publications/chief-publi c-health-officer-reports-state-public-health-canada/2016-health-status-can adians.html?_ga=2.140097971.1839025077.1536365448-1892565615.15 29431314 How Healthy Are Canadians? 78 https://www.canada.ca/en/public-health/services/publications/healthy-livin  Next week Health Promotion 79