SPH200 - Fall 2024 - Unit4 - All Slides.pdf

SPH 200 Unit 4 Module 1 The determinants of health The (social) determinants of health Income and social status Employment and working conditions Education and literacy Childhood experiences Physical environments Social supports and coping skills Healthy behaviours Access to...

SPH 200 Unit 4 Module 1 The determinants of health The (social) determinants of health 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 Public Health Agency of Canada The (social) determinants of health Dahlgren and Whitehead, 1991 DOH and pathways to health and illness Brunner and Marmot, 2006 Occupational class and life expectancy in England and Wales, 1997-1999 There are numerous transitions that occur throughout life Early childhood Education Starting work Starting family Changing jobs Facing skill phase out Retirement Each of these transitions can influence health by moving someone to a more or less advantaged path Those disadvantaged in the past face greater likelihood of continuing on the pathways leading to continued disadvantage Good health policy aims to assist those disadvantaged WHO: The Solid Facts; Bartley M, Plewis I. 2002, 31:336–341.  Canada is no different Life expectancy based on neighbourhood Wilkins, R. (2007) Comparison of health care spending as a % of GDP Canada is one of the biggest spenders on health care per capita in the world What is the good when that spending helps someone return to the conditions that made them ill in the first place? CIHI; Mikkonen and Raphael, 2010 SPH 200 Unit 4 Module 2 The determinants of health  Income and social status Income distribution across population Actual income received De Vogli et al, 2005; Wilkins, R. (2007)  Income and social status Income and social status is a cornerstone DOH Income shapes many other factors that influence health and are DOH themselves Overall living conditions Quality of diet Extent of physical activity Tobacco use The importance of income as a DOH is magnified in countries where fewer services and benefits are provided as a matter of right Education Health care Childcare Housing Post-secondary education Retirement resources Guaranteed basic income Wilkins, R. (2007)  Income and social status Wealth inequality is increasing in Canada Addressing issues with minimum wage Expanding health benefits Prescriptions Dental Eye Stats Canada Employment and working conditions Employment and work tie closely to income and social status In general, having a job is better for health than having no job Stress stemming from the workplace can significantly impact health Little to no opportunity to use skills Low decision making capacity Job uncertainty Self reported level of job control and incidence of coronary heart disease in men and women Bosma et al, 1998; WHO Employment and working conditions Work-related dimensions that shape health outcomes in Canada Employment security Physical conditions at work Work pace and stress Working hours opportunities for self expression and individual development Imbalances between work demands and rewards often lead to health problems Only 4 in 10 Canadians (in 1994) said that they had a lot of freedom over how to work Mikkonen and Raphael, 2010; Jackson, 2009  Education and literacy Internationally, Canada performs very well with respect to education In 2017 Canada was: In the top 10 performing countries on the International Pisa Maths, Science and Reading Among Organisation for Economic Co-operation and Development (OECD) countries, Canadian teens are among the best educated in the world Canada has the highest proportion of working-age adults that have completed higher education (55% compared with OEDC average of 35%) So what do we know about education and health? Public Health Agency of Canada  Education and literacy Higher education levels associate with higher income Better job security and upward mobility within the workforce Literacy increases chances one can promote their own health through individual action Public Health Agency of Canada; Stats Canada SPH 200 Unit 4 Module 3 The determinants of health  Childhood experiences Includes supporting mothers and young children The foundations of adult health are laid out in early childhood and in some cases, before birth Environmental exposures Poor emotional support Poor intellectual stimulation Circumstances during pregnancy can also impact fetal development Nutritional deficiencies Smoking and misuse of drugs and alcohol Insufficient exercise Barker (1998) Childhood experiences Belbasis et al, (2016)  Healthy behaviours Many of our behaviours impact our health Eating habits Exercise Tobacco and alcohol use Violence Healthy behaviours stem from early environment and reinforcement, but are also influenced by other DOH Income and social status Social inclusion/exclusion Employment Health promotion campaigns aim to advance healthy behaviours Healthy behaviours  Access to health services A universal health care system (like Canada’s) protects the health of citizens while spreading the costs across the whole society Especially effective for protecting citizens with lower incomes The Canada Health Act (1984) sets out the requirements provincial governments must meet through their public health-care plans This is also termed a single payer system – all primary costs are dealt with by the public authority The CHA requires provinces to provide all ‘medically necessary’ services on a universal basis There is a great deal of discretion with respect to which services are included (provincial variation)  Access to health services Despite the universal system, there are inequities Lowest 33% of Canadian earners are: 50% less likely to see a specialist when needed 50% more likely to encounter difficulty receiving care on weekends or evenings 40% more likely to wait 5 or more days before seeking care While 70% of total health care costs are covered Drug coverage Dental Covered by private insurance or out of pocket Vision  Physical environments Maslow, 1943  SPACE Land Resources Carrying Capacity Population 24 ECOSPHERE  Genetic endowment Most chronic diseases in humans thought to be result of complex interactions between genetic factors and environment. Here “environment” refers to all external factors (diet, lifestyle, exposure to potentially hazardous agents in environmental media, etc.). All human may be exposed in some way to potentially hazardous agents – micro organisms, organic chemicals, metals, ionizing radiation – associated with lifestyle activities: § at work Nature versus Nurture § at home § during recreation § while traveling on a roadway § etc. SPH 200 Unit 4 Module 4 The determinants of health  RACE and SOCIAL CULTURE GENDER RACISM SUPPORT SPH 200 Unit 4 Module 5 The determinants of health Health inequalities in Canada Health inequalities in Canada Health inequalities in Canada: Infant mortality Health inequalities in Canada: Infant mortality Health inequalities in Canada: Diabetes Health inequalities in Canada: Diabetes Health inequalities in Canada: Diabetes