Health Inequalities & Social Inequalities (2023 Past Paper)

HEALTH INEQUALITIES & SOCIAL INEQUALITIES THEIR INTERACTION WITH FOOD SYSTEMS Clara Cheng APD (Aust.) A.Inst.Pa  OBJECTIVES Able to describe and quote examples of social inequality Able to describe some health determinants Able to describe health inequal...

HEALTH INEQUALITIES & SOCIAL INEQUALITIES THEIR INTERACTION WITH FOOD SYSTEMS Clara Cheng APD (Aust.) A.Inst.Pa  OBJECTIVES Able to describe and quote examples of social inequality Able to describe some health determinants Able to describe health inequality and inequity Able to distinguish health inequality and inequity Able to briefly describe local and modern food systems  CONTENT Determinants of health Health inequalities v Health inequities The relationship between social inequality and health inequity Social factors that shape lifestyle and dietary patterns Overview of food system and its evolution The modern food system Conventional v Local Stakeholders along the food system and their impacts Sociological change and consumer choice Specific population groups (vegetarianisms, religions… etc) Global economic growth and cultural diversity  WHAT IS HEALTH? Health promotion is the process of enabling people to increase A state of control over, and to improve their health. To reach a state of complete physical. complete physical, mental and social well being, an individual or mental and social group must be able to identify and to realise aspirations, to well-being and not satisfy needs and to change or cope with the environment. Health merely the absence is, therefore, seen as a resource for everday life, not the objective of disease or of living. Health is a positive concept emphasisng social and infirmity personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, ~ WHO but goes beyond healthy life-styles to well-being. 1948 ~ WHO 1986  TO ACHIEVE HEALTH A sustainable state of equilibrium or harmony between humans and their physical, biological and social environments that enables them to coexist indefinitely. A structural, functional and emotional state that is compatible with effective life as an individual and as a member of family and community groups. ~ A Dictionary of Public Health Oxford: Oxford Universty Press 2007  HEALTH IS A FUNDAMENTAL HUMAN RIGHT “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”  HEALTH AT DIFFERENT LEVEL Global Health Directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe International Health Focuses on the health of participating countries with intention to affect non-participating countries Community Health A medical specialty that focuses on the physical and mental well-being of the people in a specific geographic region  I’m not healthy~ Whom should I blame? ~Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment~  SOCIAL DETERMINANTS OF HEALTH The broad social and economic circumstances that together influence health throughout the life course are known as the ‘social determinants of health’ There is a social gradient across many of these determinants that contribute to health with poorer individuals experiencing worse health outcomes than people who are better off ➔ Health Equity and Health Equality UK – The Marmot Review Report “Fair Society, Healthy Lives”  THE DETERMINANTS OF HEALTH The person’s The social and The physical individual economic environment environment characteristics & behaviours The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health  HEALTH DETERMINANTS Income and social status Education Physical environment safe water and clean air, healthy higher income and social status are linked low education levels are linked with poor workplaces, safe houses, communities and to better health health roads all contribute to good health Gender Genetics Health services inheritance plays a part in determining Men and women suffer from different access and use of services that prevent lifespan, healthiness and the likelihood of types of diseases at different ages and treat disease influences health developing certain illnesses Social support networks greater support from families, friends and communities is linked to better health Culture - customs and traditions, and the beliefs of the family and community all affect health  THE RAINBOW MODEL OF HEALTH Personal characteristics occupy the core of the model and include sex, age, ethnic group, and hereditary factors individual ‘lifestyle’ factors include behaviours such as smoking, alcohol use, and physical activity social and community networks include family and wider social circles living and working conditions include access and opportunities in relation to jobs, housing, education and welfare services a systematic framework for showing the relationship between general socioeconomic, cultural and approaches to health and total, whole-of-life development environmental conditions include factors such as disposable income, taxation, and availability of work Artist: Angus Maguire  HEALTH INEQUALITIES Generally refer to the differences in the health individuals or groups Any measurable aspect of health that varies across individuals or according to socially relevant groups The presence of disease, health outcomes, or access to health care between population groups Absent from the definition of health inequality is any moral judgement on whether observed differences are fair or just E.g. Women are more susceptible to breast cancer compare with men  HEALTH INEQUITIES Also called Health Disparity Health inequities are the unjust and avoidable differences in people’s health. OR, Health inequities are system differences in health that could be avoided by reasonable means Often, inequity is measured in terms of the inequality of health E.g Types II diabetes has been found to be 4 times higher among Canada’s lowest income group than its highest income group.  WHO - HEALTH INEQUITIES WHO – Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government policies  FEATURES OF HEALTH INEQUITIES Systemic Avoidable Unfair / Unjust There is a linear pattern Not the result of A moral judgement ~ a relationship is biological refers to health present throughout society is not simply differences differences that are between the most and unfair or stem from the least healthy But result of injustice differences in This health difference is distribution of Resources should be not random, but are resources & allocated according patterned across the population opportunities in a to need, not based E.g. Higher social status society on underlying social people tend to have better advantage or health than those with lower social status disadvantage  AN EXAMPLE four major factors determining the eating behavior and dietary intake of resident students in the university. PLoS One. 2018; 13(6)  THE IMPACT OF SOCIOECONOMIC STATUS ON HEALTH ACROSS THE LIFE COURSE The impact of socioeconomic status on health across the life course. Source:Glob Health Action. 2015; 8: 10.3402/gha.v8.27106. WHO – FACTS ON HEALTH INEQUITIES Every day 16 000 children die before their 5th birthday They die of pneumonia, malaria, diarrhea, and other diseases They are 14 times more likely to die before the age of 5 in Sub-Saharan African than the rest of the world WHO – FACTS ON HEALTH INEQUITIES Maternal mortality A key indicator of health inequity Developing countries account for 99% of annual maternal deaths in the world Woman in Chad have a lifetime risk of maternal death of 1 in 16, while a woman in Sweden has a risk of less than 1 in 10 000 WHO – FACTS ON HEALTH INEQUITIES 87% of premature deaths due to noncommunicable diseases occur in low- and middle-income countries WHO – FACTS ON HEALTH INEQUITIES Life expectancy varies by 34 years between countries A child born in Sierra Leone can expect to live for 50 years while a child born in Japan can expect to live 84 years WHO – FACTS ON HEALTH INEQUITIES Health inequities have a significant financial cost to societies The European Parliament has estimated that losses linked to health inequities cost around 1.4% of GDP within EU WHO – FACTS ON HEALTH INEQUITIES Persistent inequities slow development Close to 1 billion people in the world live in slum conditions SDG (Sustainable Development Goal) the linkage between Goal 3 and Goal 11  SOCIAL FACTORS THAT SHAPE LIFESTYLE AND DIETARY PATTERNS Social class Finacial status Cultural Accessibility influence Education Social context Knowledge Social setting Internal Environmental  HEALTH INEQUITIES – FUNDAMENTAL CAUSES AND HEALTH OUTCOMES - Global economic forces - Marco socio-political Inequalities - Unequal distribution of - Wellbeing environment income power & Wealth - Political priorities and - Poverty - Healthy life expectancy decisions - Morbidity - Discrimination - Societal values to equity and - Mortality fairness ANY OTHER EXAMPLES IN HONG KONG?  HEALTH INEQUALITIES VS. HEALTH INEQUITIES Example A Male babies are generally born at a heavier birth weight than female babies. Health inequalities? Health inequities? Example B Babies born to Black women are more likely to die in their first year of life than babies born to White women. Health inequalities? Health inequities?  HEALTH INEQUALITIES VS. HEALTH INEQUITIES Example A This difference is unavoidable. We expect to see this difference in birth weight because it is rooted in genetics Example B The difference between the populations is unfair, avoidable and rooted in social injustice. Some of this difference can be attributed to poverty – a higher percentage of Black mothers are poor and face hardships associated with poverty that can affect their health; however, we find differences in the health of Black and White mothers and babies even if we compare Blacks and Whites with the same income. Many scientists have shown links between the stress from racism experienced by Black women and negative health outcomes  HEALTH INEQUALITIES VS. HEALTH INEQUITIES Key distinction: Inequality is simply a dimensional description employed whenever quantities are unequal Inequity requires passing a moral judgement that the inequality is wrong Often Inequality constitutes inequity http://www.sollis.co.uk/wp-content/uploads/2016/10/equity-vs-equality.jpg A SCENARIO – DISCUSSION ON INEQUALITY & INEQUITY GUT MICROBIOME AND HEALTH INEQUITIES  HEALTH INEQUITY & FOOD INSECURITY Prof. Johan Swinnen, who is on the project management team of the EU-funded FOODSECURE project and sits on the EU scientific steering committee for Expo Milano  FOOD SYSTEM How we eat determines, to a considerable extent, how the world is used. – Wendell Berry United Nations (UN). Universal Declaration of Human Rights. Article 25. Available at: www.un.org/Overview/rights.html. Accessed February 26, 2007.  FOOD SYSTEM A food system encompasses all the stages of keeping us fed. It is a complex network that is connected to health, society, community economic development and agriculture FAO  OVERVIEW OF FOOD SYSTEM – THE EVOLUTION Hunter gathering societies Hunter-gatherer culture is a type of subsistence lifestyle that relies on hunting and fishing animals and foraging for wild vegetation and other nutrients like honey, for food Until approximately 12,000 years ago, all humans practiced hunting-gathering Later when agricultural practices were first developed, some groups abandoned hunter-gatherer practices to establish permanent settlements that could provide for much larger populations With increase in density of human beings, cities started to grow The need to feed people encouraged development of trade and this has been a major driver of food system changes Info fr National Geographic Society  FOOD SYSTEM – A SIGNIFICANT IMPACT Industrial Revolution During 18th and 19th centuries, the Industrial Revolution brought about significant impacts on food production Per-capita income growth was created, a wealthy class emerged, and they became more sophisticated in their food preferences Transportation breakthroughs and food preservation techniques were ushered and changed over time INDUSTRY 4.0 – HOW WOULD IT AFFECT THE FOOD SYSTEM? THE MODERN FOOD SYSTEM A FOOD SYSTEM INCLUDES ALL PROCESSES AND INFRASTRUCTURE INVOLVED IN FEEDING A POPULATION From growing, harvesting, processing, packaging, transporting, marketing, and consumption, are examples of components involved Land, farm inputs (water, fertilizer, seeds, energy, pesticides, animal feed) Outputs (crops, food, manure, water and air pollutants, environmental degradation) Transportation, processing, packaging, marketing Consumption by consumers for home use, and purchasing by institutions, restaurants Eating Pic source: FAO  MODERN FOOD SYSTEM Operates on economic scale, aiming at lowering the consumer costs and increasing the food production via maximizing the production efficiency The complexity of a food system varies depends on the food per se Often, food travels thousands of miles Pic source: Google image where it is produced to where it is sold and eaten FROM FARM TO FORK Pic source: Google image  EXAMPLE - WASHINGTON APPLE SUPPLY CHAIN Info ref from John Hopkins, and from Discovering the Food System. www.hort.cornell.edu/foodsys  GLOBAL SUPPLY CHAIN COMPLEXITY Pic source: Google image Pic source: Google image BREASTFEEDING V FORMULA FEEDING  FOOD PRODUCTION – SUPPLY & DEMAND Old time, people bought food from the local farm or local retail store which purchased food from the local farm Food consumed was driven by supply, which depended largely on the farmers’ ability to farm their land and breed the animals With the industrialization, people nowadays are further away from the production The leading role of farmers has been shifted, i.e. food production has been changed from supply driven to consumer driven GLOBAL PRODUCTION – CROPS GLOBAL PRODUCTION OF MAIN PRIMARY CROPS BY MAIN PRODUCERS (2020) GLOBAL PRODUCTION OF MAIN VEG OILS BY MAIN PRODUCERS (2019) GLOBAL PRODUCTION OF MEAT BY MAIN ITEMS  TRENDS IN CROP PRODUCTION In the past 50 years, global crop production has expanded threefold increase has been driven largely by higher yields per unit of land, and crop intensification resulting from multiple cropping and/or shortening of fallow periods Cereals are the most important food source for human consumption. Of the approximately 2.3 billion tonnes of cereals currently produced, roughly 1 billion tonnes is destined for food use, 750 million tonnes is employed as animal feed, and the remaining 500 million tonnes is processed for industrial use, used as seed or wasted – FAO  TRENDS IN MEAT PRODUCTION The production of live animals is increasingly driven by a shift in diet and food consumption patterns towards livestock products Over the last decade, consumption of meat in the developing countries of Asia – where the bulk of the world population increase has taken place – has been growing by about 3 percent per annum, and dairy product consumption by almost 5 percent Aggregate agricultural output is affected by these trends, not only through the increase in livestock production itself, but also through the linkage of livestock production to the crop sector – which supplies feedstuffs, mainly cereals and oilseeds – and the fisheries sector.  A BROKEN FOOD SYSTEM People are fed by the food industry, which pays no attention to health, and are healed by the health industry, which pays no attention to food. – Wendell Berry  MODERN FOOD SYSTEM & HEALTH DETERMINANT The improvement in economic status drives people to consume more energy from meat and dairy products All of these drives the modern diet to be richer in fats, sugar and salt. At the same time, people’s lifestyle has become more sedentary with reduction of physical activity This in turn, lowers the energy expenditure and result in a more widespread obesity  MODERN FOOD SYSTEM & HEALTH DETERMINANT The improvement in economic status drives people to consume more energy from meat and dairy products More crops are used to raise livestock More energy are used to process the food More impact on the ecosystem More impact on the food production…  IMPACT OF BROKEN FOOD SYSTEM – HEALTH ASPECT ACCORDING TO UNITED NATION (THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2017), WORLD HUNGER IS ON THE RISE. THE ESTIMATED NUMBER OF UNDERNOURISHED PEOPLE INCREASED FROM 777 MILLION IN 2015 TO 815 MILLION IN 2016. AT THE SAME TIME, CHILDHOOD AND ADULT OBESITY IS ALSO RISING EVERYWHERE AT AN ACCELERATING PACE. IN 2016, 41 MILLION CHILDREN UNDER 5 YEARS OLD WERE OVERWEIGHT. IN 2014, MORE THAN 600 MILLION ADULTS WERE OBESE Pic source: Google image  https://www.un.org/en/sections/observ ances/international-years/index.html Pic source: WHO HOW ARE WE GOING TO CHANGE THE FOOD SYSTEM  TAKE HOME QUESTION DOESS THE MODERN FOOD SYSTEM CLOSE THE GAP OF HEALTH INEQUALITY/INEQUITY? HOW TO FACILITATE A HEALTHY SUSTAINABLE FOOD SYSTEM