Social Determinants of Health PDF

The Social Determinants of Health (SDH) ‘The SDH consist of a number of overlapping factors that determine health and wellbeing. These include factors that begin at birth, such as biology and genetic characteristics, gender, culture, and various family influences on healthy child development. Family...

The Social Determinants of Health (SDH) ‘The SDH consist of a number of overlapping factors that determine health and wellbeing. These include factors that begin at birth, such as biology and genetic characteristics, gender, culture, and various family influences on healthy child development. Family influences include having socioeconomic resources for parents to provide for their child, parenting knowledge and skills, a peaceful family life and adequate support systems. Social support networks that are inclusive across genders, cultures and educational opportunities are also social determinants. Support systems influence a person's ability to cope with life's stressors, and to make decisions about personal health practices that either prevent illness or maintain health. Other social determinants are a function of interactions between the individual, family and community, such as having a healthy and supportive neighbourhood with adequate transportation and spaces for recreation, being able to access food and water, and services for health and childcare when they're needed and having employment opportunities with good working conditions and sufficient income. Many of these determinants are embedded in the political and economic environment,5 where policy decisions affecting community life are made’ (McMurray & Clendon, 2011, p.11). Despite a common biology, people across the globe experience health and illness differently. Mortality and morbidity data point to wide variations within and across cultures, and across time. According to the World Health Organization (WHO) the social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries (WHO, 2020, para.1). Rarely does one factor alone contribute to compromised health status; in fact, it is common for an individual's health6 status to be associated with a combination of factors which are influential in determining the patterns of health. These factors are known as determinants and can have either a positive or negative influence on health. Of these factors, the social determinants are considered to have the most impact on the health of individuals and communities, and this understanding of relationship is closely aligned with a PHC approach to health. Education7 Education is a key determinant of health as it fundamentally provides individuals with the knowledge and skills to solve problems and take control of their life circumstances. It is strongly associated with life expectance, morbidity, health behaviours and increases the opportunity for a job, income security, and job satisfaction (The Lancet, 2020). Employment The most important factors shaping people’s social position include employment and working conditions. The higher the wages, the better the health outcomes would be for an individual or their dependents. Low income is often associated with poorer health outcomes and higher incidences of mental illness. The psychological stress caused by low income or unemployment has a strong impact on physical and mental health and wellbeing. Once employed, participating in quality work helps to protect health, instilling self-esteem and a positive sense of identity, while8 providing the opportunity for social interaction and personal development (AIHW, 2020). Activity: How else can high income contribute to better health outcomes? Early/healthy Child Development The early child period is considered to be the most important developmental phase throughout the lifespan. Healthy early child development (ECD)—which includes the physical, social/emotional, and language/cognitive domains of development, each equally important— strongly influences well-being, obesity/stunting, mental health, heart disease, competence in literacy and numeracy, criminality, and economic participation throughout life. What happens to the child in the early years is critical for the child’s developmental trajectory and life course (WHO, 2018). Employment and working conditions/occuption9 Employment and working conditions: People who have control of their work circumstances and have less stress or safer work often live longer in comparison to those who do not have control of their work environment and its associated risk and stress. Furthermore, unemployment and underemployment are strongly correlated with poorer health; this could be again linked to lower levels of income as well. Paid employment, in addition to money, provides a sense of purpose, identity, social contacts, and opportunities for personal growth. Socioeconomic position In general, people from poorer social or economic circumstances are at greater risk of poor health, have higher rates of illness, disability and death, and live shorter lives than those who are more advantaged (Mackenbach & Mckee, 2015). Generally, every step up the socioeconomic ladder is accompanied by an increase in health. Socio-economic position can be measured through characteristics such as income, level of educational attainment and occupation (AIHW, 2020) On most health risk factors, adults living in the lowest socioeconomic areas fared worse than adults in the highest socioeconomic areas. Based on the10 Australian Bureau of Statistics 2017–18 National Health Survey, it is estimated that adults in the lowest socioeconomic areas were: 3.3 times as likely to smoke daily (AIHW 2020) (Figure 1) 1.6 times as likely to be obese (AIHW 2019k) 1.3 times as likely to be insufficiently active (AIHW 2019i) 1.2 times as likely to have uncontrolled high blood pressure (AIHW 2019g). Adults in the lowest socioeconomic areas were at similar lifetime risk of harm from drinking alcohol to adults in the highest socioeconomic areas (AIHW 2020). Rates of chronic conditions were also higher for adults in the lowest socioeconomic areas, compared with adults in the highest socioeconomic areas. In particular, it is estimated that adults in the lowest socioeconomic areas were: 2.0 times as likely to have chronic obstructive pulmonary disease in 2017–18, among people aged 45 and over (AIHW 2019e) 2.2 times as likely to have diabetes in 2017–18 (AIHW 2019f) 1.7 times as likely to be newly diagnosed with lung cancer in 2010–2014, among people of all ages (AIHW 2019b) 1.6 times as likely to have biomedical signs of chronic kidney disease in 2011–12 (AIHW 2019d) 1.3 times as likely to have heart, stroke and vascular disease in 2017–18 (AIHW 2019c). Occupation11 Occupation is different to being employed. Whilst being employed guarantees an income, occupation refers to the task or activity that is being undertaken by an individual. Occupation has a strong link to position in society. The better the occupation, the higher the pay. For example, a person who works at a fast-food outlet will not earn the same amount of money as someone who is a lawyer. So, whilst both individuals are employed, their occupation defines their remuneration. Generally, those who are skilled will receive better pay than those who aren’t. The association between occupation and health outcomes are described below: Occupation (parental or own adult) is strongly related to income and, therefore, the association with health may be one of a direct relation between material resources—the monetary and other tangible rewards for work that determines material living standards—and health. Occupations reflect social standing and may be related to health outcomes because of certain privileges—such as easier access to better health care, access to education and more salubrious residential facilities— that are afforded to those of higher standing.12 Occupation may reflect social networks, work-based stress, control and autonomy, and, thereby, affect health outcomes through psychosocial processes. Occupation may also reflect specific toxic environmental or work task exposures, such as physical demands (e.g. transport driver or labourer). (WHO, 2010). Income and wealth Income and wealth play important roles in socioeconomic position, and therefore in health. Besides improving socioeconomic position, a higher income allows for greater access to goods and services that provide health benefits, such as better food and housing, additional health care options, and greater choice in healthy pursuits. Loss of income through illness, disability or injury can adversely affect individual socioeconomic position and health (Galobardes et al. 2006).13 Gender Gender refers to the characteristics of women, men, girls and boys that are socially constructed. This includes norms, behaviours and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time (WHO, 2021). The term gender is usually used interchangeably with sex however the two terms have different meanings. The term sex refers to the physiological and biological factors such as chromosomes, hormones and reproductive organs whereas gender refers to internal and individual experience of gence which may or may person’s physiology or designated sex as birth (WHO, 2021). Gender inequality damages the physical and mental health of millions of girls and women across the globe, and also of boys and men despite the many tangible benefits it gives men through resources, power, authority and control. As gender inequality affects a large number of people worldwide, taking action to improve gender equity in health and to address women’s rights to health is one of the most direct and potent ways to reduce health inequities and ensure effective use of health resources. Most often women are more prone to poverty, sexually transmitted infections, unintended pregnancies, malnutrition, increased rates of domestic violence, child marriages and female genital mutilation. Deepening and consistently implementing human rights instruments can be a powerful mechanism to motivate and mobilize governments, people and especially women themselves (WHO, 2018)14 Culture Culture is a person's upbringing, background, traditions, customs, and the beliefs of their family or community. This plays a huge role on overall health because it influences how one may think, feel, act, and value. The term “Cultural and Linguistically Diverse” (CALD), is used to describe groups who were either born overseas, have a parent born overseas or speak a variety of languages (AIHW, 2018). According to the 2016 Census of Population and Housing, almost half of Australians (45% or 10.6 million) were either born overseas (26% or 6.2 million) or had one or both parents who were born overseas (19% or 4.5 million) (ABS 2017a). The hospitalisation rates seem to vary within different cultural groups e.g. higher rates of admissions for diabetes or its complications (people born in Lebanon and the Philippines), for coronary heart disease (people born in Lebanon, Fiji, Sri Lanka and Iraq) and cardiac revascularisation procedures (people born in Fiji, Lebanon, Sri Lanka, Greece, Indonesia, India, Italy and Iraq) (NSW Department of Health, 2008, 2010), and for gastritis and duodenitis among persons born in Continental Europe and Asia (AIHW, 2004).15 A subsection of the CALD group that is particularly vulnerable are the refugees. The rates of mental health conditions for refugees that came from conflict zones are higher than those who have not experienced extreme forms of violence (AIHW 2018). Due to language, cultural and financial barriers and low health literacy refugees tend to experience poorer health outcomes. Another group of people that have significantly poorer health are the Aboriginal and Torres Strait islanders. They have lower life expectancy than other Australians and how they view health is different to others. “Aboriginal health” means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community. Social support networks Social support networks can provide sources of resilience against poor health through social support, which is critical to physical and mental wellbeing, and through networks that help people find work, or cope with economic and material hardship. Often in literature, the term social exclusion is used. Social exclusion is one of the driving forces behind health inequalities. The inability to fully16 participate in the society is referred to as social exclusion. Conversely, social inclusion refers to the one’s ability to fully be involved in the society in which they live in. Factors influencing health outcomes in the context of social inclusion or exclusion are complex and often interrelated to other determinants of health however according to WHO social exclusion is driven by unequal power relationships interacting across four main dimensions—economic, political, social and cultural—and at different levels including individual, household, group, community, country and global levels. Physical environments Physical environments play a vital role in overall health. Contaminants in the air, water, food, and soil can impact health negatively. These effects can vary from cancer, birth defects to other diseases whether it be chronic or acute (AIHW, 2018). In Australia, there are many policies that safe guard our health from environmental pollutants however an increase in population is placing a greater demand on the availability of natural resources. Consequently, this increases risk of health problems. Housing and homelessness as an environmental determinant of health affects the population through overcrowding, presence of toxins, hot or cold indoor temperatures, mould and lack of personal space. Poor quality housing is a result of social standing within the society whereby if the household income is high, the individual or family unit can afford better quality housing. Whereas, those that cannot afford proper housing tend to17 either live in cheaper quality houses, low socio-economic areas or are homeless. Young people, Indigenous Australians, people with long-term health conditions or disability, people living in low-income housing, or people who are unemployed or underemployed are at greatest risk of living in poorquality housing (AIHW 2018). Activity: Can you think of any other diseases that result from the environment we live in? First Contact - Episode 1 Elcho Island snippet18 Biology and genetics Biology and genetics may affect specific populations more than others. Examples of biological and genetic determinants of health include age, sex, inherited conditions, and genetic make-up. Health services Health services including access and quality of health services can impact health. Barriers to accessing health services include lack of availability, high cost, lack of insurance coverage, limited language access. These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services, hospitalisations that could have been prevented.19 Social environments Social environments refer to concepts beyond community and also includes the strength of social networks within any perspective (community, province, country, region, or even organisations and institutions). A social environment can help people to share resources together and build attachments with each other. The values, norms, social stability, diversity, and cohesiveness can definitely help avoid potential risk to good health. Determinants of health are factors that influence how likely we are to stay healthy or to become ill or injured. Many of the key drivers of health reside in our everyday living and working conditions—the circumstances in which we grow, live, work and age. These social determinants include factors such as income, education, employment and social support. Social determinants can strengthen or undermine the health of individuals and communities. For example, in general, people from poorer social or economic circumstances are at greater risk of poor health than people who are more advantaged. A person's health is also influenced by biomedical factors and health behaviours that are part of their individual lifestyle and genetic make-up. These factors can be positive in their effects (for example, being vaccinated against disease), or negative (for example, consuming alcohol at risky levels).20 Biomedical risk factors such as high blood pressure can have a direct impact on illness and chronic disease. For example, in 2014–15, 23% of Australian adults had high blood pressure, which is a risk factor for stroke, coronary heart disease, heart failure and chronic kidney disease. Behavioural risk factors such as tobacco smoking, risky alcohol consumption, using illicit drugs, not getting enough exercise and poor eating patterns can also have a detrimental effect on health. Although there is a lot to celebrate about Australia's changing smoking and drinking behaviours, there are still areas of concern. Some population groups are far more likely to smoke daily than the general population—for example, smoking rates are much higher among single parents with dependent children, and Aboriginal and Torres Strait Islander people are more likely to smoke than non-Indigenous Australians. Although the overall volume of alcohol being consumed by Australians aged 15 and over has fallen to its lowest level in 50 years, some people still drink to excess, putting them at risk of short- and long-term adverse health effects (AIHW, 2016). Remember: The social determinants of health are the causes of the cause of ill health21 The social gradient Research studies have shown that there is a ‘social gradient’ in health, whereby those employed at successively higher levels have better health than those on lower levels. This inequity creates disadvantage from birth for some children. A child born into a lower socio-economic family for example, may be destined for an impoverished life, creating intergenerational ill health. This child lives in a situation of ‘double- jeopardy’, where interactions between the SDH conspire against good health. Without external community supports the family may spiral into worsening circumstances, affecting their child's opportunities for the future