NBSS The Social Determinants of Health Dr Andy Guise.pdf

The social determinants of health Dr Andy Guise Senior lecturer in Social Science and Health March 2024 Cholera in Soho (and Southwark) The social determinants of health are the conditions in which people are born, grow, live, work and age....

The social determinants of health Dr Andy Guise Senior lecturer in Social Science and Health March 2024 Cholera in Soho (and Southwark) The social determinants of health are the conditions in which people are born, grow, live, work and age. WHO, 2008 WHO - https://www.who.int/health-topics/social-determinants-of-health Clues to the social determinants of health Health across human history Early humans (2.5 million – 10,000 years ago) –Parasites, violence, injury Agriculture (10,000 years ago to 1400 CE) –Rise of epidemic disease Urbanisation 17th – 19th C – High mortality from infection Globalisation (20th C - ) –Chronic disease, cancer, obesity (and infectious disease, and unsanitary conditions) Harari, Y N (2015) Sapiens, a brief history of humankind Comparing life expectancy Comparing Life expectancy The geography of liver disease Hiv, hcv, Health and income COVID-19 and income Marmot et al 2020 The social determinants of health are the conditions in which people are born, grow, live, work and age. WHO, 2008 WHO - https://www.who.int/health-topics/social-determinants-of-health But determined? Determined? (?Determinism - individual human beings have no free will and cannot be held morally responsible for their actions.?) Determined – controlling or influencing Some people are controlled, some people are influenced  Are individual actions socially determined? Individuals can shape, and are Society Individual choice shaped by their society (Agency (structure) (agency) creates structures, and structures create and limit agency) Freedom, The possibilities for any individual or Marginalisation, rational choice group at any given time are limited discrimination, and meritocracy by particular social and historical violence and conditions (‘choice’ can be shaped, history or constrained, or denied) (Bourdieu, Crenshaw, Fanon, Mol, (Marx, Foucault) (Hayek, Friedman) Said, Sandel, Sen, Smith) FREEDOM CONSTRAINT OPPRESSION Determined? Understanding individual action What resources do people have to manage or access influences on health? Social resources – who you know and can support you Economic resources – do you have cash, or goods/materials that can be easily exchanged Cultural resources – do you know ‘how things work’ and can you speak in a way that reflects dominant norms Bourdieu, Friedman and Laureson Calton, Glasgow: male life expectancy is 54 Lenzie, Glasgow: male life expectancy is 82 Determined? “Jimmy’s start in life was characterised by adverse childhood experiences. He came from a single parent family in poverty. His mother had a succession of male partners each of whom abused Jimmy, physically if not sexually. He had behaviour problems by the time he reached school and did poorly educationally. Inevitably he got involved in gangs and violence. He left school to no proper job. His diet looks like a health educator’s nightmare. Any money he gets goes on drink and drugs – as another despairing Glasgow resident said: he is one drink away from the abyss. If you are of a bent to blame Jimmy for his unhealthy behaviour, I invite you to go to Calton and lecture Jimmy about the virtues of non-smoking and five fruit and veg a day. Useless, as these are neither priorities for Jimmy nor are they within Jimmy’s individual control.” (Michael Marmot) Thinking through the pathways of the social determinants of health Housing as a social determinant of health https://www.instituteofhealthequity.org/resources-reports/left-out-in-the-cold-the-hidden-impact-of-cold-homes How can housing like this impact on health? How does housing like What are the resources this happen? people have to manage housing? Social economic cultural and symbolic Action on the social determinants of health The McKeown Thesis Cholera → Sanitation The McKeown thesis: TB decline mainly due to social factors Most improvement occurred before modern therapeutics (in second half of 20 th century) 1. Better hygiene and sanitation 2. Better nutrition (and so (Small) effect of medical interventions)) Summary and implications 1 Where you live in space and time is really important for health 2 Because of the social determinants of health and the varying resources individuals have to manage these 3 So we need hospitals and we need sewers Summary Patterns of health are socially patterned, they are determined by social factors (as well as biology and psychology) We can identify a range of social determinants influencing health, including population change, urbanisation, development of health care systems Social determinants can be experienced differently, with health inequalities emerging Explaining these social patterns of health can build on core ideas of the social determinants of health (and also with other ideas, introduced in later lectures) Recommended reading New England Journal of Medicine case studies in social medicine https://www.nejm.org/case-studies-in-social- medicine Harari, Y N (2015) Sapiens, a brief history of humankind Marmot, M et al (2020) Build Back Fairer, the COVID-19 review McKeown, T. "Determinants of health." Life 60.40 (1978): 3.  Questions, comments [email protected] @andyguiseKCL