Notes MIDTERM SODH PDF

UNIT 1: INTRO TO SODH Terms and concepts Control/choice The sense of security and options that a person feels that have or do not have access to; 70% of factors are beyond individual control; those with more control over their work environment live longer and healthier lives; education provid...

UNIT 1: INTRO TO SODH Terms and concepts Control/choice The sense of security and options that a person feels that have or do not have access to; 70% of factors are beyond individual control; those with more control over their work environment live longer and healthier lives; education provides a sense of control over life Power The relative access to resources that one is able to obtain in comparison to others and what responsibilities are associated with these resources Societal forces shape the quality and distribution of societal factors; for example, political forces shape the way healthcare is distributed among people, including who gets what quality of care Societal Factors shape health and explain health inequities, which is influenced by societal forces (see above); for example, employment and income availability Equality refers to giving everyone the same resources equally but may not benefit those in greater need Equity refers to providing an extra support for those requiring it, ensuring resource distribution is proportional to the unique needs of individuals (fairness) Social determinants of health Shaped by the distribution of money, power and resources throughout local communities, nations and the world which shapes the health of people; relies on quality and quantity access to resources for individuals Original SDoH (4): biological factors, environment, health care, lifestyle Current SDoH (12): Socio economic position Includes the individuals’ social class, gender, ethnicity, education, occupation, and income Structural determinants of health Emphasizes that there are structures in place (ex. public policy, stigmatization, etc.) that affect health outcomes; for example, the cost of gyms may prevent people with Type II diabetes from visiting; we cannot simply say ‘they are too lazy’ without this structural determinant in mind Toxic stress Constant stress has the ability to change the neurochemistry of the brain, as the HPA Axis becomes over activated; ◦ consequences include a psychobiological stress response that can act upon neuroendocrine, autonomic, and immune systems; ◦ adverse childhood events (ACE) can contribute to the manifestation of toxic stress; is a cascade that happens before biological responses occur This model includes 3 core components 1. Structural determinants and political context 2. Socioeconomic determinants 3. Intermediary determinants of health Explains that Structural determinants ◦ (including the societal, economic and political context in which a person lives) influences their socioeconomic position Socioeconomic position ◦ (including social class, gender, ethnicity, education, occupation and income) feeds into intermediary determinants Intermediary determinants ◦ (material circumstances, biological and behavioural factors, psychosocial factors) influence health equity and well being Social cohesion and social capital can act as a bridge ◦ this means that policies and structures can be put in place to influence health outcomes for people MEDIA FILES UNIT SYNTHESIS The majority of factors that contribute to our health are beyond individual control; as much as the current biomedical model focuses on telling people to ‘stop doing’ something, we need to look beyond individual factors and find key patterns (i.e. between ethnic groups, socioeconomic positions etc. Income inequality: small proportion of a population has a high concentration of income while the rest has a small percentage Job insecurity: associated with poorer health outcomes and less control over environment leads to shorter life expectancy Income is an excellent marker for a cluster of other life circumstances May be a better marker than tobacco use, diet, and physical activity Prime determinant of premature mortality Lower income children show worse rates of almost all adverse health outcomes Nordic countries do better in public policy to close income gap; better population-wide health outcomes compared to North America There are various models to explain the social determinants of health Materialist: suggests that living conditions influence SDoH which influence health ◦ Material living conditions; poor conditions= worse outcomes ◦ Experience of psychological stress ◦ Adoption of health-supporting/ health-threatening behaviours ◦ Income potential; related to education, related to accumulation of childhood experiences which influences job opportunities in the future ◦ Health capital; childhood experiences shape the health an individual can access in the future (similar to income potential because of accumulation) Life course: suggests that latent, pathway or cumulative effects can take place ◦ Latent effects: ‣ usually genetic or taken on early in life (ex. maternal addiction while pregnant affects drug dependence in newborn); early maladaptive behaviors in childhood can shape the way they behave in the future ◦ Pathway effects: ‣ individuals have various paths shaped for them as they grow up and positive effects can lead to greater outcomes (ex. child gets send to private school and later-in life, is more educationally involved than public school students their age)  ◦ Cumulative effect: ‣ people can have an accumulation of advantages or disadvantages throughout their life; learned helplessness; even if they escape a poor situation, they carry these effects with them through life (ex. child is born in poverty, escapes, becomes an accountant but still has pre-disposing health risks from childhood Neo-materialist: ◦ focuses on the distribution of wealth and social resources and how health-advantageous vs health-threatening living conditions came to be Social comparison-model ◦ argues that social hierarchies and social distance explain health outcomes in individuals; people compare themselves to other UNIT 2: Canadian Healthcare System Terms and concepts Federal responsibility ◦ Federal responsibility is to act as mom and dad to the provinces and territories; they set standards and award money if provinces and territories are following the rules ‣ Setting and administering national rules and standard ‣ Distribution of money ‣ Delivery of healthcare to specific groups (military veterans, Indigenous on reserves, federal inmates, refugees, RCMP Provincial/ Territorial responsibility ◦ provinces and territories are responsible for delivering orders of the federal system; they deliver the healthcare ‣ Follow the rules ‣ Receive money ‣ Deliver health care Primary Health Care (PHC) ◦ One of the most important ways to ensure accessible and comprehensive health care; encourages people to optimize their overall health (mental, physical, psychosocial) Health care financing Health care spending accounts for 1/3 of provincial program expenditure Public Administration means that healthcare insurance plans must be non-profit by a public authority (ex. HSS; Hamilton Health Science Services HSSisnonprofit Universality ensures that if you are a Canadian citizen, you will get treated the same and there are no special privileges Portability means that if we were to travel outside of Canada, our insurance covers any potential health  costs; need to be careful of what is deemed “medically necessary” however, so travel insurance is recommended Comprehensiveness understandthatnotallservicesarecovered ensures that hospital costs are covered but does not cover other services (ex. long term care, home care, etc.); all medically necessary services provided by hospitals and doctors must be insured Accessibility ensures reasonable access for people based on medical need not ability to pay Private Funding (private insurance or out of you pocket) 30% healthcare spending comes from private sources (i.e. out of pocket, private insurance Public Funding (Tax revenue) 70% healthcare spending comes from public source Canada’s system is predominantly publicly financed and privately delivered Shows that we spend: 26.6% of money on hospitals 15.5% of money on drugs 15.1% on physicians Indicates that hospitals represent highest percentage of spending and drugs are more paid into than physicians Health care is expensive and can push people into poverty due to high costs; UHC supports people by removing financial burden associated with healthcare costs and goes beyond (ex. public health campaigns), though minimal services are not covered. PHC is the most cost-effective way to ensure access to essential healthcare; we need to invest in it. ie mowirins e itoiini UNIT SYNTHESIS Canada’s healthcare system is predominantly: publicly financed and privately delivered Tommy Douglas impact ◦ Saskatchewan (1947) was the first to establish public, universal hospital insurance Lalonde Report (1974) - the White Paper ◦ Identified the issues with health outcomes; they were minimal and did not help marginalized people ◦ Sick care was taking place; we treated people when they were sick only ◦ First formal document linking health with social determinant LalandeReport Emmett Hall pointed out issue of two-tiered system; poor people couldn’t pay Canada Health Act a federal document for publicly funded health care insurance Gives healthcare based on need and not their ability to pay Based on 5 criteria: p.u.p.c.a Our healthcare system is not ‘free healthcare’, money comes from Citizens: we have provincial and federal taxes that pay into the healthcare system; also, private insurance purchase feeds into the healthcare system money ‘pool’ Federal government: has the Canada Health Transfer which represents its ‘pool’ of money (mom and dad); gives health services to priority people Provinces and territories: get money from Federal Government and covers medically necessary programs for people Canada Health Transfer the federal government has a pool of money and will provide money to the provinces and territories to carry out healthcare; in order to receive the money, the provinces and territories need to make sure they’re following the rules of the CHT (if they don’t follow the rules = don’t get money!) Canada Health Act Annual Report part of CHT validation; checks to make sure provinces and territories are using their allowance from federal gov. wisely and according to CHT  ◦ Example: B.C. has been penalized many times based on its CHAAP because in the past, they have charged healthcare premiums, but the money did not get allocated to healthcare (big mistake) Gaps in the system were addressed with Romanaw Report ◦ Focused on home care, palliative care, long-term care, social determinants of health, delivery of quality services and Primary Care reform UNIT 3: Income and Health Terms and concepts Inequity unfairness or bias Often due to intersectionality; differences relating to factors like race, gender, sexuality, disability “Health inequities are avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies” -WHO Inequality Condition of being unequal which may or may not be unfair Impact of low income on health individuals Low income means: ◦ Greater risk for any possible disease ◦ Greater risk to live in poverty for longer Poverty in childhood affects poor health over the life course (even when removed) More likely to have.. ◦ poor mental health ◦ symptoms of a mood disorder ◦ pre-term births or small-for-gestational-age births Less likely to have.. ◦ feel a sense of community belonging ◦ perceive good/excellent health ◦ engage in politics and use their vote; they may believe that their vote doesn’t even matter GINI Coefficient Measures income inequality and distribution, and countries hopefully have a Gini coefficient closer to 0 ◦ 0= everyone has the same income (low inequality) ◦ 1= one person has all the income (high inequality) Government transfers Provide additional support to individuals financially; they provide extra employment through pensions, welfare, and unemployment benefits (the largest subsection of government transfers) Human capital The extent to which one invests in public infrastructure such as education, health services, housing etc. Social capital The extent to which one interacts with others and their community around them Low income decreases both human and social capital which can lead to psychosocially mediated effects (ex. developing health-threatening biological responses) Income Earnings (can include market income and gov’t transfers) Wealth Assets - debt Low-income-cut-off(LIOC) The level at which families or individuals spend 20% of more than the average family on food, shelter and clothing than the average family/individual in a given location (relative to where they are and how they compare to others around them High decision latitude You are empowered to develop and implement potential solutions Low decision latitude You have narrow options bound to few options Market income (sum) Sum of income from employment and pensions; the richest 20% of Canadian families own almost 50% of the market income Poverty Condition of a person who is deprived of the resources, means, choices and power necessary to acquire and maintain a basic level of living standards and to facilitate integration into society; lack of power and choice Relative Poverty A state of having significantly less than the rest of the population Absolute Poverty Having less than the objectively defined minimum- life-threatening Self Determination The process by which a person controls their own life Social Class A group of people with similar backgrounds, income & ways of living Social gradient Explains that the poorest of the poor, around the world, have the worst health; the social gradient explains that health status is related to inequalities in social status  Illustrates that the median income (tells the middle) is going to be more accurate than the mean income If Bill Gates were included, mean income would shoot up greatly Be aware of observing economic info Difference between mean and median has been increasing overtime Means that 86% of wealth is only available to 8.6% of the world’s population Shows that even if you qualify for programs like Ontario Works (OW) or Ontario Disability Support Program (OSDP), claw backs can redact 50 cents for every dollar you make if you make more than $200 a month UNIT SYNTHESIS Median, after-tax income ◦ for two-parent families is generally much higher than those who are lone-parents or are unattached; two parents = twice the assets Hardest hit populations for poverty ARE... ◦ Women and children ◦ Older adults (many may not have employer pension plans ) ‣ 1/13 seniors today are living in poverty ‣ Medical bills and prescription costs ‣ Many carry debts into retirement; back to work (precarious possibly) ◦ People experiencing homelessness; almost all live below LICO ‣ Have the lowest life expectancies ◦ Racialized individuals: immigration status, education and language ‣ 28-34% of shelter population is Indigenous (and they have small numbers) ‣ 40% of people staying in Toronto city shelters are refugee/asylum claimants ‣ Racialized children are more likely to live in poverty than white children ‣ Systemic barriers, including racism that harms employment opportunities Child Tax benefit: helped to alleviate some poverty rates but it depends on if you look at LIM-AT (12%) or MBM, market basket measure (9%) on the Canadian Income Survey ◦ It notably did not include First Nations communities ◦ Can make it appear that poverty dropped more than it actually did Market Basket Measure (MBM): goods people live off of ◦ Areas that they can add to the MBM-> shelter, clothing, food, transportation and inclusion of Indigenous peoples Absolute Income Hypothesis: ◦ suggests that there is a positive, non-linear association between personal income and health. Also, if someone dips below a certain income, minimal gains to their health can be achieved Income Inequality and Health: ◦ suggested that this is due to rising inequalities between the rich and poor which leads to under investment in social capital