Social Determinants of Health_2024_NOTES.pdf

Food Environment and Eating Behaviour NDT 2126 : Social Determinants of Health May 27, 2024...

Food Environment and Eating Behaviour NDT 2126 : Social Determinants of Health May 27, 2024 Copyright (C) 2020. IMU Inspire Empower Elevate Limitations: For internal circulation in the International Medical University ONLY Lesson outcomes Discuss the social determinants of health with examples of its application Describe the Ottawa Charter of Health Promotion  Social Determinants of Health (SDOH) The World Health Organisation defines these as “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”. https://www.who.int/social_determinants/sdh_definition/en/ Social Determinants of Health The PROGRESS acronym was created by Evans and Brown (2003) to describe factors that contribute to health inequity. PROGRESS stands for: Place of residence Race/ethnicity/culture/language Occupation Gender/sex Religion Education O'Neill, J., Tabish, H., Welch, V., Petticrew, M., Pottie, K., & Clarke, M. Socioeconomic status (2014). Applying an equity lens to interventions: Using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology, 67, 56-64. Social capital Examples of SDOH include: Place of residence Urban or rural / Access to housing and utility services Race/ ethnicity/ culture/ language Racial segregation Social support and community inclusivity Occupation Occupation, employment status, and workplace safety Gender/sex Gender inequity Religion Early childhood experiences and development Education Educational opportunities Socioeconomic status Income level Food insecurity and inaccessibility of nutritious food choices Social capital Access to safe drinking water, clean air, and toxin-free environments Availability of transportation Neighborhood conditions and physical environment Recreational and leisure opportunities Crime rates and exposure to violent behavior SDoH influence health in many positive and negative ways. SDoH are apparent in the living and working conditions that people experience every day. Extreme differences in income and wealth have negative health consequences for those who are living in poverty especially when these people are congregated in poor regions. In contrast, those who are well-off and living in well-off regions have better overall health. This variation among individuals and groups due to income is referred to as the "social gradient. The Canadian Public Health Association (CPHA) Examples of how SDOH work - Eg from a high income country- Canada - Eg. from Middle income country- Malaysia Example: Income divide in high income country Higher income levels result in better health outcomes, where lower income levels result in poorer health outcomes. Even in affluent countries such as Canada the income disparity exists But its effect go unnoticed because of the high overall population health status. The social gradient not only represents the effects of income on health but also the importance of income as a means of gaining access to other SDOH such as education, food, housing, recreational activities, and other societal resources. The Canadian Public Health Association (CPHA)  Urban rural divide in Malaysia Datuk Dr Denison Jayasooria, principal research fellow at the Institute of Ethnic Studies (Kita) at UKM, and also a Human Rights Commissioner with the Human Rights Commission of Malaysia (Suhakam) had said poverty has reduced drastically but inequalities have increased across the board. “… development planning has been very much urban-biased, with increasing infrastructure and facilities developing in urban areas. “Therefore, rural-urban migration has had an impact on the population, with young people shifting out, and development in small towns almost at standstills,” https://www.thestar.com.my/lifestyle/living/2015/05/02/is-there-bias-when-it-comes-to-development Programmes using SDoH to improve health An example of the Healthy Neighborhoods Healthy Families in USA Healthy Neighborhoods Healthy Families One of the most inspirational and far-reaching provider-based programs developed to provide SDOH solutions is Nationwide Children’s Hospital’s Healthy Neighborhoods Healthy Families (HNHF) initiative in the US. Nationwide Children’s has partnered with multiple community partners to tackle five high-impact social determinants: affordable housing, education, health and wellness, safe and accessible neighborhoods, and workforce development. They promote access to affordable housing,- renovation, energy efficiency and green living projects, and repair and maintenance grants to homeowners. They also offer low-income housing to families where residents can participate in on-site classes that provide training targeted toward local job openings and career success skills. They are also tackling challenges in education with kindergarten readiness, mentoring, and STEM programs. They have created a mobile care center to provide pediatric primary care including immunizations, developmental screenings, teen health education, and well-child and sick visits. Social determinants of obesity - a case study in nutrition Obesity results from an energy imbalance, where energy intake exceeds energy expenditure. Genetics predisposes some individuals to become obese and powerful biologic systems designed to prevent weight fluctuation can make losing excess weight difficult. However, the roles of social, environmental, and economic factors in the obesity epidemic are becoming increasingly important. Obesity is impacted by the social environment, including societal norms for eating, physical activity, and body image; marketing activities; and cultural forces, such as food preferences. Social determinants of obesity - a case study in Nutrition (cont…) Obesity can also be either facilitated or prevented by the “built “Food deserts” = area that environment,” which is: has few supermarkets 1. the availability and accessibility of food and drink, and “Food swamps” = area with an abundance of fast-food 2. the safety, accessibility, and existence of space for physical restaurants & convenience activity. stores. Food deserts and food The built environment is affected by economics: swamps are associated with 1. poorer communities often have limited access to affordable reduced healthy food intake healthy foods and water but have ample access to affordable and increased community energy-dense, nutrient-poor foods and drinks such as sugar obesity rates. drinks 2. Poorer access to parks and less safety An overlap of food deserts and food swamps occurs in low SES Areas Food Deserts and Obesity in the US Your Turn to think through IMU-Malaysian Nutrition Environment Survey (IMU-MNES) Desa Serdang Seri Mulia Harvinder et al., 2019 (unpublished) Harvinder et al., 2019 (unpublished) Eateries Stores All types of eateries in surveyed There was greater availability and neighbourhoods did not display number of choices of healthier food signs and promotions then items in the large retail stores vs. encourage healthy eating. the local-chained mini markets and Food courts offer a healthier food convenience stores choices compared to the Mamak Large retails stores also had better restaurants and Western fast food quality of fresh produce outlets. Pricing was comparable between all kind of stores SES can affect type of eateries and stores available and thereby affect food choice? Ottawa Charter of Health Promotion 24 Ottawa Charter of Health Promotion First International Conference on Health Promotion- Ottawa, 21 November 1986 The objective/aim of the conference was to take action for achieving Health for All by the year 2000. This conference was primarily a response to growing expectations for a new public health movement around the world. It built on the progress by earlier WHO work at improving health by calling for action on health promotion Ottawa Charter of Health Promotion Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector but goes beyond healthy life-styles to well-being. Ottawa Charter of Health Promotion Ottawa Charter described: 8 determinants necessary for good health condition, 3 basic strategies for health promotion and 5 areas for priority actions.  Ottawa Charter of Health Promotion Determinants of good health: 3 Strategies for health promotion 1. advocacy for health, peace 2. enabling people to achieve their fullest potential health shelter 3. mediated and coordinated actions among education all the relevant stakeholders. income food sustainable resources stable ecosystem social justice and equity. Proposed solutions to improve food and nutrition in communities Farmers Markets- collaborating more with local farmers who grow fruits and veggies Community Gardens Policy & Funding Fresh foods (Quality) in corner stores and small markets Snap Program: Increase access, restrict foods, incentives to users, incentives to stores Sponsor Education Programs: Children & Adults References & Acknowledgement: World Health Organization, Commission on Social Determinants of Health. Closing the Gap in a Generation: Health equity through action on the social determinants of health. Available from: http://www.who.int/social_determinants/en Canadian public health association- https://www.cpha.ca/what-are-social-determinants-health NEJM Catalyst Social Determinants of Health (SDOH) https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0312 World Health Organisation: Health promotion https://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html USDA: https://storymaps.arcgis.com/stories/3a1680a89e5f4339b10c267b47c6a69f Dr Sangeetha Shyam 31 Library References Lesson outcomes Discuss the social determinants of health with examples of its application Describe the Ottawa Charter of Health Promotion  Thank you. For more information please contact: Dr Tan Siew Tin Lecturer [email protected] IMU Education Sdn Bhd No. 126, Jalan Jalil Perkasa 19 199201005893 (237397-W) Bukit Jalil, 57000 Kuala Lumpur, Malaysia 603 8656 7228 Copyright (C) 2020. IMU Limitations: For internal circulation in the International Medical University ONLY Formerly known as International Medical University. imu.edu.my