Social Exam Notes .pdf

lOMoARcPSD|12596563 1RR3 All Notes Introduction to the Social Determinants of Health (McMaster University) Studocu is not sponsored or endorsed by any college or university Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 1RR3 Test #1 Unit 1: Course Introduction to the Social...

lOMoARcPSD|12596563 1RR3 All Notes Introduction to the Social Determinants of Health (McMaster University) Studocu is not sponsored or endorsed by any college or university Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 1RR3 Test #1 Unit 1: Course Introduction to the Social Determinants of Health Social Determinants of Health: the conditions in which people are born, grow, live, work and age  Social and economic factors that influence people’s health  Living and working conditions that people experience every day  Determine whether individuals stay health or become ill  About the quantity and quality of a variety of resources that a society makes available to its members  Beyond individuals’ control o Income inequality: great difference in income distributions within the population which results in a small percentage of the population having a high concentration of income o Work and health: longer hours, high-stress work, and job insecurity associated with poorer health outcomes Precariat: precarious (insecure) + proletariat (working-class)  New global class fuelling the rise of populism  Security = control o Education and health: early childhood education and care is linked to better adult health o Income is an excellent marker for a cluster of other life circumstance; mediated by education o Bartley typology  Material, cultural/behavioral, psychosocial, life course, political economy o Food, housing, and health: food insecurity – increased physical and mental health concerns o Lower income – poorer housing conditions which will impact health o Gender and health: gender inequality vs inequity (unfair) o Gender overlaps with all the SDoH o Racialized communities and health: racialized groups are more likely to live in poverty (economic exclusion) o Limited research data linking health and race o Indigenous communities and health: subjected to SDoH inequities experience poorer health outcomes o Results in difficulty accessing appropriate health-related services o Physical environment and health: climate change, agricultural practices (runoff) Structural Determinants of Health:  Structural factors: colonization, racism, social exclusion, repression of self-determination Socioeconomic position: people with less social standing usually run at least twice the risk of serious illness and premature death  The lower the socioeconomic position, the worse the health  Affects exposure, vulnerability and outcomes to conditions that have an impact on their health Societal FACTORS: that shape and help explain health inequities  Ex. Income and employment Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Societal FORCES: that shape the quality and distribution of these factors  Ex. Social and political forces Control/choice: individuals need to understand the health information they are provided to take control of their health  Increased control over the major factors that influence their health is an indispensable component of individuals’ capacity to make decisions about how they wish to live  Security, education= control Power: governments (and the citizens that elect them) have the power to determine when access to health care and these other social determinants of health are citizen rights or something that should be seen a personal liability Equity (vs equality): equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome – equality means each individual/group of people is given the same resources or opportunities Toxic stress: chronic stress - leads to prolonged biological reactions that strain the physical body  When a child experiences strong, frequent, continuous stress it weakens resistance to disease and disrupts the functioning of the hormonal, metabolic, and immune systems  Lifelong problems in learning, behavior, physical and mental health  Continual anxiety, insecurity, low self-esteem, social isolation, and lack of control over work and home life have powerful effects on health (cardiovascular and immune) Social Gradient: variation among individuals and groups due to income  Higher income levels result in better health outcomes, lower income levels result in poorer health outcomes Welfare State: stands for the public policies and how they provide economic and social security to societal members  Systems to offer protection and supports to its citizens to help deal with these threats (family allowances, childcare, unemployment insurance, health and social services, disability benefits, home care, retirement pensions)  Liberal welfare states: to strengthen the economy – least developed in providing citizens with economic and social security Unit 2: The Canadian Health Care System OHIP: Ontario Health Insurance Plan  Pays for many health services you may need  Province pays for many of the health services you may need  You need to apply, and once you’re approved, you’ll get an Ontario health card – proves that you are covered What does OHIP cover?  Appointments with family doctor  Visits to walk-in clinics and some other health care providers  Visits to an emergency room  Medical tests and surgeries  To be covered, you must have a medical reason to receive a service or treatment o Ex. Cosmetic surgery isn’t covered Who is excluded from this list? Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563      International students Out of province students Migrant workers who are here for less than 6 months People who have not physically been in Ontario for 153 days in any 12-month period People who do not have Ontario listed as their primary residence How might an individual’s access to the social determinants of health affect their ability to easily obtain an OHIP card?  Vulnerable groups – homeless o Will they be able to get the proper ID? o Don’t have an address  Need to apply in person at a service Ontario o Geography – a lot of people can’t make it, no form of transportation o Too sick/disabled to go in person  Need good literacy o English isn’t a lot of people’s first language – language barriers Federal/Provincial/Territorial/Municipal Roles in Health:  PROVINCIAL/TERRITORIAL/MUNICIPAL responsibilities: o Governments have primary jurisdiction in health care administration and delivery o Setting their own priorities, administering their health care budgets, and managing their own resources o Managing some aspects of prescription care and public health  FEDERAL responsibilities: o Federal government defines the national principles that are to be reflected in provincial and territorial health care insurance plans o Assisting in the financing of provincial health care services through fiscal transfer o Delivering direct health services to specific groups o Fulfilling other health-related functions Primary Health Care (PHC): an approach to health and a spectrum of services beyond the traditional health care system  Includes all services that play a part in health, such as income, housing, education, and environment  Focusses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury  Serves a dual function in the health care system o Direct provision of first-contact services o Coordination function to ensure continuity and ease of movement across the system, so that care remains integrated when Canadians require more specialized services  Responsiveness to community needs  Services: o prevention and treatment of common diseases and injuries o basic emergency services o referrals to/coordination with other levels of care (such as hospitals and specialist care) o primary mental health care o palliative and end-of-life care o health promotion o healthy child development o primary maternity care o rehabilitation services  Concerns: o Relative lack of emphasis on health promotion and disease prevention Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 o o o Lack of continuity Problems with access Providers’ concerns regarding their working conditions Canadian Health Act: Federal document - ensures all Canadians have equitable access to health care services based on their need, not on their ability, or willingness, to pay     When patients seek required care, they should not face the barrier of patient charges Establishes criteria and conditions related to insured health services and extended health care services that the provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer (CHT) The aim is to ensure that all eligible residents of Canada have reasonable access to medically necessary hospital, physician, and surgical-dental services that require a hospital setting 5 Principles/Criteria: o Public administration  Administration of the health care insurance plan of a province/territory must be carried out on a non-profit basis by a public authority accountable to the provincial government o Comprehensiveness  All medically necessary services provided by hospitals, medical practitioners, and dentists working within a hospital setting must be insured  Insured hospital services include: in-patient care at the ward level, all necessary drugs, supplies, and diagnostic tests, and a broad range of out-patient services o Universality  All insured persons in the province/territory must be entitled to public health insurance coverage on uniform terms and conditions o Accessibility  Reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers o Portability  Coverage for insured services must be maintained when an insured person moves or travels within Canada or travels outside the country Medicare: financed through a progressive tax system, which allows risks to be pooled and costs to be shared by all Canadians Universal Health Coverage: means that all individuals and communities receive the health services they need without suffering financial hardship  Includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course  Not only what services are covered, but also how they are funded, managed, and delivered  Purpose: protect the health of citizens and spread health costs across the whole society – protects citizens with lower incomes who cannot afford private health care insurance  Monitoring progress towards UHC should focus on 2 things: o Proportion of a population that can access essential quality health services o Proportion of the population that spends a large amount of household income on health Health Care Financing: citizens, federal government, provinces/territories  Citizens o federal and provincial taxes o direct purchase of private insurance o direct purchase of medical and non-medical services  Federal government Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Canada Health Transfer Equalization support to less wealthy provinces Programs for medical and non-medical research and public health Direct health services for selected Aboriginal populations, veterans, military personnel, federal inmates, “foreign” visitors, RCMP Provinces/Territories o Program and service payments to providers, institutions, and health authorities for “medically necessary” doctor and hospital services under the CHA o Supplementary programs not covered by the CHA (ex. home care, long-term care, drug coverage) o Programs for medical and non-medical research and public health Funding o Taxation o Some provinces use ancillary funding methods o Alberta and BC use health care premiums o Canada Health Transfer o o o o   Federal Social Transfers: sum of federal funding  The federal government provides cash and tax transfers to the provinces and territories in support of health through the Canada Health Transfer  The Canada Social Transfer (CST) is the transfer payment program in support of post-secondary education, social assistance, and social services including early childhood development and early learning and childcare Jurisdiction: the official power to make legal decisions and judgements Availability: the quality of being able to be used or obtained Provisions: no extra-billing by medical practitioners or dentists for insured health services under the terms of the health care insurance plan of the province/territory  No user charges for insured health services by hospitals or other providers under the terms of the health care insurance plan of the province/territory Private Funding: paid for out of your own pocket or private insurance  Individuals and families who do not qualify for publicly funded coverage may pay these costs directly (out of pocket), be covered under an employment-based group insurance plan or buy private insurance Public Funding: paid for out of tax revenue  To support publicly funded services, including health care, the federal government also provides Equalization payments to less prosperous provinces and territorial financing to the territories Lalonde Report – “The White Paper”  Why? Government was spending enormous sums of money on health care expenditures  “Health Care” has little to do with health  Major contention of the report o Determinants of health  Biological factors  Lifestyle  Environment  Health care  Importance? Broadened “health care” to the “health care field”  Preventing illness is better than treating illness Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563  Impact? Gave rise to several successful proactive health promotion programs which increased awareness of the health risks associated with certain personal behaviors and lifestyles Home Care:  Maintenance/prevention  Long term care substitution  Acute care substitution  Health is more than health care Maintenance/Promotion: both the federal and provincial governments have started to shift the emphasis of the health care system away from institutionally based delivery models to integrated community-based models which place increased emphasis on health promotion and prevention Tommy Douglas: he left federal politics to become Leader of the Saskatchewan Co-operative Commonwealth Federation and then the Premier of Saskatchewan  He introduced the continent’s first single-payer, universal health care program  He fought for public health insurance “the fight for Medicare” Unit 3: Income and Health Social Safety Net: range of benefit programs and supports that protect citizens during various life changes that can affect their health  Life changes include normal life transitions such as having and raising children, education, employment training, seeking housing, reaching retirement  Primary way these events threaten health is that they increase economic insecurity and provoke psychological stress  Policy implications o Social safety net provided by Canadian governments needs to be strengthened – current benefits do not provide adequate supports for life transitions o Is minimizing government intervention an ethical and sustainable approach to maintaining health, promoting social wellbeing, and increasing economic productivity Power: the ability to do something or act in a particular way o Can be positive or negative o The capacity or ability to direct or influence the behavior of others or the course of events o Control, authority, influence, dominance, mastery, domination, sway, weight, leverage, strength, force o Ex. Government is one of the main powers in Canada o Power injustices: evidence that Canadian social structures and unequal power relationships contribute to “social injustice that is killing people on a grand scale” o Power places a role in income, income distribution, and health – many other SDoH o Wealth brings political power (richest 26 billionaires hold as much as the bottom half of humanity) o Wealth = assets – debt Inequity: unfairness or bias o Often occurs when differences relate to factors such as race, gender, sexuality, disability, or intersectionality of factors o Canadian Ex. 31% of lowest income households and less than 1% of highest income have moderate to severe food insecurity Inequality: the condition of being unequal (may or may not be fair) Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Impact of Low Income on Health of Individuals and Families: o Bigger income gaps lead to bigger deteriorations in health o Life changes provoke economic insecurity o Unable to work through unemployment or illness and experiencing family breakups lead to poverty – out of an individual’s control o Citizens experience better physical and mental health when they have a secure base for living a productive life Social Gradient: means that health inequities affect everyone o People who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are advantaged o Not everyone has the same opportunities to succeed o Bigger income gaps lead to bigger deteriorations in health – seen in low, middle, and high-income countries: health inequities affect us all o The gradient must be addressed, the gap margin narrowed Income: earnings o Mean income – average income o Median income – the midpoint level of income whereby half the population had higher income and half had lower o Shapes: o Overall living conditions affecting physiological and psychological functioning  Physiological – not able to have a gym membership, not enough time from work to exercise, cheaper food options are typically the unhealthier options, pay not be able to pay for physio, medications, no clean running water  Psychological – living conditions can cause stress o Take-up of health-related behaviors such as quality of diet, physical activity, tobacco use, excessive alcohol use  May resort to self-medicating o Determines: o Quality of other SDoH such as food security, housing, education, early childhood development, etc. Low-Income Cut-Off (LICO): o After taxes: level at which families or person not in an economic family spend 20% or more than the average family on food, shelter and clothing o Individual adjusted net income for the year must be below $38, 500 o Your adjusted family net income for the year must be below $68, 500 o You must not have spent more than 6 months in prison during the year Autonomy: independence in one’s thoughts or actions – the right of competent adults to make informed decisions about their own medical care without their health care provider trying to influence the decision o Allows for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient o Ex. When patients refuse life-sustaining treatment Relative vs Absolute Poverty: Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 o o Relative: having less than the average standard of living in society in which they live and is often measured as the proportion of individuals below a certain percentage of the media income o Better and more useful approach (uses current data and statistics) o circumstances in which people cannot afford actively to participate in society and benefit from the activities and experience that most people take for granted  ex. A person who has enough money to pay their bills and bus pass but no extra money for anything else  ex. A family whose yearly income is half of that of the other people who live in their community Absolute: having less than absolute minimum income level based on cost of basic needs o Disadvantages of term include:  1. Difficult to objectively set a minimum set of necessities  2. Cut-off of what this minimum is changes over time o caused by debt, natural disasters, conflicts, child labour  ex. A 12-year-old boy who has never been to see a doctor or attended school Self-Determination: the patient should decide whether to accept the suggested treatment or care Poverty according to the Government of Canada “… the 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 and participation in society.” Upstream: collective approaches that address the SDoH  Welfare and governance o Welfare state: how society views what it owes members by virtue of citizenship or residence o Canadas electoral system a barrier to welfare state development o Implementation NOT impossible but requires members of society to demand policy changes in health and health equity Downstream: the immediate health needs of populations that are marginalized Gini Coefficient: statistical measure of distribution meant to measure income or wealth distribution  Measure income inequality  Ranges from 0 (0% perfect equality) to 1 (100% perfect inequality)  0 = everyone has the same income, 1 = someone has all the income A Few Highlights: Richard Wilkinson  Economic inequality (too wide a gap between rich and poor) can affect health, lifespan, and basic values (ex. trust)  No difference in life expectancy against gross national income when comparing poor countries and countries 2x richer  Average societal wellbeing is no longer dependent on national income and economic growth (still important to poor countries) BUT the difference between us matters very much  Suggests constraining incomes and leaders, bosses more accountable to employees Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563  Take Home Message - improve quality of life by reducing incomes between us Hardest Hit Populations - Women and children o In 2018: child poverty rate is 5.8% in couple families and is 26.2% in single parent female families - Older adults (65+) o LIM = 14% o MBM = 3.5% o Many are retiring without any employer pension plan o Challenging to live from CPP or ORPP (Ontario retirement pension plan) o Many not able to save enough for retirement o The poverty rate (MBM) was 1.7% for seniors living in families and 7.9% for unattached seniors - Homeless o Most live below LICO - Racialized groups o Even when adjusted for  Immigration status  Education  Language o 40% of people staying in Toronto city shelters are refugee/asylum claimants Market Basket Measure (MBM): measure of low income based on a specific basket of goods and services representing a modest standard of living Low Income Measure (LIM): threshold is after tax income and according to household size The Poverty Conundrum  Poverty increases risk for any possible disease  Remember that it is not only the depth of poverty that can influence health but the duration the individual was living in poverty  Poverty/deprivation during childhood contributes to poor health over the entire course of the life span (even when poverty is removed) Why does income influence health?  Underinvestment in human capital o Not investing in public infrastructure (education, health services, transportation, housing, occupational regulations)  Underinvestment in social capital o Diminishing community solidarity/cohesion  Psychosocially mediated effects o Psychological (frustration) and biological processes that are harmful Poverty Screening 1. Screen everyone 2. Poverty is a risk factor (consider high-risk groups) 3. Intervene  Have you filled out and sent in your tax forms?  Ask, educate, intervene, and connect Unit 4: Work and Health Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Readings Chapter 5: Unemployment and Job Security  Workers are not only more uncertain about the likelihood that they will be retained in their current job, they are also uncertain about whether they will be able to find another job that meets their needs  Why is it important? o Employment  income, sense of identity, helps to structure day-to-day life o Unemployment  leads to material and social deprivation by reducing income and removing benefits  the adoption of health-threatening coping behaviors  physical and mental health problems (depression, anxiety, increased suicide rates), psychological stress, disrupt routines o Job insecurity  Intense work with non-standard working hours  exhaustion (burnout)  general mental/psychological problems (high blood pressure, heart disease)  poor self-rated health  somatic complaints  negative effects on personal relationships, parenting effectiveness, and children’s behaviors  less than 2/3rd of Canadians have regular, full time work  half of working aged Canadians have had a single full-time job for six months or more  Precarious work o working part time – greater income and employment insecurity o self employed o temporary work  total employment that is temporary: Canada is 12th highest in 32 countries  women, youth, seniors, and workers without post-secondary education are more likely to be working part time or temporary jobs Policy Implications: - legally mandated to provide basic standards of employment - power inequalities reduced - unemployed Canadians need access to income, training – gov. support Chapter 6: Employment and Working Conditions  the relationship between working conditions and health outcomes is an important public health concern  Why is it important? o We spend so much time in our workplaces o People who are already most vulnerable to poor health outcomes due to their lower income and education are also the ones most likely to experience health threatening work conditions  WORK DIMENSIONS: 30% of Canadians had jobs with positive scores in most dimensions o 1. Employment security o 2. Physical conditions at work o 3. Work pace and stress o 4. Working hours o 5. Opportunities for self-expression and individual development at work  Increased health problems – high demands, little control, little reward  Canadian women score higher than men for high stress levels Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563     Canadians whose jobs were extremely stressful were 3 times more likely than non-stressed Canadians to have been treated for a mental health problem in the last year men are more likely than women to die on the job collective bargaining helps to equalize the power balance between employers and employees union advantage = higher wages, benefits, greater opportunities (only 32% of Canadians) Policy Implications: - gov. policies must support Canadians working life – balance demands and reward - improving conditions of employees in high-strain jobs - unionization of work places – balancing power Canadian Centre for Policy Alternatives: Persistent Inequality  racialized Ontarians experience higher unemployment rates, lower earnings, and employment segregation  racialized women – highest unemployment rate at 10% o lowest paying occupations  racialized men – 8.7%  the racialized gap can be found both at the bottom and top of the occupational distribution  the labour market is not equally welcoming to all immigrants  continuous deterioration in labour market conditions for both racialized and non-racialized workers – sharper decline for men  persistent gap in average employment income between racialized and non-racialized workers  income inequality between racialized and non-racialized Ontarians extends beyond the immigrant experience, affecting second and third generations, and beyond  higher prevalence of poverty among racialized communities in Ontario  provisions of Bill 148 (increase in minimum wage) are important ways to reduce racial inequality Guy Standing: What is the precariat  global market increased and opened - tiny minority of people are receiving most of the income  the elite at the top – receiving more and more of the world’s income with vast power  salariat – employment, security, pensions, paid holidays shrinking – worried about next gen  proletariat – working class – shrinking  precariat – millions of people o 1. unstable labour, unstable living – extensional insecurity  level of education is above level of labour o 2. Rely on money wages – bear risks themselves, on edge of unsustainable debt o 3. First emerging class that is systematically losing rights  (civil rights, political rights, economic rights)  Desired by global capitalism  Factions o 1. Atavists  Looking backwards – used to have pride, status o 2. Migrants, refugees, roamers – no sense of home, head down to survive o 3. Progressives – go to school, no future – debt stretching into future - anger  Income distribution system has broken down  Fight for basic income – encourages virtues because they have security Precarious work in Toronto public library  Existing more than living  Doing what you have to do to get by  Unsteady work is the new reality – precarious work Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563       Low paid, insecure, unstable – doesn’t allow people to support themselves Part time, short contract Widening income gap Usage increases, staff and support decreases Trickle down effect – stress on household, stress on family – intergenerational effect Barrier to success Canada’s color coded labour market  More diverse, but there is still a racialized gap – issue of equity Unit 4: Work and Health Labour Market Transformation  How did we arrive here? o Farming/agriculture o 1st and 2nd industrial revolution o 3rd industrial revolution o 4th industrial revolution: artificial intelligence  Careers related to the development of projects (consultant, project management, coordinator)  Work in several jobs over the course of a lifetime Intersectionality  K. Crenshaw (civil rights activist, legal scholar) o Coined phrase in 1989  The interconnected nature of social categorisations such as race, class, and gender, regarded as creating overlapping and interdependent systems of discrimination or disadvantage Colour-Coded Labour Market  1980: 5% were racialized Canadians  2006: 16.2%  2031: 32% of Canada’s population  Pay Gap o Racialized workers are more willing to work but have a harder time finding jobs  Why is there a gap? o Racialized workers are more willing to work but have a harder time finding jobs o Jobs found are more likely to be part-time, low wage, insecure  Gender-based Inequity o Non-racialized women earn 69 cents per dollar non-racialized men earn  Race-based Inequity o Racialized men earn 76 cents per dollar non-racialized men earn o Racialized women earn 85 cents for every dollar non-racialized women earn  Gender-based + Race-based Inequity (intersectionality) o Racialized women earn 58 cents per dollar non-racialized men earn Active Labour Force  Unemployment fell to 40% low in self-employment was responsible for growth  Drop in rate due to surprise decline of 50, 000 in labour force size Unemployment rate: number of people in the labour force (15-64 yrs.) actively looking for a job Employment rate: employed divided total labour force Work-Related Health Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563  Why are working conditions important SDoH? o Great amount of time spent in workplace o People already vulnerable are most likely to experience health threatening working conditions WORK DIMENSIONS  30% of Canadians had jobs with positive scores in most dimensions 1. Job strain 2. Effort-reward imbalance 3. Organizational justice 4. Work hours 5. Status inconsistency 6. Precarious work Boundaryless Careers  Nomadic/unstable careers  Work in several jobs over the course of a lifetime  Often represents tech/knowledge economy: mobile work, networks and virtual communities of practice  More “flexibility” in jobs and self-employment  False sense of self-employment  Precarious work (lack of stability, permanence and/or benefits)  New classifications of employment statuses (casual, contract, temporary, reduced-time, part-time, etc.) – “gig” economy Traditional Career  Represents industrial work: one stop shop, first job/last job, climbing the vertical ladder Employment Strain  Exists when people’s autonomy over their work and their ability to use their skills are low, while the psychological demands placed upon them are high  Unemployment can lead to: o Material and social deprivation o Psychological stress o Adoption of health0threatening coping behaviors  Unemployment is associated with: o Physical and mental health problems  Ex. Depression, anxiety, increased suicide rates  Job security causes: o Burnout, mental/psychological problems, poor self-rated health, variety of somatic complaints Employment Protection in Canada  Organization for Economic Co-operation and Development (OECD)  OECD guidelines set standards for responsible business conduct across a range of issues such as human rights, labour rights, and the environment  Canada ranks poorly – 35/36 in employment protection index of rules and regulations that protects employment and provides benefits to temporary workers Job Security: enables economic + social inclusion Income Security: economic inclusion Precarious Employment Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563    Describes work experiences that are associated with instability, lack of protection, insecurity across various dimensions of work, and social and economic vulnerability Work is uncertain, insecure, unstable Working part time, self-employed, temporary work, short contract, uncertain work Precariat  Precarious (insecure) + proletariat (working-class) o Security = control  Classes o 1. unstable labour, unstable living  extensional insecurity  level of education is above level of labour o 2. Rely on money wages  bear risks themselves, on edge of unsustainable debt  all it takes is one mistake or life change o 3. First emerging class that is systematically losing rights  (civil rights, political rights, economic rights)  Factions o 1. Atavists  Looking backwards  Parents/family used to have pride, status o 2. Migrants, refugees, roamers  no sense of home  head down to survive o 3. Progressives  go to school, come out with no future  debt stretching into future  anger  More than 1 in 5 Canadian professions have precarious jobs (2018) Health Consequences of Precarious Employment  The new economy: flexible production  Good produced faster and cheaper – consequence – people change brands more often and want latest product  Companies cope by: o Functional flexibility: workers work harder and longer, focus on outcomes “lean production” o Numerical flexibility: downsizing, part-time/contract, focus on cost-reduction        Intensification of work o Leisure sickness, repetitive strain injuries (less visible and hard to connect to one job) Non-standard work hours o Long hours, physiological and psychological health disturbances, family conflict Precarious work o Poorer conditions, low control, less socialization Job insecurity o Associations between illness and downsizing, family dynamics, parenting Employment insecurity o Stress of no employment options Income insecurity o Income inadequacy (poverty) associated with ill health (depression) Most impacted populations: Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 o o o o o o  Women Youth New immigrants Racialized minorities Persons with disabilities Persons with lower education Key Dimensions of a “Good” Job 1. Secure – permanent with benefits 2. Addresses workplace injuries 3. Control – autonomy at work 4. Opportunities for self-development (paid) – allows for advancement 5. Free time – vacation, limit work taken home 6. Work-life balance – time stress (child care) 7. Attention to social aspects of job (positive and negative) Organizational Justice  Reflects the extent to which people believe that their supervisor considers their viewpoints, shares information concerning decision making and treats individuals fairly Effort-Reward Imbalance  Underlines the health importance of rewards being in line with the demands  When efforts are perceived to be higher than rewards, this leads to emotional distress Status Inconsistency  A situation where an individual’s level of education is higher than the skills her or she requires for the occupations  “goal-striving stress” What should be done?  Research and education o Link between precarious employment and health  Cultural change o More employer social accountability  Institutional change o Free trade vs fair trade (think about impact on people)  Power and equity o Address that those already economically marginalized are disproportionately impacted by “flexible” workplace strategies  Policy and legislation o Increased minimum wage o Incentives to hire permanent staff o Access to training opportunities, EI, pension plans o Occupational health for well-being vs reducing injury/illness  Policy implications o Support working life so demands and rewards are balanced o Improve conditions in high-strain jobs o Collective and organized action (unionization) as means to balance power between employers and employees Critical Thinking Questions Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 1. Have you previously considered job (in)security as a health issue? Why or why not?  Yes, I have considered job insecurity as a health issue  Stress can have significant effects on one’s health 2. High-stress jobs are often defined as those with demands but low levels of control. What kinds of jobs are most stressful by this definition?  Unit 5: Education and Health Readings Chapter 4: Education  Canada as a whole performs well on national and international assessments, but disparities exist among populations and regions that do not seem to be diminishing with time  Why is it important? o People with higher education tend to be healthier than those with lower educational attainment  1. Level of education is highly correlated with level of income, employment security, and working conditions o Education helps people to move up the socioeconomic ladder and provides better access to resources  2. Higher education makes it easier to enact larger overall changes in the Canadian employment market o People attain a better understanding of the world o Can influence societal factors that shape their own health  3. Education increases overall literacy and understanding of how once can promote one’s own health through individual action o Evaluate their own behaviors o More resources to attain healthier lifestyle  Lack of education in itself is not the main factor causing poorer health  The link between children’s educational performance with parents’ education levels would be reduced if there were affordable and high-quality early learning programs in Canada  High tuition fees influence whether children of low income families can attain post-secondary education Policy Implications:  Commit to funding the education system so schools provide well-developed curriculum for students  Universal high-quality childcare would reduce link between generational educational achievement levels  Tuition fees for post secondary education must be better managed, reduced, or eliminated Chapter 7: Early Childhood Development  There is strong evidence that early childhood experiences influence coping skills, resistance to health problems and overall health and well-being for the rest of one’s life  Why is it important? o Early childhood experiences have strong immediate and longer lasting biological, psychological and social effects upon health  Latency Effects: how early childhood experiences predispose children to either good or poor health regardless of later life circumstances  Pathway Effects: a situation when children’s exposures to risk factors at one point do not have immediate health effects but later lead to situations that do have health consequences  Weaken relationship between parents’ socioeconomic status and children’s developmental outcomes = provision of high-quality early child education regardless of parents’ wealth  Cumulative Effects: the longer children live under conditions of material and social deprivation, the more likely they are to show adverse developmental and health outcomes (learned helplessness) Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563    33% boys, 19% girls – vulnerable Child Poverty: living in families which have access to less than 50% of the median family income of that nation Canada is one of the lowest spenders on supporting families with financial support Policy Implications:  Gov. guarantee affordable and quality child care is available for ALL families  Providing support and benefits to families to form base for healthy child development (reduce child poverty)  Improved early child development Unit 5: Education and Health Key Concepts    Higher education is positively associated with better health o education id correlated with other SDOH such as income, employment security and working conditions Having more education makes it easier to enact overall change in the employment market o New training opportunities, civic activities, and engagement, etc. Education increases overall literacy and health literacy o More skills to adopt healthy behaviors Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563    Canada has good scores o If you were born in a different country, you are almost doing the same as people who were born here (foreign born vs native born) Shows an equitable and equal distribution of resources and education People who are born in a country where their parents are also born in the country do better o They can support the children with learning State of education in Canada: 53% of Canadian population has post-secondary education  HOWEVER:  Children whose parents do not have post-secondary education perform worse than children of more educated parents  We need to reduce this link Access to Early Childhood Education and Care  High quality Early Childhood Education and Care (ECEC): important for the growth, development, and health of a child o High costs = barrier to access for many families o Many families do not qualify for subsidies so they must pay out of pocket  Policy Goals o 1. Enhancing children’s well-being, healthy development, and lifelong learning  Quality matters High quality ECEC should have…  More staff to fewer kids  Staff who have an education in ECEC + decent working conditions/wages  Ensure consistent adult and peer groups in well-designed environments  Provide challenging, non-didactic, play-based, creative, enjoyable activities  Needs to be early, intensive, and systematic 2. Supporting parents in education, training, and employment  o Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Childcare allows parents (often single mothers) to upgrade education and/or enroll in education/training (*increase income) 3. Strong communities  Ensures that young children learn to respect diversity and develop their own identity  Parents come together to build social networks and support 4. Providing equity  ECEC basic human right (especially for those with disabilities and women)  o o  Canadian Context o Responsibility for early education is primarily provincial/territorial o Reliance on informal/for-profit childcare until kindergarten, typically paid for by parent fees o Means testing for subsidies Critiques of Canadian ECEC & ECEC in Ontario Critiques of ECEC  No systematic/integrated/universal approach – “tangle of programs” o Incoherent development o Eligibility criteria segregated by race, class, income, etc. – siloed programming  Disconnect between ECEC and education system o Kindergarten treated as a public goof o Responsibility for care is primarily private o User fees a barrier  Inadequate wages and training o Canadian caregivers receive little public support, few resources, and unacceptably low wages  Lack of systematic attention to monitoring and data collection o No reliable, consistent, comparable data on various aspects of ECEC that can inform policy or improve service provision  Unstable investment and long-term agenda (changes based on which government is in power) Canada’s Response to the Critiques  Government of Canada to provide provinces and territories with $1.2 billion for early learning and child care programs  Three-year bilateral agreements Impact in Ontario  Provincial Centre of Excellence o Western University and Ontario Reggio Association  Indigenous Centre of Excellence o Ontario Aboriginal Head Start Association and Kenjgewin Teg Education Institute  Francophone Centre of Excellence o College Boreal and Association francophone a l’education des services a l’enfance de l’Ontario  Find an EarlyON child and family centre o Centres offer free, high-quality drop-in programs for families and children from birth to 6 years old o You can learn and play with your child, meet people, and get advice from early childhood professionals  Started in 2018 (4 programs) o Ontario Early Years Centres o Parenting and Family Literacy Centres Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 o o  Child Care Resource Centres Better Beginnings, Better Future Impact of Provincial Election o “flavour of the month” o Based on conservative or liberal – what programs stay, what programs get cut How are we doing? Learning Environment  In September 2017, Nunavut signed a three-year, $7 million bilateral agreement with the federal government as part of the Federal-Provincial/Territorial Early Childhood Learning and Care Agreement (ECLC)  Funding will be used for the development of standardized program materials to help support the delivery of consistent, high-quality instruction in early years programs  Resources will be available in all official languages and will reflect Nunavut, life in the North and the Inuit culture ECLC Critique  Remains an inconsistent patchwork of policies and programs  While the 2017 ECLC Framework Agreement starts with a set of principles, it does not recognize children’s rights and has no mechanisms to ensure equitable treatment, outcome-based accountability, or regular, transparent reporting Key Terms High Quality/Affordable/Regulated Early Childhood Education and Care Why Study Early Childhood Development?  Early childhood experiences have immediate and long lasting biological, psychological, and social aspects on health  The quality of early child development is shaped by economic and social resources available to parents, which is primarily through employment Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Bartley Typology  Socioeconomic position + children’s health  Materialist  Political Economy  Life Course  Psychosocial  Cultural/Behavioral Early Childhood Experiences  Early childhood experiences have strong immediate and longer lasting biological, psychological, and social effects upon health    Latency Effects o Early childhood experiences predispose children to either good or bad health o Biological processes during pregnancy o Developmental early life experiences that produce health effects later  Low birth weight (predictor of incidence of cardiovascular disease and type 2 diabetes in later life)  Adverse childhood events (trauma) Pathway Effects o Exposures to risk factors that may not have immediate health effects, but can later lead to situations that do have health consequences  Lack of readiness to learn when children enter school (may not be an immediate health issue, but can lead to experiences later in life that are harmful such as lower education attainment and paid employment  Can be interrupted if high quality ECEC is provided Cumulative Effects o The longer children live under conditions of material and social deprivation, the more likely they are to show adverse developmental and health outcomes o Accumulation of advantage or disadvantage over time – manifests in a range of indicators of health o “learned helplessness” – strong SDoH Inequities in ECEC Early Development Instrument (EDI): physical health and well-being; social competence; emotional maturity; language and cognition; communication skills and general knowledge  27% of Canadian children are vulnerable in 1 or more areas of development prior to entering Grade 1  Percentage of Canadian children vulnerable in at least 1 area of development at age 5 o 20% girls o 34% boys  Percentage of children vulnerable in at least 1 area of development by neighbourhood income o 36% poor neighbourhoods o 21% rich neighbourhoods Child Poverty  Children living in families which have access to less than 50% of the median family income of that nation UNICEF: An Unfair Start  Inequality in children’s education in rich countries Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563    Sustainable development goals “By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes” ~ Global Goals for Sustainable Development “The average dual income families in wealthy nations spend approximately 15 percent of their net income on childcare. In Canada, this figure is as high as 22 percent on average, with the United Kingdom having the highest figure with 33.8 percent” (2016 OECD Study) What Can Canada Do? 1. Improve Services  Focus on quality 2. Change Behaviors  Too simplistic and stigmatizing 3. Strengthen Environments  Community advocacy (force vs persuade government) 4. Strengthen Environments  Healthy public policy (most effective) Critical Thinking Questions 1. 2. 3. What surprised you the most about the link between early childhood education and care and health? How would the provision of high-quality, regulated, and affordable childcare impact some of the issues identified in the readings? What are the implications of limited education for individuals and families? Lecture notes: Women with a Bachelor’s degree earn – 63% more than women with a high school diploma Men with Bachelor’s degree earn – 45% more than men with a high school diploma Unit 6: Food, Housing, and Health Readings Chapter 8: Food Insecurity  A very brief history of food insecurity in Canada: poverty increased, then it deepened. Food insecurity emerged, then it increased in severity  Food is one of the basic human needs and is an important determinant of health and human dignity  Barrier to adequate nutritional intake as they consume fewer servings of fruits and vegetables, milk products, and vitamins than those in food-secure households    Marginal HFI: worrying about running out of food and/or limited food selection due to a lack of money Moderate HFI: consuming food inadequate in either quality or quantity Severe HFI: experiencing reduced food intake or disrupted eating  Canadian Community Health Survey – 12.7% of Canadian households experienced some form of HFI – 4% experienced marginal HFI, 5.7% experienced moderate HFI, 3% experienced severe HFI Provinces and territories with higher concentrations of First Nations and Inuit populations report higher rates of HFI  Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563  The risk of food insecurity is especially great in female lone-parent families (33.1%) and families receiving social assistance (60.4%)  Events that move families into hunger: o family acquiring another mouth to feed o change in the number of parents in the home o loss of a job o change in employment hours o decline in the health of adult or child Getting out of hunger: o Mother began a full-time job – income rising  Dietary Deficiencies – more common among food insecure households – increased likelihood of chronic disease and difficulty managing disease, increased stress and feelings of uncertainty  Malnutrition during childhood has long term effects – experience range of behavioral, emotional, and academic problems  Worse the food insecurity – the greater the likelihood of poor health  Food banks – last resort – can make the situation worse by giving the mistaken impression that food insecurity is being dealt with  Public policies that reduce poverty are the best means of reducing food insecurity Policy Implications:  Increase minimum wages and social assistance rates  Make healthy foods affordable  Provide affordable housing and childcare  Better monitoring systems  Chapter 9: Housing  It would hardly seem necessary to argue the case that housing – and homelessness – are health issues, yet surprisingly few Canadians studies have considered it as such  Why is it important?  Housing is an absolute necessity for living a healthy life and living in unsafe, unaffordable, or insecure housing increases the risk of many health problems  Lack of economic resources is the prime reason many Canadians experience housing problems  Also, a result of Canadian public policy – reduced spending on affordable housing      Governments have a responsibility to provide citizens with the prerequisites of health – doesn’t fulfill these commitments Housing influences health: o Overcrowding = transmission of respiratory and other illnesses o Lack clean water and basic sanitation = public health risk o Housing provides self-expression and identity o Poor housing = stress and unhealthy means of coping (substance abuse) o Lead, mold, poor heating, inadequate ventilation, vermin, overcrowding o Dampness = respiratory illness Canada is experiencing a housing crisis Housing insecurity = precursor to homelessness Core housing need o Affordability: household spends 30% or more of their income on shelter costs o Sustainability: housing is inappropriate for the size and composition of a household (overcrowding) o Adequacy: the housing requires major repairs (plumbing, structural damage) Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563       12.7% of Canadians were in core housing need (2016) Homeless people experience a much greater rate of a wide range of physical and mental health problems than the general population Early death among homeless people is 8-10 times greater than general population Contributing factors: o Lack of affordable rental accommodation o Growth of part-time and precarious work o Low-paying jobs o Family poverty National Housing Strategy: identifies a number of housing initiatives to address the needs of different populations and areas of the housing system o does little to address the weaker features of the housing system Housing policy must support non-profit and cooperative housing sectors and quality affordable housing in existing neighbourhoods Policy Implications  Housing policy needs to be linked to income programs and public health  Boosting access to social and affordable housing for low-income Canadians  Maintaining the funding levels and priorities of National Housing Strategy  Federal government must increase funding Annual Reports: Household Food Insecurity in Canada  Household food insecurity in Canada is measured by Statistics Canada using the Household Food Security Survey Module (HFSSM) on the Canadian Community Health Survey (CCHS)  HFSSM: 18 questions about the experiences of food insecurity due to financial constraint  Nunavut had the highest prevalence of food insecurity (57%)  The health consequences of food insecurity are a large burden on our healthcare system Seed Sowing: Indigenous Relationship-Building as Process of Environmental Action  Indigenous leadership can enhance community efforts to transform our shared social spaces, build environments and ecological climates o Finding Land use opportunities in natural urban places o Imagining and creating place for Land-based learning o Building and mobilizing community to enhance local biodiversity o Enhancing Indigenous food sovereignty practices towards community wellbeing  Truth and Reconciliation Commission of Canada: calls for actions that close gaps in health equity RNAO: Housing is a Human Right and a Determinant of Health  Ontario’s housing costs are the highest of any province  Living in shelters, rooming houses, and hotels is a marker for much higher mortality  Stressful, isolating, dangerous  RNAO endorses the Housing Network of Ontario’s Declaration built on the foundation that “we believe everyone in Ontario has the right to live poverty-free and with dignity in housing that is stable, adequate, equitably accessible and affordable.” Valerio Tarasuk: The full story of food (in)security  We don’t need any more public policies that support food banks or food donations, we need policy that tackles the bottom end of the income spectrum – changing the circumstances of people at the very bottom of the income spectrum to tackle food insecurity Reaching Home: Canada’ Homelessness Strategy  A community-based program aimed at preventing and reducing homelessness across Canada Downloaded by Erna G ([email protected]) lOMoARcPSD|12596563 Provides funding to urban, Indigenous, rural and remote communities to help them address their local homelessness needs  Support the most vulnerable Canadians in maintaining safe, stable, and affordable housing and to reduce chronic homelessness nationally by 50% by fiscal year 20217 to 2028 Committed $2.2 billion to tackle homeless ness across the country  Unit 7: Gender and Health Sex vs Gender Sex: biology Gender: socially constructed Gender and Health  Women tend to utilize healthcare services more than men  Women have higher rates of depression, but men have higher rates of suicide  Many of our objective and subjective screening tests are “one size fits all”  Most research studies are carried out mainly on men Gender Inequality: sex-based differences - female having a MI presenting with upper back pain/fatigue Gender Inequity: unfair – female gets sent home with no MI work-up Gender and Income Women and Children: “in 2018, the child poverty rate was 5.8% for those living in couple families, compared with 26.2% for those in female lone-parent families” Gender Hourly Wage Gaps 2018  Ontario: males ($31.43) females ($27.60)  Wage gap declining BUT still significant with men earning hourly wages on average $31.05 and women $26.92  Eliminating various forms of gender-based discrimination is needed to close the gap o Ex. Pay equity; reducing extreme forms of poverty and social exclusion, provide national affordable ch