HHP 4030 Social determinants of health

Social determinant of health refers broadly to any non-medical factor that influences health, including health-related knowledge, attitudes, beliefs, or behaviors

Downstream social determinants – influenced by upstream factors

Upstream social determinants – fundamental causes of health and disease, distant from the outcomes

Poverty, Housing, Education, Neighborhood, Stress, Employment, Conditions of Life

Innate characteristics of an individual, typically unmodifiable

- age

-sex

-genetics

Environmental factors and non-innate individual characteristics and, often modifiable

- The Political Economy

- Conditions of Life

- Health Outcomes

- Environmental factors that are usually not controlled by individuals

- Lifestyle factors that are determined by individual choice

• Lead in drinking water

• Air pollution

• Seatbelt law

• Physical activity

• Sleep

• Cancer screening behavior

- Healthcare System

- Biomedical Model

- Resistance

- Lack of Political Will

- Neighborhood and Built Environment

- Healthcare Access and Quality

- Education Access and Quality

- Economic Stability

- Social and Community context

High School Graduation

Enrollment in Higher Education

Language and Literacy

More Education > (More personal control, better employment, and increased social support )

poverty

employment

food security

housing stability

social cohesion

civic participation

discrimination

incarceration

• Link between greater social disadvantage

with poorer health

• Better health linked with higher educational

attainment

• More economic resources, healthier housing

and living conditions linked with better health

• Having a higher social capital linked with

better health

• Having access to health care linked with

better health

• Reduced stress linked to better health

• Numerous associations between social

determinants of health and health status

• Social factors are more likely to predict

disease rather than medical care

• Too little attention has been given to the

upstream social determinants of health

• More research on pathways and

biological mechanisms is needed

Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society

• Is it income? Or the things income represents?

- when it comes to income, those who are typically healthier are the ones who are healthier. Presumably, due to the ability to have greater amounts of access to that healthcare.

• Collinearity

• Income distribution is a marker of how unequal a society is

• Income inequality measures the differences in social standing or social

status

• Lower income bracket

• Stress, envy, inferiority, lack of self-esteem, etc.

• Those with higher income have access to:

• Education, better housing, health care, employment, etc

• Most commonly-used measure of income equality

• Represents the income or wealth distribution of a nation’s residents

• Scoring

A score of 0 would mean income is perfectly, evenly distributed

A score of 1 means that a single person has all the income in that society

• Increased chances of exposure to conditions that lead to negative health outcomes

• Approximately 14 percent of the entire population in the U.S. live below the poverty line• Poverty determines the conditions in which we live

• Government programs that target the poor or disadvantaged disproportionately benefit the less well-off (narrow the gap)

• Distribution of benefits of public programs is most progressive in Australia – least progressive in the U.S.

• Public spending paid to people in the lowest income quintile, the bottom 20% of the income distribution (Australia at 41.5%; U.S. at 24.8%)

Life expectancy in Australia: 83 Life expectancy in U.S.: 78.9

Cost of health care

Medicaid has low reimbursement

Health care providers often deny people with Medicare

The current health care system in the U.S. is complex and very fragmented

Safety net: Hospital emergency rooms

Neighborhoods tend to be economically homogenous

• Poor people: poor conditions

• Wealthier people: wealthier conditions

- Housing

- Pollution

- Healthy Products

• Limited choices resulting in housing that is unsanitary and unsafe

• Minimal reinforcement of housing codes

• Higher rates of eviction

• Increased exposure to pollution, both air and noise

• Linked to historical policies, such as redlining

• Jobs

• Less likely to have high-paying jobs

• Jobs more associated with hazards such as safety issues, strenuous, low control, and minimal benefits

• Stress

• Toxic stress strongly associated with poor health outcomes

• Reduced coping ability and self-efficacy

• Children in poverty are living in sub-standard housing conditions

• Toxic Stress

• Lower quality schools

• Vulnerable to marketing by the tobacco companies

• Differences in health status have mostly to do with differences in the resources available to, and the related capacities of, individuals

• Income is the single most powerful measure of resources and capabilities

• The gap continues to broaden between the rich and the poor

• Causal connection between income inequality and health

• How society organizes its taxation system, programs, and services has a dramatic effect on the income, inequality, and the number of children and adults in poverty