W10-general determinants

IS INEQUALITY MAKING US SICK?
- America highest gross capital in world (2 trillion per year on med care (nealry ½ in world)) BUT AMERICANS LIVE OFTEN SICKER AND SHORTER LIVES THAN NEARLY EVERY OTHER DEVELOPED NATION (number 30 in life expectancy)

- Higher percentage of babies die in first year of life in america than in slovakia, etc

- 47 mil. Don't have healthcare in america

- Identical twins have shown that if they diverge and end up living different lives later in life, they end up having different health statuses

- Ways In which society is organized that is bad for our health

- Excess death=death that should not have occurred

- Cancer and heart disease are higher in some areas than in others

- If you have more money then you are going to be healthier(fine gradation through wage)

- Whitehall studies gave hard data-->sir marmot—looked at and charted health of british social servants—lower grade employment then higher the rate of almost all major causes of ill health --- slowly increasing health as income/status increased

- If a poor person is smoking, higher chance of sickness than a rich person smoking

- Over 71% americans who make over 80K report good health, while only 37% who make under 20K report good health

1) - caused 11000 hospital admissions
- 21000 deaths in canada
- cost of $8 billion

2)$3.7 billion in healthcare costs in 2009

3) - 14.8% of the Canadian population
- increase from 13.7% (by 2036, it will be 24.5%)

4) 10 to 15%

authors of The Communist Manifesto--calls for proletarian evolution and redistributive wealth

METHOD: examined observed differences in mortality rates in suburbs of Manchester
FINDINGS: observed death rates correlated with quality of housing and quality of streets ("conceived evils are heaped on poor. They are given bad conditions and supplies/exposed to neg things)

- sent to investigate an epidemic of typhus in Upper Silesia

FINDINGS:
- feudalism, unfair tax policies, and lack of democracy leads to poor living conditions, inadequate diet, and poor hygiene=epidemic of typhus

CONCLUSION: preserving health and preventing disease requires "full and unlimited democracy"

biomedical model
pathogenesis-origins of disease
Emphasis on personal factors/consciousness raising

(disease prevention and personal practices like smoking and working out. Improve health consciousness of individuals, because 'risk factors are modifiable.' Highlights individual responsibility.)
this model omits critical determinants of population health

-Upstream approach, emphasizes social determinants of health
-salutogenesis (origins of positive health)
-structural factors

(Based on assumptions that the most important health determinants are beyond our control--· basic idea of the population health approach is while discovering causes of conditions you must learn about the causes of good health and what factors are health protective)

· highlights the importance of improving living conditions for a healthy environment
· recognizes health is shaped by societal factors we can't control
· meanwhile the traditional health promotion message reflects a pathogenic approach (find origins), highlights importance of changing behavioral practices

. Lay health beliefs

- Self-health management:
. Self care capacity
. Coping skills

. Biology & genetic endowment

- Health protective behaviour:
. Personal health practices
. Healthy lifestyles

- Social environment
. Socioeconomic Status
. Income & income distribution
. Education
. Employment & working conditions
. Gender, ethnicity/race, age, culture
. Social support networks

-Health Care Services
. Disease prevention
. Health promotion

Personal determinants are evident at the individual level and include factors such as genetic makeup as well as beliefs, attitudes, and personal health practices.

Structural determinants are evident at the societal level and include aspects of the social and economic environment
- such as income distribution, rates of unemployment, living and working conditions, changing age structure, etc.

1. Income and Social Status
2. Social Support Networks
3. Education and Literacy
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices & Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture

origins of disease

risk factors: microorganisms, viruses, infectious diseases

illness avoidance:
preventative medical care, risk reduction

factors that protect and enhance good health

salutary factors:
- sense of coherence
- coping skills
- supportive social environment

health maintenance:
- health resource management
- enhanced self-care capacity

we need to learn about the maintenance of good health, enhance individuals health protective behaviors, understand social and physical conditions that cause ill health

- biology(15%)
- life(50%)
- environment(10%)
- health care (25%)

a. Sociology of the body paradigm shows biology shapes our health status. (Bourdieu's concept of the habitus preaches that culture affects the body, and sociology of body paradigm says body affects health!).

b. Genetic endowment and the body's functioning is biological: eg. development of asthma is often genetic.

a. Eating habits, exercise habits, substance usage, personal practices, affect health for all ages

b. A large proportion of death every year results from modifiable lifestyle related behaviors like tobacco use, poor diet, and physical inactivity

c. People in poverty / socially excluded have higher rates of risky lifestyle behaviors

a. Physical: industrialization / pollution. Natural environment (factors like water and air quality) and built environment (our planning and design of cities)

i. People living in urban centers have worse health: this = urban health penalty

ii. At the same time health researchers have said health decreases the farther one is from an urban center, because some features of urban life like increased access to health and social services, and availability of social support, benefit people

- Urban sprawl---urbanization where there's separated areas of commercial and residential, and automobile dominance is found! Associated w/ less physical activity, more pollution, etc.

a. higher income = better health: distribution of wealth in society determines population health (equal income distribution is one of the best health predictors!)

b. Workplace position (Stress of unemployment = health probs )

c. Level of formal education: health status improves with education level

d. Changing age structure as 'baby boom' people are now older... privileges are distributed based on age group
(Medicalization: Doctors transformed aged bodies into sick bodies)

e. Social support is an important health determinant: Supportive social network leads to emotional support, instrumental support (give assistance for daily activities) and informational support (provide info about health)
- More socially connected adults live longer and healthier than isolated people

the publication in 1974 by Lalonde, federal Minister of Health, acknowledging health status is not the direct result of formal healthcare service access. other factors are important for determining population health: biology, lifestyle, environment, and health care
Spending more on healthcare will result in further improvements in population health

- primary determinants directly influence health and impact secondary determinants.

- secondary determinants are factors
that reflect our living and working conditions and play an important intervening role between social status and health status such as our daily behavioral practices (e.g., smoking) and our psychosocial well-being (e.g., sense of coherence, self-esteem).

Horizontal structures: direct effect on health (family environment, nature of work and conditions, housing quality, etc.)

Vertical structures: more distant, macro-level factors that indirectly influence health and wellbeing (policies for social welfare, taxation, etc.)

Proximal cause (downstream): direct cause
Distal cause (upstream): indirect cause

for example, income is thought of as distal (upstream) because it doesn't directly affect health.

researchers studying social determinants may intend to explore positive factors that determine good health but end up studying negative factors contributing to ill health because they constrained by the concepts and methods of the medico-centric illness model

Major health determinant categories are just groupings of known epidemiologic risk factors (related to the bio medical model)

To better understand the variation in positive health we need to develop better independent measures of the determinants of good health, instead of just being able to measure illness risk factors