4. The social determinants of health

according to the government of Canada, what are the most important determinants of health?

social supports and coping skills

income and social status

employment/working conditions

education

physical envrionments

access to health services

gender

culture

race / racism/ discrimination

what are health disparities?

inequalities in health (morbidity and mortality) or health care between groups

describe how health disparities exist in Canada

Health inequalities in Canada exist, are persistent, and in some cases, are growing. Many of these inequalities are the result of individuals and groups’ relative social, political, and economic disadvantages

describe why diabetes morbidity rates are different in first nations compared to Canadians

envrionmental and lifestyle factors are largely to blame

• less healthy diet, lower consumption of tradition food, less physical activity due to historical changes to way of life

  • poverty: lower income and education contribute to increased stress and poorer health

how might diet and stress lead to diabetes?

diet → fewer healthy dietary options; reliance on processed food which are cheaper

stress → elevated cortisol levels

both cause high blood glucose → over time cause insulin resistance

describe how colonization has affected the health of indigenous people

colonization introduced new disease, loss of land, criminalization / loss of culture, genocide, and forced assimilation → higher psychological distress and higher prevalence of PTSD

what is intergenerational trauma?

trauma that is passed down to subsequent generations

what direct & indirect mechanisms may be involved in intergenerational trauma

• Vicarious trauma (hearing about trauma from others that we love, increased the risk of the individual who isn’t actually affect to get PTSD)

• Lack of culture & cultural identity 

• Marginalization & discrimination

• Compromised parental functioning 

• Modelling of poor coping 

• genetic/biological vulnerabilities 

what is epigenetics?

the study of changes in organisms caused by changes in gene expression due to environmental influences

what is intergenerational epigenetic effects?

epigenetic changes can be heritable via various processes; can affect multiple generations

describe the intergenerational effects of residential schools

Maternal and paternal attendance at residential schools was associated with increased childhood adversity in their adult children.

Maternal residential school attendance was also linked to increased allostatic load (a measure of cumulative physiological stress) in adult children.

how does cultural identity influence health?

historical and ongoing attacks on indigenous culture have compromised cultural identity clarity

what is resilience?

the ability to recover from a traumatic event

what is the socioeconomic gradient in health?

the pattern where health outcomes improve with each step up the socioeconomic ladder — not just between the poorest and the richest, but across all levels of income, education, and occupation.

what is the most decisive social factor that affects health?

SES

what factors mediate the SES-health relationship?

access to resources, living / working conditions

amount of chronic stress

perceived control

diet, physical activity, substance use, sleep

what is displacement aggression?

a psychological defense mechanism in which someone redirects their anger or frustration from the original source onto a safer or more convenient target — usually someone or something less threatening.

describe the status-health relationship

low status is associated with…

• increased morbidity & mortality

• lower QOL

but stress appears to be one key mechanism

describe how low-SES individual experience stress

report more frequent stressful life events and more chronic stressors

have a tendency to interpret stressors as more threatening

cope less effectively with stress

describe the relationship between low SES and allostatic load

burden of coping with limited resources and negative life events results in increased allostatic load in those with low SES

describe the biological embedding model

childhood adversity gets programmed into the immune system through multiple mechanisms, including epigenetics

describe the shift-and-persist strategy

an approach to life for low-SES individuals to overcome those adversities that prioritizes

1. shifting oneself → accepting stress for what it is and adapting through reappraisals

2. persisting → enduring life with strength by maintaining meaning and optimism

how might inequality affect everyone, regardless of status?

status anxiety: some people look down on me because of my job situation or income

describe how status anxiety affects people of low and high income in societies of high or low inequality

Low income, regardless of inequality, have high status anxiety. But those in countries with higher inequality will still have higher status anxiety than those in lower inequality

High income, regardless of inequality, has low status anxiety, but is still affected. But those in countries with higher inequality will have higher status anxiety than those with lower inequality

describe how exactly is social inequality having a negative impact?

• heightened levels of competition in a society

  • social evaluation anxiety — increased stress due to greater threats to self-esteem, social status, and fear of judgment

what is stigma

negative and discriminatory attitudes about a person or people based on some quality or characteristic

what is marginalization?

treatment of person or group as less important

describe the minority stress model

stigma, prejudice, and discrimination create a hostile social environment → increased stress for minorities and increased incidence of disease and illness

describe how and which population is minority stress primarily investigated in

african americans: higher rates of stroke, diabetes, perinatal disease, certain cancers, depression & substance use

2SLGBTQIA+ people: higher rates of immune dysfunction, some cancers, substance abuse, depression, anxiety, suicidal ideation

what are some of the sources of minority stress?

direct experiences of discrimination, prejudice, harassment

social stigma; internalized bias and stigma

rejection and expectations of rejection

hiding or concealing identity

describe the relationship between racism and health

racism places a substantial strain on the mental and physical health of targeted individuals

what is the mechanisms behind racism and health

institutional racism limits resources and opportunities

personal experiences of racism increases stress over time

describe resilience in black individuals after experiencing racism

racial socialization and racial identity are correlated with heightened resilience

subjective social status and perceived social support are correlated with greater resilience

racial identity clarity also matters

describe how trans stigma influence trans individuals’ health

trans people are at higher risk of suicidal ideation due to stigma and hate

in trans people, what is psychological well-being associated with?

personal control

support-seeking and social support

positive reappraisal

considering the populations discussed (indigenous, low-SES, racialized, and transgender/gender-diverse people)...

Are there any common themes that emerge (pertaining to factors in resilience)?

• Control over one’s identity and autonomy

• Social acceptance and support

• Equality matters, more equality is better

• Positive reappraisal

• Identity clarity

summarize the status-health relationship

how might disease threat affect inequality, discrimination, and other sources of division

inequality is exacerbated by socioeconomic disparities in disease threat

pandemics can either worsen inequality or reduce it