[02.14] Social Determinants of Health V2.2.pdf

Structural determinants and conditions of daily life

What are responsible for a major part of health inequities between and within countries?

Conditions in which people are born, grow, live, work, and age

What do the Social Determinants of Health encompass regarding people's lives?

Distribution of money, power, and resources at global, national, and local levels

What primarily shapes the circumstances in which people live, according to the SDH framework?

Access to healthcare, schools and education, conditions of work and leisure, homes, communities, town and cities, and chances of leading a flourishing life

List some of the visible circumstances of people's lives that are considered social determinants.

Broad and complex array of social, political, economic, environmental, and cultural factors

What is the shorthand definition of social determinants?

Strong impact on health status and equity

What is the primary effect of social determinants?

Unfair and avoidable differences in health status seen within and between countries

What is the definition of health inequities?

Avoidable

According to the PowerPoint and external sources like WHO (2018), are health inequities avoidable or unavoidable?

Post-2015 sustainable development global agenda and the push towards progressive achievement of Universal Health Coverage (UHC)

Health inequities and social determinants are acknowledged as a critical component of what two global initiatives?

Addressed in an integrated and systematic manner

How do SDH and UHC need to be addressed to reduce health inequities?

Adopt improved governance for health and development; Promote participation in policy-making and implementation; Further reorient the health sector towards promoting health and reducing health inequities; Strengthen global governance and collaboration; Monitor progress and increase accountability

Name the five areas of action set out by the Rio Political Declaration to address health inequities.

World Conference on Social Determinants of Health in October 2011 in Rio De Janeiro, Brazil

Where and when was the Rio Political Declaration adopted by Member States?

65th World Health Assembly (WHA) in Geneva, Switzerland in May 2012

When and where was the Rio Political Declaration endorsed by the WHO Member States?

2007

In what year was the framework for social determinants of health and health inequities reported?

Governance, policy (macroeconomic, social, health), cultural and societal norms and values

What are the components of the socioeconomic and political context box in the SDH and Health Inequities Framework?

Education, occupation, income, gender, ethnicity/race

What factors comprise "social position" in the SDH framework?

Socioeconomic and political context, material circumstances, social cohesion, psychosocial factors, behaviors, and biological factors

Social position goes hand-in-hand with what other factors that contribute to healthcare and the distribution of health and well-being?

Health sector

What sector itself is also an important social determinant?

Inverse care law, providing differential treatment for marginalized groups, or impoverishing people through healthcare costs

How can health systems exacerbate health inequities?

Attention to SDH and guarantees fair financing mechanisms (e.g., prepayment) and social protection for all groups

What is required for implementing universal coverage, beyond just healthcare services?

Health inequities continue to widen even as average health status often improves

What has the increase in knowledge shown regarding health inequities, putting them at the forefront of the health policy agenda?

Governance structures that enable intersectoral action

What is necessary for the role of governance and leadership in SDH?

Consider SDH and be informed by the status of health inequities in their jurisdiction

What do health leaders need to do regarding SDH?

Allow groups who are disadvantaged to claim more power to press their claims for better health

What is one outcome of health leaders being informed by the status of health inequities?

COVID-19 pandemic, where A1 group (medical frontliners) were first to be vaccinated, followed by senior citizens and those with comorbidities

Provide a recent example of prioritizing certain groups in health, as seen in the context of SDH.

Moving from offering top-down solutions to negotiating between different partners and facilitating participatory democracy

How is health leadership being reconfigured?

An important approach to organizing society, including health systems, with the aim of achieving health equity

What is Primary Health Care?

It is owned by and thus starts with health systems

Why is it important to have good governments in health systems regarding PHC?

Intersectoral action and public policy

How does PHC consider how the rest of society can support health systems to reduce health inequities?

Universal coverage reforms, social or service delivery reforms, leadership reforms, and public policy reforms

Name the four primary health care reforms necessary to refocus health systems towards Health for All.

Improve health equity

What is the aim of universal coverage reforms in PHC?

Make health systems people-centered

What is the aim of social or service delivery reforms in PHC?

Make health authorities more reliable

What is the aim of leadership reforms in PHC?

Promote and protect the health of communities

What is the aim of public policy reforms in PHC?

Primary Health Care (PHC)

What was presented as a tool to reach health for all by the 1978 Alma Ata Declaration?

The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries, as politically, socially, and economically unacceptable

What was identified as a major driver for PHC in the Alma Ata Declaration?

Health sector, agriculture (for food security), animal husbandry, food, industry, education, housing, public works, communications, and other sectors

Beyond the health sector, what other related sectors and aspects of national and community development did PHC involve, according to the Alma Ata Declaration?

Pan American Health Organization

During which organization's meeting was the 2005 Declaration of Montevideo released?

Reiterated the support for Primary Health Care

What was the main outcome of the 2005 Declaration of Montevideo?

Central focus on health equity

What is a key commonality between PHC and SDH paradigms regarding their main objective?

Relevant in all countries and contexts

What is a key commonality between PHC and SDH paradigms regarding their applicability?

Health as more than the absence of disease

How do both PHC and SDH paradigms define health?

Key role for the health sector

What is a key commonality between PHC and SDH paradigms regarding the health sector?

Promotion of multisectoral action and consideration of health in all policies

What approach to policy and action is common to both PHC and SDH paradigms?

Emphasize the role of empowered communities and the social environment

What is a key commonality between PHC and SDH paradigms regarding community involvement?

COVID-19 pandemic

What recent event serves as a good example of how health can impact all other sectors in society, illustrating a commonality between PHC and SDH?

Halving extreme poverty rates to halting the spread of HIV/AIDS and providing universal primary education

What were some of the key targets of the Millennium Development Goals?

2015

What was the target date for achieving the Millennium Development Goals?

Blueprint agreed to by all the world's countries and leading development institutions

What did the MDGs form?

Sustainable Development Goals (SDGs)

What were the MDGs later converted into?

September 2015

When did world leaders commit to the Global Goals for Sustainable Development?

17

How many goals are included in the Sustainable Development Goals?

End extreme poverty, fight inequality and injustice, and fix climate change

What three extraordinary things are the 17 SDGs aimed at achieving in 15 years?

Help them become the generation that changed the world

What is the intended impact if every school in the world teaches children about the SDGs?

Several social and structural factors

Why are even simple and effective tools like vaccines against childhood diseases unable to reach those most in need?

Broader approach that addresses the social determinants to reduce inequities in programme performance and health outcomes

What kind of approach is called for to address the ineffectiveness of technologies in reaching the most needy?

Intersectoral action, community participation, and empowerment of populations that are most vulnerable to health threats

What are the key components of the broader approach needed to address social determinants in public health conditions?

Primary Health Care (PHC)

What tool is referred to as a means to reach health for all, according to the analytical framework?

Check and Balance approach

What kind of approach does the Priority Public Health Conditions Analytical Framework utilize?

Socioeconomic context and position, differential exposure, differential vulnerability, differential health outcomes, and differential consequences

What five main areas does the middle section of the analytical framework posit us to analyze?

Society

What does the analysis of "socioeconomic context and position" relate to in the framework?

Social and physical environment

What does the analysis of "differential exposure" relate to in the framework?

Population group

What does the analysis of "differential vulnerability" relate to in the framework?

The very young and the very old, and other affected aspects (e.g., women and children)

What groups are usually considered vulnerable sectors in the analytical framework?

Individual

What does the analysis of "differential health outcomes" relate to in the framework?

Individual

What does the analysis of "differential consequences" relate to in the framework?

Correct the implementation of an intervention

What is the purpose of the Intervention-Implementation Two-by-Two Matrix?

Iterative

What kind of process is described for intervention and implementation in public health?

Translated into concrete action and implemented at the scale of populations

What must ideas and concepts be to have meaning in public health?

Transition from the drawing board, the experiment, or the pilot project into the real-life situation

What phase has challenged many public health or healthcare programmes?

Pilot testing

What is very important in order to plan for any challenges that may come your way during program implementation?

Programmes address social determinants of health conditions, and how health is distributed in a population

When is pilot testing particularly true and important?

COVID-19 pandemic: testing and distribution of vaccines

Give an example of a program where real-life challenges were evident during intervention implementation.

Fundamental structures of societies, including who controls power and resources

What will public health programmes inevitably have to deal with?

There may be a range of nuances that belongs in the gray area

In the real world of public health, why is there no such thing as 100% right or 100% wrong in interventions?

Be flexible, monitor, and evaluate interventions

What three actions are necessary given the nuances in real-world public health interventions?

When going to scale (from experiment/pilot project to full-scale intervention) and when the programme is to be sustained (e.g., Project Sustainability, to be funded and institutionalized for the long term, and to operate without day-to-day involvement of those who conceived it)

What are two critical phases in most public health programmes?

Intersectoral action

What is key to success in improving the social determinants of health?

Health promotion experts

Who has been aware of the importance of intersectoral action for a long time?

Communication for Behavioral Impact (COMBI)

Through what method can intersectoral action for improving SDH be achieved?

Problem identification, community dialogue to set up an action plan, execution of community programs, and monitoring and evaluation

List the four-cycle problem-solving approach mentioned in the context of intervention and implementation.

Planning framework and implementation method for communication

What is COMBI in relation to social determinants of health?

Behavioral models, communication, and marketing theory and practice

What is COMBI based on?

Achieve behavioral results in public health programmes

What is the primary goal of COMBI?

Communication has to come from the cultural context of the community we are serving and needs to be aligned to serve those who are vulnerable in the community

What are two important considerations for communication in the context of SDH, according to COMBI?

Behavioral aspects and social aspects

What two aspects of disease prevention and control does effective, strategically applied communication address?

Reveal potential routes for amplification and transmission embedded in deep-seated cultural practices

What unique insight can COMBI provide, especially critical to outbreak control?

Outbreaks

Traditionally, during what specific situations has COMBI been used?

Consumer communication, linking education and information with marketing

From what does COMBI stem?

"Zero base"

From what starting point does COMBI begin, meaning nothing can be assumed?

Through market research, barriers and constraints that prevent people from choosing to adopt healthy behavior are identified

How are barriers to healthy behavior identified in COMBI, given its "zero base" approach?

Communication staff, health education staff, health promotion staff, information staff, education staff, and communication and social mobilization staff

List some of the staff who can use COMBI.

Appropriately applied and able to contribute to achieving tangible results

What two qualities does COMBI ensure communication possesses?

Constructed opportunities for learning, involving some form of communication conducive to individual and community health

What is health education?

Improve health literacy, improve knowledge, and develop life skills

What are health education opportunities designed to do?

Degree to which people can access, understand, appraise, and communicate information to deal with different health situations

What is health literacy?

Promoting and maintaining good health across the lifespan

What does health literacy contribute to?

Comprehensive approach to increase individual and collective participation in health action by integration of various methods

What is health promotion?

Improving individual knowledge and skills through health education, information, and communication

What is one role of health promotion in COMBI related to individual capabilities?

Strengthening community action through social mobilization

What is one role of health promotion in COMBI related to community action?