social determinants of health - 23

what are determinants

most appropriately defined as causal

factors, and variations in these factors are followed

systematically by variations in a behaviour.

what are correlates

factors associated with a behaviour but the

relationships are not necessary causal

what is the Relationship between determinants, health behaviours

and health outcomes

What does social determinants of health mean?

• Circumstances in which people are born, grow up, live, work

and age.

• These circumstances shape a set of socioeconomic positions

within hierarchies of power, prestige and access to resources.

• Several structural mechanisms are responsible for creating the

differential social positions of individuals

– governance,

– education systems,

– labour market structures,

– welfare policies.

what is health inequality

occurs when there are

differences in experiences or outcomes

between different populations

what is health inequity

attribute these differences to

systematic disadvantages that are potentially

remediable and considered to be unequal and

unfair

what are four examples of health inequities between countries

• the infant mortality rate (the risk of a baby dying between

birth and one year of age) is 2 per 1000 live births in Iceland

and over 120 per 1000 live births in Mozambique.

• the lifetime risk of maternal death during or shortly after

pregnancy is only 1 in 17, 400 in Sweden but it is 1 in 8 in

Afghanistan.

• in Bolivia, babies born to women with no education have

infant mortality greater than 100 per 1000 live births, while

the infant mortality rate of babies born to mothers with at

least secondary education is under 40 per 1000 live births.

• life expectancy at birth among indigenous Australians is

substantially lower (59.4 for males and 64.8 for females) than

that of non-indigenous Australians (76.6 for males 82.0, for

females).

what are the key concepts of a social gradient

• Between countries, the poorest of the poor, around the

world, have the worst health.

• Within countries, the evidence shows that in general the

lower an individual’s socioeconomic position the worse their

health.

• There is a social gradient in health that runs from top to

bottom of the socioeconomic spectrum.

• This is a global phenomenon, seen in low, middle and high

income countries.

• The social gradient in health means that health inequities

affect everyone.

what is the whitehall 1 study

• The Whitehall I Study, a prospective cohort study of male civil

servants (government workers), was set up in 1967 to

investigate the causes of heart disease and other chronic

illnesses.

• Researchers expected to find the highest risk of death from

heart disease among men in the highest status jobs

(Administrator or Manager)

what is the whitehall 2 study

• Followed ~10,000 non-industrial civil servants (men and

women) in London, England aged between 35 and 55 from

1985 onward

• Have shown that low job status is not only related to a higher

risk of heart disease:

– Chronic diseases(e.g., some cancers)

– Mental health (e.g., depression, suicide)

– sickness absence from work

– Overall health (e.g., self-reported health)

what do income and income distributions effect

• Shapes overall living conditions

• Food Security

• Affects psychological functioning

• Influences health-related behaviours

- Quality of diet

- Extent of physical activity

- Tobacco use

- Excessive alcohol use