L.4-6 Modeling Determinants of Populaiton Health

How do we explain health status?

• By referring to factors that affect health of individuals and populations

• AKA determinants of health

Determinants of health vs. Health problems?

• determinants are associated with health problems but aren’t themselves health problems

What is the epidemiological triad?

• Host

• Agent

• Environment

What is etiology?

What are limitations of the epidemiological triad?

• diseases are complex

• The effects of social determineants of health are not taken into account

• Prevention vs managemnet

What was “a new perspective on the health of Canadians— the Lalonde report,1974”

It focused on health promotion and lifestyle issues

What is population health?

• addresses the entire range of facotrs that determine health rather than focusing on risks and clinical facotrs related to particular diseases

• Examining facotrs affecting the entire population rather than only ill or high-risk individuals

What are the determinants of health according to PHAC

• income and social status

• Social supports and coping skills

• Education and literacy

• Employment and working conditions

• Physical environments

• Biology and genetic endowment

• Healthy behaviours

• Healthy child development

• Access to health services

• Gender

• Culture

• Race/racism

How does income and social status effect health

• socioeconomic status and health outcomes is a persistent theme in population health research

• High socioeconomic status and smaller gaps in income equalities are associated with better health

• Populations with a smaller distribution of wealth tend to be healthier

• Within a truly fair system, having more money would NOT be a deciding factor of if you live longer than someone with less money

How does education and literacy effect health

• healthy lifestyle and practices

• Better access to information, services and resources to cope with health problems

• Less error in the use of medications

• More likely to have a good paying job

• Less likely to live in poverty

How does social support affect health? Types of support?

Support from families friends and communities is associated with better health

Emotional, instrumental (borrowing car, money, pen), instrumnetal (having info to care for self)

what are social environments?

• family, peers, community

• Strength of social networks within the community (quality of relationships)

• Values and norms of a society (recognition of diversity)

• Safety

• Good working relationships

How does employment/working conditions effect health

• high levels of economic instability is associated with mental health problems and physical illnesses among unemployed individuals and their families

• Working conditions affect health and well being

What is social participation? What are the benefits? Who/ what age group benefits most from it?

• Participating in activities that provide interaction with others in society or the community

• Longer survival

• Lower morbidity

• Better self rated health decreased risk of diability and function and mobility decline

• Decreased likelihood of depression

• Decreased risk of cognitive decline and dementia

• Imporved overall wellbeing

• Impacts of social participation increase with age

• Most profound health effects observed among older women

• Social participation is seen as a determinant of health

What are determinants of active aging?

Participation

Health

Security

How does healthy child development effect health

• early experiences affect brain development, school readiness and health in later life

How does access to health services effect health

• timely access effects health

• Limited access for low/mid income Canadians including older adults to eye, dental, and mental health care

How does gender effect health

• society-determined roles, personality traits, attitudes, behaviours, values, relative power and influence that society assign to men and women on a differential basis

• Health disparities Between genders

How does culture effect health

• all behaviours, ways of life, arts, beliefs and practices that are passed down to the next generation

• Cultural appropriate care/ services

What is the impact of the déterminantes of health overall

• working together to decide the health of individuals and communities

What is a life course approach to health?

• studying the long term effects of exposures during gestation childhood, adolescence, and adulthood on disease risk

What is the sensitive period model

• certain life stages or life transitions are more sensible periods when exposures have stronger effects on health compared to other times in life

What is the accumulation model?

• focus on the duration of accumulation of exposure across the life course which relates to disease risk and negative health outcomes later in life

What is the pathway model?

• the focus on a sequential link between multiple exposures

What is social mobility model?

Focuses on the direction of change with social exposures representing states that individual can move in and out of

What are the social determinants of health

• The economic and social conditions or living conditions that shape our health

• They are individual and structural factors

Wilkinson and marmot SDOH

• social gradient

• Stress

• Early life

• Social exclusion

• Work

• Unemployment

• Social support

• Addiction

• Food

• Transportation

US centres for disease control and prevention SDOH

• socioeconomic status

• Transportation

• Housing

• Access to services

• Discrimination by social groupings

• Social or environmental stressors

12 SDOH identifies by they organizers of the York university conference Canada

• aboriginal status

• Early life

• Education

• Employment And working conditions

• Food security

• Gender

• Health care services

• Housing

• Income and its distribution

• Social safety net

• Social exclusion

• Unemployment and employment security

What has proximity to green spaces shown in relation to the health of an individual?

• when in closer proximity health is increased

What are the two SDOH that are most important according to PHAC? Why?

• social status

• Economic status

• Well documented that SES disparities are linked to health disparities

What is the difference in lifespan between Q1 and Q5 of wealthiest neighbourhoods for men

• men in Q1 live an average of 4 years longer than men in Q5

What is the difference in lifespan between Q1 and Q5 of wealthiest neighbourhoods for women

• Women in Q1 live an average of 2 years longer than women in Q5

How did lower SES affect Winnipeg residents benefit from prenatal care?

Winnipeg residents with lower SES were less likely to benefit from prenatal care compared to those from more socially advantaged groups in the city of Winnipeg

Define health disparities/inequalities

Differences in health

Define health inequities

Differences in health between groups of people who are more and less advantaged socailly. These differences place socially disadvantaged groups at further disadvantage on health

What does the WHO acknowledge for addressing health inequities

• it requires routine monitoring systems

• An emphasis on health inequities and the social determinants of health

What is Healt surveillance

• Tracking and predicting of any health event or health determinant throughout the continuous collection of high quality data

• From the data integrating findings into reports, alerts, advisories and warnings for the general public