Chapter 5 - Health Equity and Social Determinants of Health

Influences of health

individual-dependent factors

• health diet + water intake

• physical activity

• avoidance of alcohol, cigarettes and illicit drugs

• adequate sleep (8-10 hr)

• lack of disease/stress

• general hygiene

Unhealthy

blame poor health solely on individual dependent factors

• poor diet/malnutrition

• sedentary/lack of exercise

• alcohol, tobacco, illicit drug use

• sleep deprived

• poor hygiene

Social determinants of health

non-medical factors that influence health outcomes

• conditions in which people are born, grow, live, work and age. shaped by distribution of money, power, and resources - responsible for health inequities

Myth on health

can’t assume all patients have the same opportunities or ability to make the same choices

Types of social determinants

• socioeconomic status : low-income/affordability

  • level of education, occupation

• race (black, latino and indian = decreased medical care)

• language barrier

• gender (women = decreased care)

• sexual orientation

• rural population

• marginalized populations : disabilities, substance use disorders, unhoused, immigrants, religious minorities

Health equity

absence of avoidable, unfair or remediable differences in health status among groups of people

• groups defined as socially, economically, demographically, geographically or other means of stratification

having a fair opportunity to attain full health potential

• needs health care equity, and addressing social and environmental factors (social determinants)

Health care equity

equitable access to and quality of health care services

• everyone can receive the health care they need to be as healthy as possible

Historical race health inequality

black men infected with syphilis withheld from penicillin vaccine, gynecological operations on immigrant women at US detention center

Racism

a system of structuring opportunity and assigning value based on the social interpretation of how one looks that unfairly disadvantages individuals and communities

AA and Latino with Physician

unequal care with poorer interpersonal communication, greater physician verbal dominance, less patient-centered, shorter visits

Systemic and structural racism

structures and policies that reinforce discriminatory beliefs, values and distribution of resources

• residential segregation

Equity First Paradigm

centers equity in core missions, values, goals to apply equity lens at the earliest stages of activities

Identifying and Intervening on Social needs

HCP to identify patients’ social needs with routine screening with questionaires

• help connect patients to community-based and government resources, alter treatment plan based on needs

Diversity, Inclusion and Anti-Racism

racial-ethnically diverse health workforce

Anchor Instiutions

hospitals and health systems are largest economic forces in communities, more intentionally use their economic power to advance social and health equity

Addressing the Political Determinants of Health

Health professionals to be advocates to promote health equity

Health inequities

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