Social Determinants of Health and Cultural Diversity

Social determinants

Circumstances in which people grow, live, work and age, and the systems put into place to deal with illness. The conditions in which people live and die are in turn shaped by political, social and economic factors

Social conditions

Most important determinant of good or ill health - income, education, conditions of employment, power, social support

Key concepts making up social determinants

Social class, gender, culture and ethnicity

Barriers to health

Inadequate services, inadequate policies and standards, negative attitudes and structural bias, lack of accessibility and resources, exclusion from decision making

Name social determinants of health

Income and social protection, education, unemployment and job insecurity, working life conditions, food insecurity, housing/basic amenities/environment, social inclusion and non discrimination, structural conflict, access to affordable health services of decent quality

Determinants of health for First Nations People

Cultural identity, family and kinship, country and caring for country, knowledge and beliefs, language and participation

Socioeconomic and environmental factors affecting First Nations People

Education, employment, income, housing, accessing community resources

Health risks for First Nations People

Obesity and alcohol consumption

Historical factors affecting First Nations People

Racism, structural inequality, culturally safe care, past government policies

Political factors affecting First Nations People

Political determinants, local history of colonisation

Cultural factors affecting First Nations People

Maintain practices, values, beliefs and traditions

The health gap

Disparities in health outcomes, 35 percent explained by social determinants of health

Culture

Sharing of values, beliefs, practices and behavioural norms without a specific group of people, giving them a common identity

Cultural competence

Understanding culture in the context of how people choose, access and respond to healthcare

Impacts of cultural beliefs and customs on healthcare

Gender and modesty, respect for authority (patriarchal or religious authority), religious practices, death and dying rituals, punctuality, blood transfusions, customs around food and eating, ethnicity differences

Impacts of cultural health understandings and behaviours on heatlhcare

Consent, touch/physical closeness/physical positioning, eye contact, hand gestures, expressions of pain, compliance of treatment, tradition vs western medicine

Cultural competency in healthcare teams

Culturally diverse staff, translators, culturally safe training, culturally appropriate signate and instructional literature, culturally specific heatlhcare

Cultural competency in health care benefits

Patient satisfaction, trust, reduction inequalities, better health outcomes, increased attendance and compliance

Developing cultural competency requires:

An understanding of personal attitudes, beliefs, values, biases, prejudices and judgements

Social class - income (key concepts of sdh)

Lower income = worse health, less likely to engage in healthcare, higher usage of health services, experience material disadvantage

Social class - education aged 25-64 without post school qualifications (key concepts of sdh)

Rated own health more poorly, higher incidences of illness, more likely to engaged in health risk activities, more likely to report risk factors such as obesity

Social class - occupation (key concepts of sdh)

Poor health in 9 percent employed vs 15 percent unemployed, professionals have highest proportion of self assessed good health, labourers have lowest proportion of self assessed good health and higher poor health

Gender (key concepts of sdh)

Female life expectancy higher than males, more male deaths than female, men more likely to be exposed to health risk factors, women are sicker in men in terms of illness, women have a greater use of prescribed or over the counter medications

Culture

Values, believes, practices and material objects that constitute way of life, ideas, practices values and customs learned through interactions with ones social group, community or nation state

Ethnicity

Collection of people sharing distinctive cultural heritage and a sense of shared identity, health of migrants decreases as length of residency increased, socioeconomically disadvantaged ethnic groups have higher rates of mental health disorders and lower rates of satisfaction