The Solid Facts: Social Determinants of Health & Health Inequities

Comprehensive vocabulary flashcards covering the social determinants of health, the Whitehall studies, race and health disparities, structural racism, and public health activism.

Social determinants of health (SDOH)

The non-medical, environmental, and socioeconomic conditions in which people are born, grow, live, work, and age, which are shaped by the distribution of money, power, and resources.

What are the seven major SDOH?

1. social gradient

2. stress

3. early life

4. social exclusion

5. work

6. unemployment

7. social support

Social gradient

The systematic pattern where life expectancy is shorter and most diseases are more common the further down the social ladder an individual is, demonstrating that health is shaped by relative socioeconomic circumstances across the whole population rather than extreme deprivation alone.

why is stress a SDOH?

1. Stress diverts energy and resources away from physiological processes important to long-term health maintenance

in the early life SDOH, what are the two major pathways?

1. during pregnancy

2. during infancy

in infancy, what are the two major pathways?

1. Insecure attachment & poor stimulation → reduced school readiness → low educational attainment + problem behavior later in life

2. Poor physical health → reduced cardiovascular, respiratory, pancreatic & kidney development + function → increased risk of illness in adulthood

what is a example of social exclusion?

1. Example: Someone experiencing homelessness may be excluded from employment opportunities and struggle to access healthcare because they lack a permanent address.

what are the two ways work can effect your health?

1. little control over work

2. receiving inadequete rewards

Social cohesion

The level of trust within a community and the quality of social relationships that provide people with mutual support and necessary connections for education and transportation.

what are the two different types of poverty?

1. absolute poverty

2. relative poverty

Absolute poverty

A condition of severe deprivation affecting approximately $10\%$ of the world population, defined by international poverty lines such as $\$3$ a day set by the World Bank, $\$4.20$/day for lower-middle income countries, $\$8.30$/day for upper-middle income countries, and $\$43.73$/day for an individual in the United States.

Relative poverty

Poverty assessed in relation to the prevailing living standards and economic inequality of the surrounding society, emphasizing unequal distribution rather than absolute physical deprivation.

Gini coefficient

A statistical metric that measures income inequality on a scale from $0$ to $1$, where higher values represent greater levels of income inequality.

Bottom-up organization

Grassroots community organizing initiated from the local population to drive change in health outcomes.

Top-down organization

Structural health interventions and policy changes that originate from the highest authority levels, such as governmental policies.

Social capital

Networks of trusting relationships that allow community members to support one another and access opportunities, which declines in societies with high income inequality.

Whitehall studies

A series of longitudinal investigations directed by Michael Marmot and named after a London neighborhood, designed to examine the impact of the social gradient and occupational hierarchy on health.

Whitehall I

A $1967$ cohort study of $19{,}000$ male British civil service employees followed for $33$ years across six job grades, finding that men in the lowest grade had three times higher mortality than those in the highest administrative grade, particularly for coronary heart disease.

Whitehall II

An ongoing longitudinal study initiated in $1985$ with over $10{,}000$ male and female civil servants, tracking psychosocial factors such as work stress and work-family conflict in relation to heart disease, diabetes, aging, and dementia.

Racial hypodescent

The social rule assigning a child of parents from two different races to the lower-status racial category, historically used to justify the enslavement of children born to enslaved mothers and white slaveholders.

Race

A socially constructed status often treated as biological, formed when societies create classification categories based on selected physical traits and attach social meaning and hierarchy to them.

Ethnicity

A social identity defined by the cultural salience attached to geographical birthplace, shared language, and religion.

Nativity

A demographic status determined specifically by whether an individual was born inside or outside of the United States.

Raciogenetic pathway

A causal model that attempts to explain racial disparities in health outcomes by attributing them to underlying genetic differences in disease susceptibility between racial groups.

Lived experiences pathway

A causal model explaining racial health inequalities through the chronic accumulation of everyday environmental exposures, socioeconomic stressors, systemic discrimination, and inadequate healthcare.

Heterozygote advantage (Sickle-cell trait)

A biological survival benefit where individuals carrying one normal allele and one sickle-cell allele ($AS$) acquire resistance against the malaria-causing Plasmodium parasite without developing sickle-cell anemia.

Race correction (Spirometry)

An algorithm built into modern pulmonary lung function software that automatically adjusts calculations based on the assumption that Black individuals have $20\%$ less lung capacity than white individuals.

Winnie Byanyima

The Executive Director of UNAIDS and former 11-year member of Uganda's parliament who advocates for gender equality, debt restructuring, and healthcare as a fundamental human right.

Apartheid

An institutionalized system of racial segregation and discrimination enforced by the National Party in South Africa from $1948$ to $1994$ to maintain political supremacy, cheap labor, and land ownership for the white minority.

Everyday Discrimination Scale (EDS)

A 9-item psychometric self-report survey developed in $1997$ by Dr. David R. Williams and colleagues, rated on a 6-point Likert scale to measure routine, chronic interpersonal discrimination and microaggressions.

Equality

An approach in which all individuals receive identical resources or treatment regardless of differing baseline circumstances or barriers.

Equity

An approach in which resources and assistance are distributed proportionally according to specific needs and systemic barriers to ensure all people have a fair opportunity to achieve optimal outcomes.

Health inequality

Any measurable difference or disparity in health status or health outcomes between individual populations or groups.

Health inequity

A specific type of health difference that is unjust, unfair, and preventable through policy and structural changes.

ACT UP (AIDS Coalition to Unleash Power)

A grassroots activist group that adapted nonviolent civil disobedience strategies from the civil rights movement to combat government neglect during the HIV/AIDS epidemic and frame access to treatment as a human right.

Accelerated Approval process

An FDA regulatory fast-track procedure created in response to AIDS activist pressure that permits the approval of life-saving medications based on surrogate biological endpoints (such as T-cell counts) rather than waiting years for survival endpoint data.