lecture recording on 27 February 2025 at 13.43.57 PM

Introduction

• Discussion on inequality, social gradient, and social class in relation to health determinants.

• Upcoming topics include race and issues related to sex, gender, and sexuality.

Social Determinants of Health

Overview

• Context by Wilkinson and Marmot, British researchers addressing social class and inequality.

• Emphasis on the social gradient: not just comparing wealth extremes but rather seeing it as a stepwise ladder of resources and health outcomes.

• Key finding: life expectancy decreases and negative health conditions increase as one moves down the social ladder.

Whitehall Studies

• Longitudinal cohort study tracking UK government employees, analyzing health across job grades.

• Findings illustrate differences in health even within adjacent job ranks, showing relevance in broader health discussions.

Stress and Health

• Chronic stress caused by social conditions negatively affects health (cortisol's impacts on cardiovascular and immune health).

• Early life factors: Prenatal development influences lifetime health through nutrition and caregiver engagement.

• Importance of maternal and child health programs: strong correlation between early life conditions and lifelong health.

• Discussion to include breastfeeding benefits later in the semester.

Social Exclusion

Definition and Impacts

• Social exclusion leads to hardship, resentment, and health issues.

• Relative poverty: even 60% of median income can restrict access to essential resources like housing and education.

• Conditions of living are critical for social participation and health, especially risky during pregnancy, childhood, and for the elderly.

Discrimination and Health

• The intersection of discrimination exacerbates social exclusion, leading to material and psychological health costs.

• Dose-response relationship: deeper analysis of the longer individuals experience disadvantage, the greater health consequences they suffer.

Work and Health

Work Environment

• Work plays a crucial role in health, with the standard in the U.S. being 40 hours weekly.

• Lack of control over work contributes to negative health outcomes (back pain, cardiovascular issues).

• Recognition and compensation for work impact cardiovascular health risks.

Autonomy at Work

• Positional autonomy improves health outcomes: examples from academic roles provide contexts of flexibility and control over tasks.

Unemployment

• Job security correlates with overall health and well-being.

• High unemployment rates contribute to health deterioration, anxiety over job security is detrimental as well.

Social Support

Importance of Social Networks

• Strong relationships improve individual and community health outcomes.

• Emotional and practical resources from social networks can alleviate various life challenges.

Social Cohesion

• Defined as trust and mutual obligations within communities, with health implications tied to its presence or absence.

Health Equity Recommendations (from Michael Marmot)

• Recommendations to improve living conditions, tackle inequitable distribution of resources, and measure impact.

• Notably, healthcare access is not the primary focus; structural and social factors must be addressed.

Social Gradient Graph

• Graph demonstrative: Comparing life expectancy and disability-free life expectancy across different socioeconomic neighborhoods.

Structural Impact on Health

Levels of Influence

• Individual factors (age, sex) to lifestyle behaviors, community networks, and larger societal conditions.

• Understanding how these layers relate to overall health outcomes.

Inequalities as Disease Agents

• Inequalities are seen as causes of diseases, necessitating change to social structures impacting health.

Social Structures and Health Changes

Top-Down vs. Bottom-Up Approaches

• Definitions of top-down policies (e.g. legislation) versus bottom-up community-driven initiatives (e.g. mutual aid).

• Historical examples of these approaches effectively changing structures to improve health outcomes.

Group Discussions

Social Structures Impacting Health

• Groups assigned to explore law, social class, economy, religion, and family as social structures influencing health.

• Focus on how each can be tweaked to improve overall health or address vulnerable populations' needs.

Conclusion

• Emphasis on collective ability to change social structures for improved health outcomes.

• Insight into response motivations and resistances to structural changes.

• Encouragement to reflect on galvanizing events for societal shifts and the role of social justice in health.