Determinants of Health Inequality and Inequity

Learning Outcomes

  • Describe the determinants of oral health

  • Differentiate between determinants of oral health, causes, and risk factors

  • Define and describe inequality and inequity in health and healthcare

  • Describe the life-course approach to health

Determinants of Health

  • Health determinants are underlying characteristics of societies that influence individual and community health.

  • Key Determinants Include:

    • Income and social status

    • Social support networks

    • Education and literacy

    • Cultural environments

    • Employment/working conditions

    • Physical environments

    • Genetics

    • Early child development

    • Age and gender

    • Health services

    • Health behaviors

Social Determinants of Health

  • Social Gradient in Health:

    • Includes life expectancy, chronic diseases (e.g., cardiovascular disease, cancers, oral health).

  • Key Points:

    • Factors such as poverty, social exclusion, discrimination, poor housing, and unhealthy childhood conditions work stress significantly affect health outcomes (WHO, 2004).

    • cultural, social, workplace norms can affect our health

    • unemployment, education. work environment, including job security, workplace culture, and access to resources, plays a crucial role in determining both physical and mental health outcomes for individuals.

Health Inequality and Inequity

Health Inequality

  • Definition: Differences in health status or the distribution of health determinants between various population groups.

    • Examples:

      • Mobility differences between elderly and younger populations

      • Mortality rates variance between social classes.

  • Context:

    • Some inequalities are due to biological variations or free choice (unavoidable health inequalities) while others stem from environmental factors beyond individual control.

Health Inequity

  • Definition: Unnecessary, unjust and unfair differences in health status due to unequal access to healthcare or ability to access care.leading to uneven distribution

    • Example: A salaried person with a painful tooth may choose different treatments compared to someone on a zero-hour contract. as contract may not be able to get time off without losing income

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WHO Commission on the Social Determinants of Health (2008)

  • Main Report Findings:

    • Health inequalities arise mainly from social, economic, and political factors.

  • Principles of Action:

    • Improve daily living conditions

    • Tackle inequitable distribution of power, money, and resources

    • Raise public awareness of health inequalities causes.

Lifecourse Analysis

  • Examines how early life events impact susceptibility to diseases in adulthood.

  • Life course epidemiology studies the long-term effects of exposures throughout an individual's life on health and disease risk in later life

Risk and Protective Factors

  • Protective Factors:

    • Healthy diet, supportive environment, good education, stable employment, quality housing, strong social networks.

  • Risk Factors:

    • Smoking, adverse childhood experiences, drug and alcohol misuse, poor educational attainment, poor mental health.

Public Health England - Health Inequalities Across the Life Course

  • Comparison Between Most and Least Deprived Deciles in England:

  • most deprived has higher rate of

    • Low birth weight

    • Infant mortality

    • Emergency hospital admissions for injuries

    • Overweight in youth

    • Youth justice system entries

    • Conceptions age under 18

    • mortality (death) from respiratory disease

    • mortality from all cardiovascular disease

    • mortality from causes considered preventable

    • suicide

Understanding Risk Factors

  • Risk Factor Definition: Personal characteristics, behaviors, or environments that increase disease risk, but not necessarily a causal factor

  • Types:

    • Modifiable: Environmental or behavioral (e.g., smoking, diet).

    • Non-modifiable: Intrinsic factors, not easily changed (e.g., age).

Protective factor decrease the likelihood that a disease will occur

Shared Risk for Chronic Diseases

  • Approaches to promote oral health through a common risk factor strategy

  • Risk factors - diet, stress, control, hygiene, tobacco, alchol, exerise, injuries

  • disease - obesity,cancer, heart disease, respiratory disease, dental caries, periodontal disease, trauma

Periodontal disease - stress, control, hygiene tobacco, smoking

Oral cancer - smoking, alcochol

Disadvantaged Environments and Health Inequality

  • Prevention of dental caries hinges on nutritional habits (control of free sugar intake) and hygiene practices (brushing, fluoride, flossing) established from a young age.

  • Social and cultural patterns + parental self efficacy influence the development of healthy routines.

  • supportive personal and community environment see these as normal and provide skills and materials to make these choices natural and accessible

Dental Caries in Children

  • Most Common Oral Disease: Dental caries in children leads to significant hospital admissions. increasing in extractions for children

The Causes of the Causes

  • Risk Factors:

    • Tobacco, diet, alcohol, hygiene, stress, (education, economic conditions.) —> lead to chronic disaease

Environmental Influences on Dietary Choices

  • Analysis of disconnect between dietary guidance and real-world food choices.

  • larger average resturant meal, sugary snack is normalised , and fast food options are often more accessible and affordable compared to healthier alternatives.

WHO Recommendations on Sugar

  • Sugars Intake Recommendations:

    • Reduce free sugars to <10% of total energy intake, further suggest reductions to <5%. = 25g of sugar per day for adult

Sugar Consumption in the UK

  • Average daily intake varies by age and gender, with significant differences noted. 11-18 years tend to have higher sugar intake. 65+ lowest

  • puberty? doesnt like to obey rules? less parental influence? start to have more control on their diet and daily life?

Sugar Tax as a Public Health Intervention

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  • Implementation: Tax on drinks with added sugar aimed at reducing obesity.

  • 24p on drinks containing 8g of super per 100ml

  • 18p a liter on those with 5-8g sugar per 100ml

  • exeptions - pure fruit juice, milk base drinks

  • manufactues are re formulating drinks

Inequality and Inequity in Oral Health

  • Health inequalities in oral health are influenced by inequity in access to dental services.

Variation in Dental Service Access

  • Disparities in dental care quality between socio-economic areas result in fewer treatments for disadvantaged communities.

  • children from disadvantage community - fewer carious teeth filled, less likely to have orthodontic care

  • despite its free for children in NHS

Considerations for Disadvantaged Communities

  • Issues leading to fewer fillings and orthodontic care for children in low-income areas.

  • 1. Limited access to dental care providers and transportation challenges that hinder regular visits to clinics. Long waiting list

  • less awareness and education about dental health practices, parents may not prioritize dental health due to competing financial or timerece constraints

  • parents prioritise other immediate needs over dental care

  • language barrier and cultural differnce

  • orthodontic care require consistent attendace and long term commitment - challenging for families facing instability

  • preception as cosmetic rather than essensial

Summary

  • Reviewed determinants of oral health, distinctions between causes and risk factors, definitions of inequality and inequity, and the life-course approach.