N1190B WEEK 2
Intersectionality and the Social Determinants of Health
Week 2 Overview
In this week’s segment, we focus deeply on how intersectionality intersects with health outcomes, emphasizing the vital role social determinants play in shaping these outcomes. Understanding that health is not solely a result of biology but heavily influenced by social factors is crucial in health advocacy and public policy.
Agenda
The Social Determinants of Health: Explore various social factors that influence health, including socioeconomic status, education, and access to healthcare.
Understanding Intersectionality: Examine the concept of intersectionality and how it relates to varying health outcomes based on interconnected social identities.
Self-reflection on Personal Identities: Engage in reflective practice to understand how our own identities and privileges shape our perceptions and experiences of health.
Power Dynamics and Interactions Involving Privilege and Oppression: Analyze the power structures that influence health disparities and the concept of privilege.
A Case Study for Practical Understanding: Review a real-world example that highlights the impact of social determinants and intersectionality on health outcomes.
Importance of Advocacy and Awareness: Discuss the need for continual advocacy to address systemic inequalities affecting health and policy recommendations for improvement.
Intersectional Approach
An intersectional perspective acknowledges that social identities - including race, gender, class, and sexual orientation - exist within macro systems of power. This perspective recognizes that individuals can face multiple forms of oppression simultaneously, leading to complex experiences. It is normal to feel discomfort during discussions about privilege; however, it is essential to differentiate this discomfort from genuine feelings of unsafety in discussions of societal inequities.
Social Determinants of Health
Key categories affecting health include:
Economic Stability: Income level directly influences access to resources such as nutritious food, healthcare, and stable housing.
Education Quality: Educational attainment impacts health literacy and job opportunities, which in turn affect health outcomes.
Healthcare Access and Quality: Availability and quality of healthcare services are critical for maintaining health, reflecting disparities based on geographic location and socioeconomic status.
Neighborhood and Built Environment: Quality of the environment where individuals live, including access to safe housing, clean water, and recreational spaces.
Social and Community Context: Social networks and community support systems can affect mental health and overall well-being.
Comprehensive List of Social Determinants
Health Care Access: Includes availability, affordability, and acceptability of care.
Quality of Neighborhoods and Community Stability: Safe environments contribute to better health outcomes.
Economic Factors: These influence housing, education, and employment opportunities.
Additional Influences: Health literacy affects the ability to navigate health systems, transportation allows accessibility to healthcare, and income levels impact overall quality of life.
Support Systems: Social support networks play a pivotal role in health outcomes, providing emotional and practical assistance.
Health Care System Insights
From a Canadian Perspective:
The health of Canadians is largely influenced by living and working conditions, overshadowing the importance of merely medical treatments.
This perspective is encapsulated in the reference publication: Social Determinants of Health: The Canadian Facts (Raphael et al., 2020).
Further Insights into Social Determinants
Influential factors that shape health outcomes include:
Income Distribution: Disparities in income levels strongly correlate with health outcomes.
Education Levels: Higher education often results in better health literacy and job security.
Employment Status and Job Security: Job insecurity contributes to stress, affecting both mental and physical health.
Early Childhood Development: Critical stages of development greatly influence future health trajectories.
Food Security and Housing Quality: Directly correlated with health outcomes; lack of safe housing or food can lead to various health issues.
Social Inclusion/Exclusion Dynamics: Social isolation can lead to negative health effects, while inclusion promotes healthier outcomes.
Geography: Where individuals live dictates their access to health resources and potential exposure to health risks.
Effects of Income & Income Distribution
Income is a fundamental determinant of health. Low-income individuals often encounter barriers to accessing essential resources, including nutritious food, healthcare, and education. Income inequality can lead to higher rates of preventable health issues, with estimates suggesting potential links to approximately 40,000 premature deaths annually in Canada alone.
Groups at Higher Risk of Poverty
Lone-parent families: Particularly those led by single mothers.
Youth and children: At greater risk due to family economic instability.
Individuals with disabilities/mental health issues: Face additional barriers in access and opportunities.
Indigenous peoples: Often experience systemic inequalities affecting their health status.
Newcomers and marginalized ethnic groups: Frequently encounter discrimination and reduced access to resources.
Policy Implications on Income Inequality
Addressing income inequality is crucial for fostering equitable health outcomes. Recommendations for policy improvement include:
Increase Minimum Wage: Providing a living wage is essential for supporting families.
Support Levels for the Unemployed: Safety nets must be in place to assist those without jobs.
Investment in Public Services: Enhancing services like childcare and education is vital for reducing disparities.
Education's Impact on Health
Quality education is linked to better health outcomes. However, cost barriers often prevent many from pursuing higher education, adversely impacting long-term health literacy and socioeconomic mobility. Policy changes are necessary to ensure adequate funding for education and to control rising tuition fees to improve access.
Employment and Job Security
With rising job insecurity, the prevalence of precarious work is increasingly affecting mental and physical health. Employment conditions—including stress from job instability—significantly influence overall well-being.
Early Childhood Development
The significance of early years cannot be overstated; stages of development are critical for future health outcomes. Healthy attachments, access to quality childcare, and stimulating environments lay the groundwork for lifelong health.
Housing Conditions
Quality housing is directly correlated to health outcomes. Poor housing conditions, such as those with mold or vermin, can lead to chronic health issues and exacerbate stress.
The Role of Geography
Geographical location significantly affects health, dictating access to resources such as healthcare and exposure to environmental hazards, affecting overall wellness.
Built & Natural Environment
The differences between rural and urban living have substantial health implications. Rural areas often have less access to healthcare services, while urban settings may pose risks associated with pollution but offer greater accessibility to various services.
Social Inclusion vs. Exclusion
Exclusion from social and cultural activities can exacerbate health disparities. Vulnerable groups—who face higher unemployment rates and marginalization—are particularly at risk for adverse health outcomes.
Food Insecurity
There is a direct correlation between food insecurity and adverse health outcomes. Alarmingly, food insecurity is increasing in Canada, as evidenced by rising food bank usage statistics.
Stress and Health
Chronic stress arising from adverse socio-economic conditions leads to hormonal imbalances and immune system disruptions, substantially raising the risk of numerous diseases.
Healthcare Services
In Canada, while healthcare is provided, not all costs are covered. Vulnerable populations may struggle with out-of-pocket expenses, making it challenging to access necessary health services.
Health Literacy
Health literacy is essential for effectively navigating health systems and is significantly influenced by level of education and cultural context.
Racism as a Health Determinant
Experiences of marginalization and lack of access to culturally competent care can lead to dire health outcomes. Racism extends beyond healthcare to affect several other sectors, including housing, education, and labor markets.
Gender and Health
Gender identity and societal roles play a critical role in health outcomes; individuals identifying as transgender may avoid seeking healthcare due to experiences of stigma and discrimination.
Reflective Practice
Engaging in reflection on personal experiences related to social determinants and considering policy impacts is crucial for health professionals to understand the broader context of health.
Intersectionality Overview
Intersectionality provides a framework for exploring how identity influences experiences of both privilege and oppression. This multifaceted approach acknowledges that diverse social factors interplay to shape individual experiences and health outcomes.
Key Terms Defined
Power: The capacity to affect decision-making processes and exert influence over others.
Privilege: Advantages that individuals may have due to specific aspects of their identity not afforded to others.
Oppression: Systematic barriers to accessing power or privilege that arise from one's social location.
Intersectionality: The interconnected nature of social categorizations such as race, class, and gender, which create overlapping systems of disadvantage or discrimination.
Social Justice: The pursuit of a fair and equitable society where individuals have equal rights and opportunities, and systemic inequalities are addressed.
Equity: The principle of fairness that ensures individuals receive the resources and support they need to achieve equal outcomes, recognizing that different individuals may require different levels of assistance based on their unique circumstances.
Inclusion: The practice of creating environments in which any individual or group can be and feel welcomed, respected, supported, and valued, acknowledging and embracing diversity in all its forms.
Advocacy: The active support and promotion of a cause or policy, aimed at influencing decision-makers and raising awareness about issues affecting marginalized communities.
Empowerment: The process of enabling individuals and communities to gain control over their lives, build confidence, and develop the skills necessary to advocate for themselves and effect change in their circumstances.
Consider Your Own Diversity
The Inner Circle: contains factors that influence the extent to which we experience advantages or disadvantages in our lives
The Middle Circle: contains factors that represent the broader social, economic, and cultural contexts that affect our opportunities, such as family background, education, and community resources.
The Outer Circle: contains factors that encompass global influences and systemic structures, including policies, laws, and societal norms that shape the overall environment in which individuals and communities operate.
Power Dynamics
Understanding and identifying the five faces of oppression—exploitation, marginalization, powerlessness, cultural imperialism, and violence—are critical for addressing systemic inequalities.
exploration - uber
marginalization - targeting newcomers
powerlessness
cultural imperialism
violence
Advocacy and Awareness
Recognizing that health is heavily influenced by social determinants calls for tailored health assessments. Advocacy for systemic change is essential for addressing health inequities effectively.
upstream:
Midstream: Engagement with local organizations can foster collaborative initiatives that promote health education and resource accessibility.
Downstream: Health outcomes are directly affected by the accessibility of healthcare services, individual behaviors, and the overall environment, necessitating targeted interventions to improve community well-being.
Final Note
Taking an intersectional approach entails acknowledging the existing gaps in health equity and making concerted efforts towards achieving fair and just health opportunities for all individuals.