HLTH WEEK 2 PPT

HLTH 300 - WEEK 2: Population Health and Social Epidemiology

  • Instructor: Laura Lee

  • Date: September 9, 2025

TERRITORIAL ACKNOWLEDGEMENT

  • Acknowledgement of the Lekwungen-speaking peoples, the Songhees, Esquimalt, and WSÁNEĆ peoples.

  • Recognition of their traditional territory on which the university stands.

  • Statement of respect for the ongoing historical relationships these communities have with the land.

OPENING ACTIVITY

  • Questions Presented:

    • What everyday factors (outside of doctors and hospitals) most shape people’s health?

    • Which of these factors do you think are most unequally distributed in society?

  • Method: Discussion on whiteboard.

DAHLGREEN & WHITEHEAD MODEL

  • Source: Dahlgreen, G. and Whitehead, M. (1991). "Policies and Strategies to Promote Social Equity in Health." Stockholm: Institute for Future Studies.

  • Further Learning: Video link provided for detailed understanding.

SOCIAL DETERMINANTS OF HEALTH

  • Key Factors:

    • Trauma

    • Living environment: unsafe and/or unhealthy settings

    • Exclusion: Marginalization, Racism & Discrimination

    • Economic factors: Low wages and employment challenges

    • Abuse and lack of safety

    • Gender inequity

    • Homelessness & Housing Instability

    • Access barriers: Lack of Access to health services

    • Environmental factors affecting health

    • Educational opportunities and literacy levels

    • Employment & Working Conditions: Precarious Employment and Workplace Stress

    • Psychological stress impacting mental health and addictions

    • Biological & Genetic Endowment: referring to inherent health predispositions

    • Social support networks shaping health outcomes

AUTHORITY ON FIRST NATIONS HEALTH

  • Source: First Nations Health Authority, www.fnha.ca

  • Wellness Perspective:

    • Emphasis on a visual and comprehensive framework of wellness as understood by First Nations, passed down from Elders.

    • Recognition that wellness is intrinsic to every human being, thus unique for each individual.

  • Components of Wellness Framework:

    • Social, Emotional, Physical, Mental, Spiritual aspects of health.

    • Community, Cultural respect, Responsibility, and Economic relations play critical roles.

    • Land as a foundational aspect impacting relationships and health.

FIGURE 3: The Social Determinants of Health - An Indigenous View

  • Key Elements Included:

    • Access to Health Services

    • Personal Health & Coping Skills

    • Importance of Culture, Language, and Ceremony

    • Social Inclusion measures

    • Education and Early Childhood development factors.

    • Recognition of Environmental and Social responsibilities.

CONDITIONS AND FORCES THAT SHAPE OUR LIVES

  • Neighborhood & Built Environment:

    • Importance of housing safety, food access, and transportation systems.

  • Education Access & Quality:

    • Lifelong learning opportunities necessary for individual development.

  • Economic Stability:

    • Role of income, employment, and food security in health outcomes.

  • Social & Community Context:

    • Value of social support, community ties, and the impact of discrimination.

  • Broader Forces and Systems:

    • Socioeconomic & Political contexts influencing health-policy and systems.

    • Addressing structural discrimination including Racism, Classism, and Gender disparities.

KEY PRINCIPLES OF SOCIAL DETERMINANTS OF HEALTH (SDOH)

  • Social Gradient:

    • Health deteriorates as socioeconomic status decreases.

  • Health Inequities:

    • Unfair, avoidable differences in health outcomes between groups.

  • Root Causes:

    • Health outcomes are influenced by non-medical factors, not solely by healthcare access.

  • Interconnectedness:

    • Determinants are interlinked and evolve over time.

  • Further Exploration: Participants encouraged to think of other health-related principles.

DEFINING SOCIAL EPIDEMIOLOGY

  • Core Focus:

    • Examining how social position and context influence health outcomes.

    • Expansive approach beyond individual risk factors.

  • Four Features Identified:

    1. Population-level perspective

    2. Social context of behavior analysis

    3. Multi-level analysis techniques

    4. Life-course perspective in health studies

GEOFFREY ROSE & POPULATION HEALTH

  • Considered the Father of Population Health.

  • Distinction made between "sick individuals" vs. "sick populations."

  • High-Risk Approach:

    • Focus on high-risk individuals has limited impact on overall population health.

  • Population Approach:

    • Advocates for shifting the health distribution across entire populations, not just targeting individuals.

THE HEALTH GRADIENT

  • Observation:

    • Health improves consistently with increased income, education, and job status.

  • Evidence:

    • Supported by Whitehall Studies comparing health among clerks and executives, showing a persistent health gradient.

    • The Black Report indicates health gaps widen despite universal healthcare access.

  • Key Finding:
    Health gradient observed across all socioeconomic levels, not just between extremes.

  • Source for Further Reading: Marmot M. (2017). "The health gap: Doctors and the social determinants of health." Scandinavian Journal of Public Health. doi:10.1177/1403494817717448

WILKINSON & INEQUALITY

  • Core Assertion:

    • Societies that are affluent but have significant inequality demonstrate worse overall health outcomes.

  • Mechanism:

    • Inequality sparks increased stress levels and erodes social solidarity.

  • Outcome:

    • Chronic diseases are more prevalent in societies where inequality is pronounced.

THREE FRAMEWORKS IN UNDERSTANDING HEALTH

  • Materialist Framework:

    • Health outcomes influenced by accessible resources like income, stable housing, and ample nutrition. Lack of these resources correlates with illness risks.

  • Neo-Materialist Framework:

    • Extends beyond individual resources to include public goods/services distribution, influenced by policies, taxation, welfare programs, and neighborhood infrastructure impacts on health.

  • Psychosocial Framework:

    • Posits that health is affected by relative social position; inequality causes chronic stress that erodes social trust and leads to unhealthy behaviors such as smoking and alcohol use, with adverse biological effects like elevated blood pressure.

BREAKOUT ROOM ACTIVITY

  • Instructions:

    • Choose a current health issue to discuss from provided list or others (examples: obesity, opioid crisis, housing insecurity, mental health issues, food insecurity, climate change and health issues, maternal child health).

    • Guiding Questions:

    • How is the chosen issue typically approached at individual levels?

    • What would a population health approach entail for this issue?

    • Which social determinants of health apply to the chosen topic?

    • Optionally, discuss which framework (materialist, neo-materialist, psychosocial) best explains the persistence of inequities related to the issue.

    • Outcome:

    • Summarize one or two critical points to share back with the class.

KEY TAKEAWAYS

  • Holistic Understanding of Health:

    • Acknowledgement that health is influenced by factors beyond healthcare setups (e.g., environmental conditions, social systems).

  • Geoffrey Rose's Contributions:

    • Importance of shifting focus from high-risk individuals to whole population distributions for significant health improvements.

  • Existence of Health Gradient:

    • Recognition that health inequities span the social spectrum, affecting all levels of society, not solely the poorest compared to the richest.

  • Impact of Inequality:

    • Notable that greater inequality correlates with worse overall health outcomes.

  • Frameworks for Analysis:

    • Emphasis on materialist, neo-materialist, and psychosocial perspectives as valuable in explaining persistent health inequities.

LOOKING AHEAD

  • Reading for Upcoming Week:

    • NCCDH report on Universal and Targeted Approaches to Health Equity.

  • Next Focus:

    • Week 3 will cover Income, Inequality & Health Inequities.

  • Current Affairs Journal:

    • Assignments to connect learned concepts to selected current news stories.

  • Upcoming Discussions:

    • Class discussions anticipated for further exploration.