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HLTB02- Lecture 3
What is the “gradient”?
How is it related to health?
How does the environment interact with genetics?
How does this affect early development?
Models for how this affects later outcomes
Common pattern of increases or decrease in an health outcome variable related to an increase or
decrease in am measure of SES
We will discuss the gradient effects on:
oIncreasing health status
oIncreasing neurocognitive status
Within a Social Determinants of Health Perspective
The idea of the “gradient” in predicting/accounting for health outcomes springs from the “social
determinants of health” perspective
This perspective argues that risk factors operating at the population level, that are socially distributed are
as important as individual risk factors ( E.G. smoking versus % country below the poverty line)
Public Health Agency of Canada
“ The weight of scientific evidence supports a socioeconomic explanation of health inequalities. The
roots of ill health can be found in such determinants as income, education and employment as well as in
the material environment and lifestyle. Also of significance is that poverty in Canada falls
disproportionately on children”.
Biological bases of human development : Genes, environment, Brain development
Gradient – the most important concept in understanding the outcome
oInteracts with genetics
o“engeneation” – if you were an alcoholic – weakens reproductive cells and effects offspring
Was completely wrong
But got the ball rolling
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“epigenetics” – how factors other then DNA can effect your expression of your DNA
•What your grandfather ate has an effect on your health
From Neurons to Neighborhoods
The Three Big Facts:
Difference in income distribution deeply affects health status of a country’s citizens
The steeper the SES of income gradient, the steeper the difference in health status between rich and poor
Gradient effects are found through history, across the globe and are persistently correlated with
developmental health status and outcome, when controlling for individual factors
Examples of the SES gradient Effect of Reading performance
There is a clear relationship between mean SES ( of the school the child attends) and the level of reading
ability of children attending that school
On average, Canada is a bit better, but still shows the effect
Just a line between the people who has it best, with the lowest status in community
Measurement of SES
Income gap have grown at more higher rate since 1970’s
Average worker vs CEO = huge difference now
Status = money and access to health care
Public health agency of Canada
Steeper the gradient the greater effect
Flat gradient is the best
What the Gradient reveals
SES plotted against any major disease globally reveals :
oSES is a main factor
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