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Oct 19 (Week 6, Lecture 6)
Societal determinants of health inequalities
Political economy framework (309)
-Distribution of power and economic & social resources. Shapes health
-Suggestion to Increase economic output as a solution to discrepancies in health outcomes in different
-Some countries with widely differing incomes per capita had life expectancies that are very
similar. Clearly income per capita is not explaining life expectancy, there is no automatic
-might be a result of social welfare states and income redistributions, rather than
income. Example, Cuba
-Suggestion to increase health spending?
-suggestion to examine societal determinants of health rather than medical care spending or income per
Individual experience (312-13)
-genetic conditions (outcomes socially mediated). Enormous investments and hopes to address patterns
of disease within populations and across populations. This will not happen, because even with genetic
variation, other social and environmental determinants are not taken into account in how a genetic
disorder evolves and develops.
-personal agency and decisions
-life-course trajectories: Z}}Á]ZÁZÇ}µ[ÀÆ]vÇ}µo(]vZX,}ÁÇ}µo
health is influenced by your earlier health. Example, early childhood development can remain extremely
]u}v}}v[ZoZoutcomes later on in adult life (even if rags to riches, increased income
makes no difference in health outcomes). Exposure to certain environments early on can lead to certain
health outcomes as a consequence, later on in life.
-water and sanitation: piped water linked to lower infant mortality rates.
-exception: even though Iraq much of the access to water is piped, the water has been
contaminated due to disruptions of the pipes because of bombings,
-Sri Lanka: water is not piped into individual homes, but piped water is delivered at a community
-nutrition and food security/sovereignty: Control over the kinds of food is produced and consumed
-public health/medical care
-culture and religion