HLTC05 Lecture 1: Introduction/Course Objectives – May 8, 2013
- We want to know why factors will lead one person to have better health than another. Looking at differences and disparities.
- Figure: girls on the left with different heights (may be genetic factors) yet diet, culture, environment does play a factor in
height. Thus, social factors play a role. Skeletons on the right are from the past but can inform us about the present. In the
case of these skeletons, societies and way they grew up may tell us why one skeleton is larger than the other. Taller skeleton
would have had better health/opportunities than shorter skeleton.
- What are social factors behind differences b/t health among groups, populations, countries? Health should be a human right.
If we see health disparities, we see a trampling of human rights. Should be basic human right not a privilege. This is the
perspective this course will take.
- Epidemiological Triad: relationship b/t 3 major factors when thinking of someone’s health. host (person, genetics,
physiological), interaction with pathogens (causing agent which determines health) and environment (social, living
environment of the host and the agent + interactions b/t these) and how they impact health and mortality of host. Most focus
on environmental factor.
- Figure: Biotic, Physical & Cultural/Demographic Environment
[Note that the focus of the course will be on the Cultural-Demographic Environment (bottom)]
- Figure: Influences on Health (see Mikkonen reading image below): thinking of social determinants of health as Holistic.
Everything to do with where we live besides innate biology (age, sex, hereditary factors). Consider living and working
conditions that play a role in our health. Proximate factors (immediate things like bhvr/lifestyle that inform health) vs.
Ultimate factors (cannot afford to take medicine, cannot get to clinic to get to medicine) - Considering Policies & Interventions: we are interested in ultimate factors and implementing policies/interventions to address
these determinants. Structural interventions.
- World Economy (an Ultimate Factor): Core, Semi Periphery, and Periphery. Nation(s) and their economic dominance in the
global economy. Core ie. Canada, US,Australia, Europe (dominate Global economy) Own wealth of the world in their hands.
Semi Periphery ie. Brazil, mexico, China, India, Russia, SouthAfrica – developing rapidly and gaining wealth but do not
have level of control/dominance. Peripheral ie. Rest of the world. Don’t hold wealth or control. Historically impoverished.
- Lifespan [figure]: its not a coincidence that lifespan is reflected in global economy.
- Figure of rapidly industrializing semi peripheral countries: high rise condos and swatter residences located side by side. We
are concerned why this still exists. Reflects innate inequality that exists in societies. Consider who builds the high rise
Mikkonen and Raphael – Social Determinants of Health: The Canadian Facts
Chapters 1 & 2
Chapter 1: Introduction
The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions
The importance to health of living conditions was established in the mid-1800s and has been enshrined in Canadian government
policy documents since the mid 1970s. Canada seen as a health promotion powerhouse in the eyes of the international health
Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed,
and if so, the working conditions we experience. Furthermore, our wellbeing is also determined by the health and social services we
receive, and our ability to obtain quality education, food and housing, among other factors.And contrary to the assumption that
Canadians have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us
by the quality of the communities, housing situations, work settings, health, social service agencies, and educational institutions.
There is much evidence that the quality of the social determinants of health Canadians experience helps explain the wide health
inequalities that exist among Canadians. How long Canadians can expect to live and whether they will experience cardiovascular
disease or adult-onset diabetes is very much determined by their living conditions. The same goes for the health of their children:
differences among Canadian children in their surviving beyond their first year of life, experiencing childhood afflictions such as
asthma and injuries, and whether they fall behind in school are strongly related to the social determinants of health they experience.
Research is also finding that the quality of these health-shaping living conditions is strongly determined by decisions that governments
make in a range of different public policy domains. Governments at the municipal, provincial/territorial, and federal levels create
policies, laws, and regulations that influence how much income Canadians receive through employment, family benefits, or social
assistance, the quality and availability of affordable housing, the kinds of health and social services and recreational opportunities we
can access. These experiences also provide the best explanations for how Canada compares to other nations in overall health. Canadians generally
enjoy better health thanAmericans, but do not do as well as compared to other nations that have developed public policies that
strengthen the social determinants of health. Despite this evidence, there has been little effort by Canadian governments and
policymakers to improve the social determinants of health through public policy action. Canada compares unfavourably to other
wealthy developed nations in its support of citizens as they navigate the life span. Our income inequality and poverty rates are
growing and are among the highest of wealthy developed nations. Canadian spending in support of families, persons with disabilities,
older Canadians, and employment training is also among the lowest of these same wealthy developed nations.
Social Determinants of Health Include:
Aboriginal status, disability, early life, education,
employment and working conditions, food
insecurity, health services, gender, housing,
income and income distribution, race, social
exclusion, social safety net, unemployment and
Chapter 2: Stress, Bodies & Illness
People who suffer from adverse social and material living conditions also experience high levels of physiological and psychological
stress. Stressful experiences arise from coping with conditions of low income, poor quality housing, food insecurity,
inadequate working conditions, insecure employment, and various forms of discrimination based on Aboriginal status, disability,
gender, or race. The lack of supportive relationships, social isolation, and mistrust of others further increases stress.
At the physiological level, chronic stress can lead to prolonged biological reactions that strain the physical body. Stressful situations
and continuing threats provoke “fight-or-flight” reactions. These reactions impose chronic stress upon the body if a person does not
have enough opportunities for recovery in non-stressful environments. Research evidence convincingly shows that continuous stress
weakens the resistance to diseases and disrupts the functioning of the hormonal and metabolic systems. Physiological tensions
provoked by stress make people more vulnerable to many serious illnesses such as cardiovascular and immune system diseases, and
At the psychological level, stressful and poor living conditions can cause continuing feelings of shame, insecurity and worthlessness.
In adverse living conditions, life often appears unpredictable, uncontrollable and meaningless. Uncertainty about the future raises
anxiety and hopelessness that increases the level of exhaustion. People try to relieve these pressures by adopting unhealthy
coping behaviours, such as the excessive use of alcohol, smoking, and overeating carbohydrates.
Stressful living conditions make it extremely hard to take up physical leisure activity or practice healthy eating habits because most of
one’s energy is directed towards coping with day-to-day life. Therefore, taking drugs – either prescribed or illegal – relieves only the
symptoms of stress. Similarly, healthy living programs aimed at underprivileged citizens are not very efficient in terms of improving
health and the quality of life. In many cases, individually-oriented physical activity and healthy eating program do not address the
social determinants of health that are the underlying causes of many serious illnesses. Policy Implications:
- Focus must be on the
source of problems rather
than dealing with
symptoms. Therefore, an