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University of Toronto Scarborough
International Development Studies
Guerra Salazar, Rene

Chapter 7: Societal Determinants of Health and Social inequalities in Health What makes the underlying determinants of health societal as opposed to individual? o Ill health can be understood in societal terms though people experience ill health as individuals. Ex: construction worker falls of scaffolding and dies Individual: he was inattentive and insufficiently conscious of safety (310) Household: tired from long commute to work, doesnt get enough sleep because of the poor built of his home Intermediate: earns minimal salary as an undocumented worker and poor enforcement of minimum wages National: poor government regulation to require his employer use quality materials for the scaffolding and ensure safety training Global: emphasis on profit over worker safety or unionization to ensure social security o Social determinants of health factors related to interactions among people and communities social characteristic within which living takes place (310) o Societal determinants of health structural forces political, economic, social and cultural structures that shape health and health patterns (310) the causes of causes o Health inequalities (a) individual health differences (b)differences in health between population groups (c) differences between groups linked to broader social inequalities and unequal societal structures (310) o Social inequalitiesinequities of health health disparities, within and between countries..that systematically burden populations rendered vulnerable by underlying social structures and political, economic and legal institutions (311) o Equity in health absence of systematic and potentially remediable differences in one or more aspects of health across populations (311) o Health disparities implies difference in health status without necessarily implying the presence of injustice (311) immediate determinants of health shape exposure susceptibility, and resistance to death and illness at household and community levels (311) e.g. Unhealthy behaviors (smoking, violence, etc) At national level determinants are brought about by social policy and governmental regulation (311) that directly or indirectly affect health e.g. social security protections, inadequate regulation of pollution, discriminatory policies The global level includes the underlying social, political, economic and historical context. Key determinants include class and social structure, distribution of wealth and power, and international trade regimes (311). o E.g. (+) side land redistribution and fair trade policies can improve farmer livelihood, democractization of power can improve welfare state, economic redistribution, environment regulation, infrastructural improvements o E.g. (-) side trade agreements often eliminate price protections for small farmers, leading to declines in land tenure, emphasis on production for export as oppose to consumption, concomitant income declines and nutritional deficiencies, all affecting health (311) Life-course Trajectories - explain how disadvantage (or advantage) produced through societal determinants of health accumulates over time in an individual addresses
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