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Western University
Health Sciences
Health Sciences 3071A/B
Anita Cramp

Week 8: Social Determinants Mostly responsible for health inequities – unfair & avoidable differences in health status. Income is largest determinant, then education Where inequalities lie Copenhagen video where town promoted soft drug use Had to tackle underlying factors to see root of the problem Social isolation is unhealthy Also look at family support Upstream: treat underlying factors that are getting downstream population sick Downstream: treat illnesses Week 9: Income and Social Status Poverty: lack of means of providing material needs or comfort Working poor: people who have jobs & money, but aren’t making enough to succeed Relative poverty: relative to standard of living in society; inability to be part of mainstream society Surviving: Just getting by Living: improving your situation 47% of Canadians in lowest income bracket rate their health as very good or excellent, compared w/ 73% of  Canadians in highest income group Low­income Canadians more likely to die earlier and to suffer more illnesses than Canadians w/ higher  incomes, regardless of age, sex, race & place of residence Females living on avg. 2 years less Inverse relation b/w mortality and SES is stronger now than in 1960 Higher income & SES  1. Social Selection: health determines SES and not vice versa Health problems prevent you from working SES change relative to parent (intergenerational) or relative to self (intragenerational) depends on health  status Small­moderate effect – inter and intra change Not sufficient to explain assoc. More recently indirect pathway Social mobility dependent on determinants of health Week 9: Income and Social Status 2. Social Causation: Socioeconomically conditioned determinants on health SES determines health: 1. Material: Housing, pollutants, crowding Alcohol stores, food stores Unstable, highly demanding employment Restricted access to medical care Knowledge gap, physical enviro 2. Behavioural Unsatisfactory adherence to medication Gradient is evident even before need to seek medical treatment Personal health practices and coping mechanisms Phys. Activity, consume excess alcohol, smoking Physical enviro, facilitate or inhibit Gap in smoking prevalence – increased in 30 years 3. Personal Psychosocial: Chronic stress Ethic gradient (discrimination) Social network size, participation Perceived control Ie. Low perceived job control (Demand­control model; assoc. w/ lower SES, CVD) Week 9: Income and Social Status Self­regulation, outcome expectancy  3. Population Psychosocial Factors: Low income neighbourhoods Lower collective efficacy, cohesion, control Higher social anxiety (comparison) Feeling of exclusion Narrower income differences Lower anxiety, increased interaction, bond Knowledge gap 4. Biological Week 10: Education Problem solving, control, & mastery over life circumstances We feel like we’re the driving force (ie. We can make choices that will better our health) Increased job & income security and job satisfaction Increased ability to access and understand health info Social Support Networks Support: families, friends, communities Social cohesion: neighborhood watch Live around people, but are acquaintances Neighborhood watch could bring you together Social environments:  Civic vitality: strength of social networks within region reflected in institutions, organizations & volunteerism People share resources (w/o legislation) How much do you want to give back to community as an individual Values of society, social stability, recognition of diversity, safety Measuring social support: 1. Structural approach: Name all connections (family, friends, org., leisure) Size score, integration score, participation score Week 10: Education 2. Functional approach: Supportive functions available: Emotional support, instrumental (children rely on parents for a ride), informational support Assessment based on whether you have persons available Social Support and health Findings:  Protective effects: 2­3 times less risk of mortality from diseases including CVD controlling for lifestyle health promoting lifestyle Disease progression:  Emotional support related to progression of coronary artery disease For men, having a partner helps them be healthy HIV: life events & social support – functional support Recovery from illness: Structural indices – longer survival time Coronary artery disease Controlling for income and baseline risks Emotional support – predicted mortality in 6 months after myocardia infraction Physiological indices:  Week 10: Education Female college students & systolic BP Functional support Swedish women (central obesity, hypertension, blood gluose) Buffering effects: Psychological outcomes: negative life events leading to depression Disproportionate risk: high job stress, low support Emotional support (functional) and social participation (structural) Mechanisms of support effects: Reactivity/ Responsivity: Support related to less reactivity Loneliness related to reactivity Negative social interactions Will change the way you respond/react High reactivity more likely to develop disease BETTER responses/reactions to event w/ positive social interactions Immune system: Social affiliation & perceived support T­cell proliferation and natural killer (NK) cells Large networks and functional support Relationship w. cortisol levels Week 10: Education Behavioural: High support assoc. w/ less likely to smoke, heavily drink, eat healthier, exercise, better sleep Adherence to medical treatment Summary Distinctions between structural and functional support are not always clear Larger social networks & higher function support =  better health TedX Video: Induction = domino effect Homophily = birds of a feather fly together Confounding: share common exposure like a health club making both of you lose weight Obesity 45% higher chances if friend is obese or friend of a friend Social connections matter at the individual level Employment/ Working Conditions 1. Job security Income, self­esteem, stress 2. Work pace, control and stress Week 10: Education High demand, low control, high stress = decreased health 3. Opportunities for self­development 4. Working time 5. Work­life balance If you get sick, could you take the day off Could you take a day off to be with family 6. Social relations and participation at work Managerial leadership and ischaemic heart disease among employees: Swedish WOLF study Purpose: find assoc. b/w heart disease and leadership behaviours at work Study was conducted by looking at 3000 participants in 10 years period Results: 74 incidents of heart disease (self­report) Managers w/ best performance = lowest incidence of heart disease Association was stronger, the longer someone worked there or under managerial staff More improvement in perception (feel like you’re under good leadership) Need to train managers to be coordinated, sensitive yet productive and have interpersonal skills Meta­analyses = looks at statistics and number of effects of studies 22 studies b/w 1980 and November 2009 results show moderate quality of evidence that workplace phys activity and dietary behaviour interventions  significantly reduce body weight low quality of evidence that workplace physical activity interventions significantly reduce body weight and  BMI Week 10: Education need environmental component for it to have higher significance change in context in which behaviour occurs Process evaluation results from an environmentally focused worksite weight management study Primary goal: design process evaluation that allows assessment of quality of implementation of  environmental interventions deployed in study  Validate mostly objective data w/ other data collected through interviews & surveys of key informants within  organization Healthier foods Encouraging healthy phys lifestyles  Providing rewards for eating well and staying active Training site managers about wellness & motivation Environmental assessment (EAT) results indicated that environmental/organizational supports for healthy  eating and weight management improved markedly when interventions deployed Higher scores at intense than moderate sites Employee health climate perceptions improved w/ interventions Altering basic work enviro can make employees more aware of their own health and improve their  perceptions of org in which they work as health promoting May not help lose weight, but maintain weight Characteristics of healthy work environments: 1. Share an understanding that healthy work enviro not only benefits employ
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