January 13 Birn.docx

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University of Ottawa
International Development and Globalization
Sonia Gulati

January 13, 2014 Birn “Addressing the Social Determinants of Health” • Costa Rica vs. USA o In 2006, Costa Rica had a life expectancy of 78 akin to the USA o However Costa Rica’s GDP was over 5 times lower than that of the USA o USA also spent more on healthcare than Costa Rica • India vs. USA o Citizens of Kerala earning less than $3000US in per year had a LE of 74.6. o Washington citizens earning almost $30,000US per year had a LE of 72.6. • Thus, the structure of societies comes into play. o Things like, the role of the distribution of power and of political, economic, and social resources in shaping population health. o Showing factors like genetic endowment and behaviour only explain a small fraction of health and disease and looking more at societal determinants that shape at national and global levels • What makes underlying determinants of health societal as opposed to individual? o Patterns of premature death and disability can be examined at the societal level.  Ie. Neighbourhood conditions, work environment, availability of social services, etc. o A political economy of health approach considers the political, social, cultural, and economic contexts and the way societal structures interact with particular conditions that lead to good/bad health. • Biomedical Model; views health and disease at the individual level, looking at the body as a machine with parts. • Behavioural Model; sees health and illness as a consequence for individual actions. o While individual actions can have a bearing of health outcomes. However, behaviours are mediated by political, cultural, economic, and other determinants of health.  Ie. Cancer via smoking is more prevalent among the working-class smokers than the upper-class and cessation and education are more successful with the privileged.  Ie. Congenital conditions are effected by prenatal care, which are affected by nutrition, household services, housing, etc. • Living conditions; o Poor conditions can lead to cardiovascular, respiratory, gastrointestinal diseases, and injuries/violence. o Not just housing, but neighbourhood characteristics, availability of water, social services, etc. o Homelessness is a major issue, though even those with homes may lack necessities as per location, such as mosquito nets o Can live in overcrowded areas that cause the spread of diseases such as asthma and water-borne or air-borne diseases and skin ailments. • Water and sanitation; o Competition for scarce water creates conflict o Lack of water spreads communicable diseases such as diarrhea o Poorer populations pay more for water • Nutrition and food security; o Malnutrition kills more than AIDS, malaria, and TB o Heavily determined by structural factors—power is in the hands of a few large corporations  90% of world grain trade is controlled via 5 companies o Increasing consumption of “empty calories”, ie. Junk food, even in poor nations  Caused by the mass marketing of certain food products o Soil conditions and pesticide use are also major factors and can lead to cancers and infertility • Public health and healthcare services; o Such as food inspection, epidemic/chronic disease surveillance, disposal of refuse, etc. o 10% deaths are preventable through medical care o Can promote or jeopardize health based on how it is financed • Culture; o Can affect what actions are taken to treat/prevent and illness o Some may treat some diseases, like fatigue-inducing anemia, as just another part of their lives o
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