IDSB04H3 Chapter Notes - Chapter 7: Health Equity, Population Health, Global Health

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IDSB04 Chapter 7 Reading
Chapter 7 Health Equity and the Societal Determinants of Health
Key Questions:
- Why do different societal groups have differing health profiles?
- How does the society in which people live shape the health and ill health of social groups and their members?
- What are health inequities and how might they be addressed?
- Questions about why some countries populations live as long as significantly richer places has a lot to do with the structure of
their societies and their position in the global economy
- This chapter focuses on health inequities where the health statuses differ between socially defined groups that are unjust,
unfair and avoidable
Box 7-4 SDOH and Health Equity Definitions
- Population health = looks at the interactions of three components they aim to maximize overall health outcomes and minimize health inequities at the
population level
o Health outcome and distribution in a population
o Patterns of health determinants over the life course
o Policies and interventions at the individual and social levels
- Social determinants of health = conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of
health, functioning and quality-of-life outcomes and risks
o The patterns of social engagement and sense of security and well-being are also affected by where people live
- Societal determinants of health = the political, economic, social and cultural structures (institutions, rules, and social relationships between groups) that
all work to shape health and health patterns across key societal categorical such as social class, race/ethnicity, sex/gender, and geographic setting
- Social/societal determination of health = this looks at the process that directly shape that modes or ways of living of communities within the broader
context which then influences styles of living at the macro individual/family scale
o The processes whereby those who are affected also respond to these circumstance within and across scales
- Health inequities = the differences in health profiles within and across countries by social groups, geography and other factors that are necessary and
avoidable but are also unfair and unjust
How is Health Socially Determined and What Explains Health Inequities: Pathways and Possibilities
Key Questions:
- What makes the underlying determinants of societal as opposed to individual?
- How does a political economy of health perspective health operationalize societal determinants of health?
- How do different theoretical and conceptual lenses explain health inequities?
- Different groups in each population are exposed, susceptible and resistant to different diseases in different ways
o Ex. Pesticide plant workers or people that live near toxic waste dumps are most likely to get cancers that are linked
to their exposure to dangerous chemicals
- The people that work or live near hazardous conditions are not randomly decided it reflects the societal arrangements
according to different powers such as wealth, social class, race/ethnicity, gender, location and political structure etc.
- The quality and accessibility of services is also reflected in location
o Diseases are distributed through chance variation where not everyone who is exposed with get sick sometimes at
the population level, these haes ae stutued  histoiall otiget ausal poesses that shape a
hierarchy and range of existing societal factors = this is societal determinants of health
- Societal determinants of health (SDOH) refers to more structural forces such as institutions or politics
o They emphasize the broader array of structural factors and process that determine the rules of who has access to
resources and relationships between and among societal groups
- Social determinants of health refer to concrete factors that are related to resources and interactions among people and
communities
- Social production of health is what factors to who is determining the factors and processes that produce and reproduce
health
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- Societal determination, which is the understanding of society as beyond the sum of individual experience it seeks to
characterize the dynamics of the process where these determinants are not disembodied or separate from larger political
forces but are rather embedded in them
o Ex. Instead of identifying housing as a key determinant of health, societal determination would examine how real
estate and other business interests and governmental actors drive land costs, land use policies, housing markets,
maintenance of housing stock etc.
Operationalizing Political Economy of Health through SDOH
- An SDOH approach looks to operationalize political economy of health by understanding how health and ill health are
produced and reproduced are different levels
- Broadest (macro) level soeoes iju a e liked to the fee-market economic system whereby profits come before
worker safety and well-being
o A building boom is driven of global financial interests and facilitated by trade treaties that are signed by
governments
- Intermediate (macro-meso) linked to government policies Lees lo eaig oe fo iiu age leels that ae ot
enough and poorly enforced
o His position as a foreign worker is precarious
- Individual level Lee may have been inattentive and insufficiently conscious of safety or just unlucky (accident) and therefore
slipped to his death
o The meso-local level would look at his living and home conditions where it may be revealed that he was very sleep-
deprived because of his long commute to work
Understanding Health Inequities
- Theoretical approaches are needed in order to link ideas of society to human biology
o Bioedial odel doest doest oside that ee ouee of disease, death, o iju is iflueed 
society, the lifestyle odel doest look at the da-to-day constraints such as affordable/accessible foods
o Critical political economy approach would focus more on the role of power and control over resources
Psychosocial Theory
- This theory emphasizes the health impact of individual perceptions and responses to the social environment such as family,
community, school, workplace and the wider society
- Whe oied ith oes soial status, the shape epeiees of pshologial stess ad assoiated eotios
o A pesos eposue to both stressor and forms of coping with stress can be depend on their social hierarchy where
a person who is a part of the working class is exposed to more stress
o The ialae i stess has a effet o a pesos lood pessue, etal eous sstem
- To deal with these physiological responses are different coping mechanisms such which include over eating, sleep disruption
hih a hae a geate effet o a pesos etal health
- It not only accepts the importance of social causes, but it also de-emphasizes who and what causes the different exposures
and capacities of resistance to stress in the first place and the role of political, social and economic agendas
- It underplays the role of politics and power in shaping material and social conditions
Ecosocial Theory
- Developed by Nancy Krieger
- It seeks to integrate political, social and biological understandings of the determinants of health it reconciles the limits to
political economy and psychosocial theory
- Outcomes in this theory would look at the biological expressions of living conditions, social relations and structure of power
- It uses two key concepts
o uulatie interlace of eposue, suseptiilit ad esistae hih is ho the past ad peset of iologial
incorporation of social relationship of power are integrated into present health and disease experience
o aoutailit ad age, histoiall, ad daiall hih is the iopoatio of elatios of poe though
actors, institutions, actions and inter-relations, both in the past and present
- it builds upon the political economy approach by specifying not just macro, but micro-level mechanisms
Intersectionality
- Coined by Kimberlé Crenshaw
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- Argues that simultaneous forms of identity and social position (race, class, gender, sex etc.) interact dynamically, making
their separate and hierarchical analysis problematic
o What Intersectionality seeks to do is to explain how multiple social factors reflect interlocking systems of privilege
and oppression
Life course Approaches
- Considers 3 things
1) Important early-life experiences have a role in shaping development (especially brain development) and vulnerability or
resistance to future disease into adulthood
2) The impact of early-life exposures on social conditions affects adult health
3) Accumulation over the lifetime of advantages and disadvantages marks adult health and disease
Health and Human Rights
- This approach looks at respecting, protecting and fulfilling human rights
- The lack of government action and policies has an effect on health and human rights
Table 7-1 Theories Explaining Health and Disease Patterns (and their Contribution to Understanding Societal Determinants and Health Inequities)
Theory
Main arguments on health and disease determinants/health inequities
Mainstream
Biomedical
-Health derives largely from genetic heritage and other individual biological factors
-Age, chance and prior health and disease experience and exposure explain health differences
Behavioral/Lifestyle
-Individual choices, behaviors, practices, and beliefs are key determinants of health outcomes
-Health differences arise from freely chosen lifestyles
Alternative
Critical Political Economy
-Societal political structures and class relations are central to explaining health outcomes
-Explains the causes of health inequities as manifested through various power mechanisms (ex. Material conditions,
distribution of power and resources through the political system and workplace)
Psychosocial
-Idiiduals peeptios of thei soial oditios, loatio ithi soial hieahies, ad iteatios particularly
through stress responses have psychological, behavioral and physiological consequences
-Seeks to understand how responses to social-structured environments affect health and health inequities
Ecosocial
-Health/disease is the embodiment of social and living conditions, political, economic and ecologic context, and
power relations experienced intergenerationally and over the life course
-Examines how the interplay over time of exposure, susceptibility, and resistance in individuals and social groups
forms patterns of population health that result in greater or lesser health equity
From Political, Economic, Social and Historical Context to Population Health and Health Inequities
Key Questions:
- How do past patterns of political, economic and social relations affect SDOH?
- What makes the uneven distribution of power and wealth a SDOH?
- How do global trade and financial regimes influence health?
Colonialism, Imperialism, Militarism and Violence
- Power configurations such as the global financial system, discriminatory social structres and divisions, uneven distribution of
wealth can all be seen to come from long historical processes of accumulation and exploitation under imperialism and
capitalism
- War allowed for capitalism to exist which made it bad for health it leads to disease, death, rape, environmental
contamination, physical and mental health problems
- The use of weapons can cause physical trauma and long-term disability
- Military expenses also take money away from social and infrastructural plans
Trade, Finance and Governance, and Production Regimes under Contemporary Global Capitalism
- Trade treaties, IFIs, rule-making bodies all have a direct and indirect effect on health
- Profit motives are more important than equity
- With neoliberal globalization, the power, capacity and accountability of democratically elected governments are more
incorporated through trade and investment
o IFIs loan out money, force countries to give up resources to invest in social policies and well-being, which allow for
unemployment, malnutrition, increased poverty
- The global trade system which is governed by the WTO and separate trade and investment agreements, shows how unequal
power is created and maintained resulting in inequitable health outcomes
- Privatization is promoted this is done with water provision, health care, education
Wealth and Health: Distribution, Assets, and Land Tenure
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Document Summary

Chapter 7 health equity and the societal determinants of health. Questions about why some countries populations live as long as significantly richer places has a lot to do with the structure of their societies and their position in the global economy. This chapter focuses on health inequities where the health statuses differ between socially defined groups that are unjust, unfair and avoidable. Population health = looks at the interactions of three components they aim to maximize overall health outcomes and minimize health inequities at the population level. Patterns of health determinants over the life course. Policies and interventions at the individual and social levels. Social determinants of health = conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks. The patterns of social engagement and sense of security and well-being are also affected by where people live.

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