IDSB04H3 Chapter Notes - Chapter 7: Infant Mortality, Keratin

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Chapter 7: Societal Determinants of Health and Social inequalities in Health
ž 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
 /v]À]µoW^ZÁ]vv]Àv]vµ((]]voÇ}v]}µ}((Ç_~310)
 ,}µZ}oW](}uo}vP}uuµ}Á}lU}v[Pv}µPZo
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 t ^(}o}]v]}vu}vP}ov
}uuµv]]Y}]oZ]]Á]Z]vÁZ]Zo]À]vPlo_ (310)
o Societal determinants of health t ^structural forcesY}o]]oU}v}u]U}]ov
cultural structures ZZZoZvZoZv_ (310) the causes of causes
o Health inequalities t ^~]v]À]µoZoZ]((v~]((v]vZoZÁv
population groups (c) differences between groups linked to broader social inequalities
vµvµo}]oµµ_ (310)
o Social inequalities/inequities of health t ^ZoZ]]]UÁ]Z]vvÁv
countries..that systematically burden populations rendered vulnerable by underlying
social structures and politioU}v}u]voPo]v]µ]}v_ (311)
o Equity in health t ^absence of systematic and potentially remediable differences in one
}u}}(ZoZ}Y}µo]}v_ (311)
o Health disparities t ^implies difference in health status without necessarily implying the
v}(]viµ]_ (311)
¾ ^Y]uu]u]vv}(ZoZZÆ}µµ]]o]ÇUv]v}Zv
]oovZ}µZ}ov}uuµv]ÇoÀo_ (311) t e.g. Unhealthy behaviors (smoking, violence,
etc)
¾ v]}vooÀou]vv}µPZ}µÇ^}]o}o]ÇvP}ÀvuvoPµo]}v_
(311) that directly or indirectly affect health t e.g. social security protections, inadequate
regulation of pollution, discriminatory policies
¾ TZPo}ooÀo]voµ^ZµvoÇ]vP}]oU}o]]oU}v}u]vZ]}]o}vÆXKey
determinants include class and social structure, distribution of wealth and power, and
]vv]}voP]u_ (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,
o]vP}o]v]vovvµ_, emphasis on production for export as oppose to
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}vµu]}vU^}v}u]v]v}uo]vvvµ]]}vo(]]v]Uoo((]vP
ZoZ_~ïíí
¾ Life-course Trajectories - ^Æo]vZ}Á]ÀvP~}ÀvPt produced through
societal determinants of health t µuµo}À]u]vv]v]À]µoY}]o
conditions, the resulting influence on present-day health status, and possible future directions
}(ZoZ_~ïíî
ž Health behaviors t individual behaviors influenced by determinants on other levels t e.g. lung
cancer morality is higher among working-class smokers than upper-class and cessation efforts
are more productive among the latter which have better means to relieve stress
¾ Influence of living conditions t u(}^Z}µ]vPvv]PZ}Z}}Z]]U
À]o]o]Ç}(}oÁUvµv]]}vU(}}µo]Çvµ]Ç_~ïíïZoZ
and social services] etc
o Water and sanitation t 1/3 of the world pop. lives with moderate to severe water
stress, ½ of the world lacks access to basic sanitation. There is a correlation between
high access to an in-house water connection and low infant mortality but there are
exceptions (e.g. Iraq has high IMR and in-house water connections, high IMR could be
explained due to interruption and water contamination due to bombings, and poor
health and nutrition due to sanctions, repression and violence. Sri Lanka has a low IMR
and low in-house water connection but invests in social programs)
o Nutrition and food security t ^food sovereignty refers to self determination in the
production and consumption of food in terms socially, economically and culturally
consistent with loco]v}v]]}v_~ïíñXDovµ]]}v]}(v}]
Á]Z^uÇo}]_~}(}}Á]ZZ]PZµPv(Z}v]µ}
obesity, CVD, cancer, etc.
 Some determinations of food (in)security: hunger (e.g. in Bengal poor people
starved despite availability of food wasting away in storehouses because they
lacked purchasing power), poor nutrition (partially due to excess production and
ul]vP}(µvZoZÇ(}}U^}v](]]}v_ (refers to corn-based products in
most foods) due to US corn subsidies global prices have lowered forcing small
farmers out of business in developing countries (corn production can also cause
pollution and health problems), concentration of power in food production and
trade in the hands of few corporations, which is bad since 50% of the population
of developing countries work in agriculture
o Housing and human settlements t overcrowding and inadequate ventilation and
sanitation (air and water-borne disease, TB, lice, etc), sharing beds /, flimsy
construction bad during natural disasters or easier access for mosquitoes, homeless ppl
have 2-10x higher death rates
o Neighborhood conditions t affect housing, water, sanitation quality, food availability,
access to infrastructure and institutions, note: slums have higher air and soil pollution
because of vicinity to factories and waste facilities
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