Chapter 7 Book Notes

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International Development Studies
Anne- Emanuelle Birn

Chapter 7: Social determinants of health and social inequalities in health. BOX 7-1: **Social determinants of health: social characteristics through which living takes place. **Societal determinants of health: broader (poli, economic, social, and cultural) structures that shape health and health patterns. -Social inequalities (inequities): health disparities win & btw countries, that systematically burden pop rendered vulnerable by underlying social stru & poli, econ, & legal institutions. -Health Disparities (mostly used in US) implies differences in health status without necessarily implying the presence of injustice. The social determinants of health: What makes the underlying determinants of health societal as opposed to individual? - Virtually every bout of ill health or injury can be understood in societal terms. - Ex: Construction worker falls off building and dies. - At a population level, patters of premature death and disability can also be examined in societal terms. - Societal determinants of health refer to those factors related to interactions among people and communities, whereas societal determinants emphasize a broader array of structural influences. Societal determinants of health framework illustrates how political economy of health pathways operate - The most immediate determinants of health shape exposure, susceptibility, and resistance to death and illness at household and community levels - At the next level are a range of determinants that manifest themselves largely in terms of social policy and govnt regulation. Ex: poverty levels, education, etc. - The final level includes the underlying social, political, economic, and historical context. Key determinants=classsocial structure, distribution of wealthpower, etc Check figure 4-2 *Individual Characteristics and Experience (Individual) - Medical models of health largely attribute ill health to personal features and actions. Every occurrence of disease, death, or disability includes varying degrees of societal influence. Life-course Trajectories - A life-course perspective helps explain how disadvantageadvantage produced through societal determinants of health accumulates over time in an individual Health Behaviours - Behavioural understanding of health largely ascribe health status to personal practices and habits. Ex: unsafe sex, smoking, alcoholdrugslifestyle approach - Health behaviours: known as lifestyle approach- covers only one small component of multiple levels of influences on health (differences in mortality bw working and upper class smokers). o Criticism: assumes that ppl are perfect decision makers w day to day control over work & neighborhood conditions, indi approach removes responsibility for change from govt, private business and other actors. o ex: hygiene, genetic factors The Influence of Living Conditions (Community and household) - Numerous ailments result from poor living conditions cardiovascular, respiratory, gastrointestinal, endocrine, nutritionalmetabolic disease, injuries and violence. 18mil (13 of all) deaths = directly attributed to conditions of povery. Water and sanitation - 16 of the world lives wo adequate water supply - Almost half of the worlds populations (2.6bil) lack access to even the most basic sanitations and must resort to using fields and ditches mostly in rural areas - Access to an in house water connection is closely associated w infant mortality. - Connection between watersanitation and health is complex. Ex: WHO says washing hands reduces diarrheal diseases by 50%, but its not simply a matter of habits, but rests on sufficient access to clean water (and soap) - Womengirlsrefugees particularly affected by poor water supply. They are responsible for getting water can get injured, assaulted, and they miss school Nutrition and food security - Food security: availability of and access to sufficient qualities of nutritious food - Food sovereignty: self determination in the production and consumption of foods in terms socially, economically, and culturally consistent w local practices - 50% of child deaths, a result of poor nutritionunder nutrition - Mainstream medical community leaves the structural factors of food distribution and production unaddressed. Only addresses through clinical approaches. - Malnutrition, today, is largely associated w empty calories. Chemically processed food that not only has little nutritional value, but can cause various disethes. Ex: certain cancers, obesity, cardiovascular disease, etc. - 17 of the world have a severe hunger problem. Hunger and famine are caused more by the economics of maldistribution than by food shortages - Although tradition, culture, and household resources play an important role, dietary patters are increasingly influenced by the industrialization of food production. Processed food = cheaper calorie than fresh produce. - 13 of global grocery sales are in the hands of 30 food retailers, and 90% of worlds grain trade is controlled by just 5 companies. This affects another determinant of health local sustainable farming practices. Housing and human settlements - Provides safety, stability, rest and leisure, and conditions that foster physical and mental health
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