Sociology 2247A/B Chapter Notes - Chapter Social Determinants of Health: Thomas Piketty, Job Satisfaction, Ottawa Charter For Health Promotion
8 Jun 2018
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Chapter 4 Social Determinants of Health:
Neoliberalism, Social Inequality, Diseases and Death: The Social Determinants of Health
Intro
- Social structure is a metaphor for the different ways people in society differ from one another
- The social structure can be thought of as a hierarchy which can be observed on multiple dimensions
- The fat that e ae oe likel to ea oe tha oe illustates to aiales o oditios okig
together and reinforcing one another
o By adding minority status – we see a greater decline and can exacerbate the health and income
circumstances of certain doubly defined groups of people and individuals within those groups
How Do Inequity and Health Relate
- Individual level of well-being tends to correspond to the location of the individual in the social structure
o The overall degree of inequality/equity tends to affect everyone in the social structure
o As degrees of equity fluctuate so will levels of health
- Why would relative equity I society be associated with health while a lower position in the economic structure is
associate with illness?
o Daniel Raphel:
▪ Most obvious consequence is that health is linked to the provision of basic material goods and
services
▪ Material approach: humans health depends fundamentally on available, accessible and
available water; good transportation systems, infrastructure, stable safe transportation
▪ Income is central to this view – two aspects of income are relevant
• Income sufficiency and income adequacy for such things like food, shelter,
transportation and recreational/leisure
• Income stability so that money is consistently available and predictably from month to
month and year to year
▪ Access to material goods is necessary for the health of the family
▪ Low income can perpetuate through the family – children born into wealthier families tend to
have greater health benefits throughout life
- Material circumstances can influence health directly thru assaults to the physical body – ie spread of infections
through homeless people
- Nutritional inadequacies due to insufficient funds are linked to illness
o Once a person is ill – relative poverty takes a toll on their ability to cope and to earn income
- Violence and accidents occur more often in situations of low material adequacy
o Children are more likely to be left alone or abused
o Material insufficiency is associated to mental illness and may be linked to human physical as well
o The stress responds to the body and weakens the immune system and can lead to more aliments
- Poor people are more likely to cope by engaging in some life-threatening behaviours such as poor diet and
inadequate exercise
o A correlation exists between a persons position in the social structure and specific behaviours known to
be associated with specific diseases
▪ For instance, smoking is linked to lung cancer and for those who inhale it second hand
▪ Smoking is also negatively associated with income and children – thus porter and less-educated
people are more likely to smoke
- Second explanation between inequality and health is neo-materialist approach
o Acknowledges the importance of the basic level of material adequacy and centres attention on the
significance of the relative distribution of material and social goods in society
o Once you reach material adequacy (living above the poverty line) then equity in the society and
perceived equity become essential to overall health of a population
o This is empirically supported: societies with progressive redistribution and equalization policies designed
to give the basic material and social welfare to the population are more likely to have a population with
lower infant mortality, longer life expectancy and longer disability-free life expectancy
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- Third explanation show how material and neo-material may work empirically at the individual level of social-
psychology
o Focuses on social inclusion/exclusion to the ongoing daily processes of life for individuals people as
social beings in a community
o Social capital is said to enhance inclusion
o Ada uilds o Bodieus soial, ultual ad eooi apital ad theoizes ho people ok togethe
thru social networks and community inclusion
▪ Aday – capital necessary for health includes: natural capital (parks/environments), human
capital (education, amount and quality); material capital (occupation, income and employment)
and social and cultural capital (social support, absence of discrimination and freedom from
stereotyping) and bodily capital (body shpe/size and health background)
o Social inclusion is related to social capital – evident in communities such as representation of diverse
people nd voter turn out
▪ Well-organized social structure includes availability and access to green spaces, libraries, public
transportation, community centres
▪ Private education, sports complexes margianlize people
▪ Lack of universal available infrastructure leads to negatative social comparisons, low self-esteem
and pooerer health
- Life Course Approach overlaps with the three but draws attention to the harm caused by impoverished,
inequity, social exclusion and lack of distribution equality
o Early childhood costs consequences are found thru pathways, latency and cumulative effects
o This is called fundamental cause of health and illness and cumulative advantage theory: explains how
advantages and disadvantages build over time like a snowball
o Another way health ideas cumulate is thru 3 ideas:
▪ Pathway effects set children on the right direction to help them thru compounding effects – for
instance, a child who has been practicing counting is likely to be better in Kindergarten –
preconditions them to do better in elementary school – then high school
▪ Latency effects occur early in childhood and influence later life – premature birth is a strong
predictor of developmental delays in cog and physical functions
• Associated with diseases later in life
• Underweight babies are likely to be overweight later in life
• Overweight and obesity are linked to diabetes and vascular disease
▪ Cumulative effects: are repeated additions of disadvantages or advantages over life and include
a combo of both latency and pathway effects that lead to disease later in life
o Example of generational and life course approach
▪ Working-class and lower-class girls are more likely to be a teen mom
▪ Teen moms end not to have adequate support to take care of themselves and this if they get
pregnant this lack of support to affects their babies
▪ Stress may lead them to alcohol use
▪ Low-birth weight babies are more likely born to these mothers
▪ Low birth weight tis likely to result including greater likelihood of childhood death, disability and
disease
Political Explanations for Inequality and Poor Health
- Navarro and Shi compare four OECD countries into four categories
o Soial deorati, Christia deorati, ‘lieral, and ex-fascists – then compared the golden years of
capitalism
o The comparison focused on degree of inequality, public spending and health benefits, disease and death
of a population
▪ Social Demo: most extensive taxes and redistribution polices – Denmark, Sweden, Norway,
Finland and Austria
▪ Christian demo: Belgium, Netherlands, Germany, France, Italy and Switzerland
▪ Liberal: Canada, UK, The US, Ireland
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▪ Ex-fascist: Spain, Greece, and Portugal
o Soial Deoati outies ae oe oitted to edistiutie poliies ad full-employment polices
ad ee oe suessful i ipoig health o populatios
▪ High levels of unions, full-employment policies, high spending and high % of employment in
health, education and welfare
▪ Characterized by high rates of female engagement in the labour market
▪ In comparison to liberal countries infant mortality rates are higher in neo-liberal countries and
lowest in social democratic – infant mortality is telling of a healthy nation
- David Coburn assumes neo-liberalism are:
o Markets are the best allocators of resources in production and distribution
o Societies are composed of autonomous individuals motivated by material or economic considerations
o Competition is the major market vehicle for innovation
o States this ideology has led to market deregulation and the push for free trade by the Thatcher
Conservatives in the UK, Regan Republicans in the US and Mulroney/Harper ideologies
- Neo-liberalism is antithetical to redistribution of goods and services because it interferes with the free-wheeling
powers of the market is believed to fetter economic growth and that is good
o Neo-li ests o the fee aket ill podue ealth ad tikle do
o States handle high degrees of inequality because they its fundamental belief is that the market will
eventually provide wealth for all
o Neo-lib is consistent with low social cohesion and higher levels of social exclusion
o Social exclusion and inequality are linked to poor health
An Operating Model for the Social Determinants of Health
- Analyzing the relationship between illness and death in the social structure must be put into a board context
o One the broadest level 1) globalization of capital, trade, regulation and business decisions
o 2) neo-liberal ideologies at the state level encourage dominance of free markets and impact the
diseases burdens of people around the world
o Soe soieties ae oe edialized the othes
▪ Developing societies are increasingly linked to discursive allopathic practices which may been
seen as problems in society and education
▪ For example, hyperactivity which use to be seen as bad behaviour is now treated with Ritalin
o Differences in mortality and morbidity are related to political-economic systems at the nation-state level
as well as to national cultural differences – uneven distribution of shelter, food and access to meaningful
work
- Social policies have an impact on health of pops
o Health depends on the availability of regulations and monitoring to ensure safe consumer products
- Our health-care system and polices support a downstream model rather than upstream
o Diagnosing problems once they have been detected (upstream) rather than preventing them in the first
place (upstream)
o Upstream tends to allow stressors from social determinants of health (poverty, age, race) to accumulate
overtime so that disease finally occurs
- Health in all Policies (HiAP): supports the idea that health consequences result from social policy
- Cultures differ in their interpretation of illness/diseases
o For instance, aboriginal people are always relating their alignments to spiritual problems
o Education choices throughout the life course are significant determinants of health of a society
o individual behaviours and coping responses including smoking, self-esteem, sense of coherence, social
and instrumental support are implicated in health outcomes
o the socio-psychological and phenomenological strategies people use contribute to illness rates and
death rates
- health outcomes from factors are seen in mortality and morbidity rates
The Social Determinants of Health: Evidence from Canada
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