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Social Determinants of Health - Ch 2.docx

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Health Sciences
Robb Travers

S OCIAL D ETERMINANTS OF H EALTH :CHAPTER T WO Introduction - Broad frameworks that consider how social determinants of health directly and indirectly influence health are of great value o Identify the immediate and more distant societal structures that shape quality of social determinants Individual Approaches - Limits analysis of health risks to individual biomedical and behavioral risk factors for disease o Responses =behavioral regime or treatment with drugs o Approach makes individual carry out series of behavioral changes - Lack of evidence to give biomedical factors a primary role in contracting disease/illness - Lack of evident that supports people at risk can change their behaviors o Behavioral interventions in vulnerable populations aren’t very successful - Ideological view that poverty is from individual’s failure to seize opportunity/to work sufficiently hard within current social structure o Individualism assumes current social system provides equal opportunity for individuals to move within social system according to abilities - Individualist approaches dominate public beliefs, health care, governmental policy to health promotion/population health Social Determinants of Health and Living Conditions - Social determinants = social living conditions people experience - Quality of SD’s = reflection of societal organization, distribution of economic and social resources - Brunner and Marmot  model to show how organization of society shapes various SD’s/ health o No mention of political, economic, societal forces that impact social structure o 3 primary pathways  Direct link: social structure  material factors (e.g. living conditions)  health status  Social structure  social/work environments  psychological/ behavioral responses  brain responses (endocrine, immune)  health status  Social structure  social environments  health status o All have forward/backward effects  E.g. social structure  work conditions BUT work conditions influence power & ability to determine aspects of social structure (e.g. degree of political influence)  Low income neighborhoods w/ health problems b/c of societal structure can develop adverse reputation - negatively feedbacks - limits ability to influence societal attributed towards their community - Four models  materialist, neo-materialist, life-course, social comparison Materialist Explanations for the Social Determinants of Health and Health Status Relationship - Sees objective living conditions as explaining how social determinants of health shape health status - 3 key mechanisms that link SD’s to health: o Experience of material living conditions o Experience of psychosocial stress o Adoption of health-supporting/health-threatening behaviors - Individuals experience differing exposures to positive and negative living conditions o Exposures accumulate to produce adult health outcomes - Material conditions: o Childhood advantage/disadvantage related to nourishment, housing o Adult issues of employment/unemployment o Occupational quality and hazards o Access to health/social resources - Influence development, family life, community environments - Graded effects (lower middle class worse off than middle class) b/c people have different level/lengths of exposure - Income potential: accumulation of abilities, skills, education in childhood that are important determinants of adult employability and income capacity o Education, family circumstances most important - Health Capital: accumulation of health resources (physical and psychological) acquired in early stages of life that determine current health and future health potential - Childhood circumstances  HEALTH and transitions to adulthood (accumulated IP & HC) HEALTH and adult circumstances  HEALTH - Living conditions determine presence/absence of health-threatening stress o Fight or flight – activated sympathetic/parasympathetic NS, neuroendocrine system, metabolic system - Chronic threats (low income, insecure employment, housing/food insecurity) = weaken immune system disrupt neuroendocrine/metabolic systems - Maladaptive responses to stress, weakened immunity to infections/disease, greater likelihood of metabolic disorders - CVD, type 2 diabetes o Stress can promote adoption of health-threatening behaviors (tobacco, lack of PA, increased fat/sugar intake), alcohol consumption o Coping mechanisms – not reflection of lack of knowledge, incompetence of poor Life-Course Perspectives on the Social Determinants of Health and Health Status Relationship - How exposures to varying economic and social conditions have cumulative effect on health - 3 types of health effects that have relevance for life-course perspective o Latent effects: biological/developmental early life experiences that influence health later in life  Life long effects regardless of circumstances in adulthood  Nutrients, incidence of infection, tobacco use  Can lead to CVD, diabetes, cognitive development o Pathway effects: experiences that set individuals into trajectories that influence health, well-being and competence  Living conditions shape children’s vocabulary upon entering school  Sets on path that leads to differing educational expectations, employment prospects  Material/social conditions  quality of neighborhoods, schools, housing set paths o Cumulative effects: accumulation of advantages/disadvantages over time  Combination of latent and pathway effects
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