lecture 2 social determinants of health

Question 1

health inequalities

Answer 1

“Refers to differences in the health of individuals or groups. Any measurable aspect of health that varies across individuals or according to socially relevant groupings can be called a health inequality.” (Arcaya, Arcaya & Subramanian, 2015)

Question 2

what are the three basic health promotion strategies?

Answer 2

enable, mediate, advocate

Question 3

what is enable

Answer 3

ensuring equitable opportunities and equals access to resources to enable people to achieve their fullest health potential

people cannot achieve their fullest health unless they are able to take control of those things which determine their health

Question 4

what is mediate?

Answer 4

demands coordinated action by gov’t, health and other social and economic sectors, nongovernmental and voluntary organizations, local authorities, industry and media

involves individuals, families and communities

Question 5

advocate

Answer 5

political, economic, social, cultural, environmental, behavioral and biological factors can all favor health or be harmful to it

health promotion action advocates for favorable conditions (make best choice the easiest choice)

Question 6

what are the 5 key action areas

Answer 6

1. build healthy policy
2. create supportive environments
3. strengthen community action
4. develop personal skills
5. reorient health services

Question 7

how is health promo coordinate their approach?

Answer 7

health promotion looks for coordinates approaches to: legislation, fiscal measures, taxation, organization change

Question 8

creative supportive environments

Answer 8

Work and leisure should be a source
of health for people:
▪ Organize work to create healthy
society
▪ Reciprocal care for our
environment
▪ Create living conditions that are
safe, satisfying and enjoyable

Question 9

strengthen community actions

Answer 9

At heart of health promotion is
empowerment of communities:
▪ Ownership and control of endeavors
▪ Draw on existing human and material
resources in community
▪ Support public participation in health
matters

Question 10

develop personal skills

Answer 10

Health promotion supports personal
and social development:
▪ Providing information and education
for health
▪ Increasing the options available to
people to exercise more control over
their own health
▪ Enabling people to cope with illness
and injuries

Question 11

reorient health services

Answer 11

Role of health sector moves beyond
providing clinical and curative
services:
▪ Open channels between health
sector and other sectors
▪ Support needs of individuals and
communities for healthier lives
▪ Refocus on the total needs of whole
person

Question 12

what is the socio-economic gradient in health status

Answer 12

the more money you have the better your health the less money you have the worse your health

Question 13

what is the population of indigenous and how to we understand indigenous health?

Answer 13

indigenous peoples constitute nearly 4% of Canadian population
health can be understood by exploring context and history of colonization

Question 14

what are facts of indigenous status

Answer 14

life expectancies for indigenous peoples are 5 to 14 years less than non-indigenous Canadian population
infant mortality rates are 1.5 to 4x higher
higher rates of infectious and chronic diseases
suicide rates are 5 to 6x higher

Question 15

what percent of canadians report w/ a disability and what does disability stem from?

Answer 15

12.4 % of canadians report of a disability and increase with age
largely stem from social exclusion

Question 16

facts of disabilities

Answer 16

*people with disabilities are more like to be unemployed or underemployed
*Over 40% of Canadians with disabilities are not in the labour force
* Those who do work earn less on average than other Canadians
* Highly reliant on social assistance benefits
* Canada has some of the strictest restrictions on
receiving benefits and level of benefits are low

Question 17

how does early experience affect health?

Answer 17

Early experiences have both
immediate and long-term biological,
psychological, and social effects upon
health
ex. latency effects, pathway effects, and cumulative effects

Question 18

what are latency effects

Answer 18

How childhood experiences predispose children to either good or
poor health regardless of later life circumstances.

Question 19

what are pathway effects

Answer 19

Situation when children’s exposures to risk factors at one point do not have
immediate health effects but lead to situations that do have health consequences

Question 20

what are cumulative effects

Answer 20

suggest that the longer children live under conditions of material and social deprivation, the more likely they are to show adverse health and developmental outcomes

Question 21

what is the correlation b/w education and health

Answer 21

• People with higher education tend to be
  healthier than those with lower
  educational attainment.
• Not only because of correlation with
  other social determinants (income,
  employment, etc.)

Question 22

what does education do?

Answer 22

• Education facilitates citizen engagement –
  people become more aware of and able to
  influence societal factors that shape their own
  health (societal level)
• Education promotes understanding of how
  one can promote one’s own health through
  individual action (individual level)

Question 23

what are the social determinants of health?

Answer 23

1. Indigenous status
2. Disability
3. Early Life
4. Education
5. Employment and working conditions
6. Food (in)security
7. Health care services
8. Gender
9. Housing
10. Income and income distribution
11. Race
12. Social exclusion
13. Social safety net
14. Unemployment and job security

Question 24

employment and working conditions correlation to health

Answer 24

• Canadians spend a great amount of
  time at work.
• Workplaces can (in some cases)
  promote good health, but they can
  also contribute to poor health.

Question 25

what are some working conditions?

Answer 25

* Employment (in)security * Physical conditions at work * Working hours, pace, and stress * Opportunities for self-expression and individual development

Question 26

what is food insecurity?

Answer 26

* Estimated that approximately 9% of Canadian households experience food insecurity (~2.7m people) * Includes insufficient quality or quantity of foods * Uncertainty about acquiring food in socially acceptable ways

Question 27

food insecure households are more likely to report what?

Answer 27

report incidence of diabetes, high blood pressure, food allergies

Question 28

what are food deserts?

Answer 28

* Urban neighborhoods where residents have little or no access to stores and restaurants that provide fresh, healthy and affordable foods (Canadian Environmental Health Atlas, n.d.). * Oftentimes plenty of fast-food restaurants and/or convenience stores, and the possibly to find a grocery store or supermarket within walking distance is low * Food deserts also manifest socio-spatial polarization as certain groups of disadvantaged population are more likely to live in these areas (Hilario, 2021, n.p.)

Question 29

Canadian health act requires provinces to provide health services that are:

Answer 29

* Comprehensive * Universal * Portable * Accessible * Publicly administered

Question 30

what is the canadian health act (1984)?

Answer 30

Aim of a universal health care system is to protect the health of citizens and spread health costs across the whole society * All medically necessary services * All residents are provided access to public health-care insurance on EQUAL terms * Health services still provided to citizen even if they are traveling or outside the province * Provided uniform access – free of financial barriers, or discriminated against * A single public system that is financed by taxes to provide health care to the population

Question 31

the bottom 1/3 of canadian income earners are?

Answer 31

* Less likely to see a specialist * More likely to have difficulty accessing weekend or evening care * More likely to wait five (5) days or more for appointment with a doctor

Question 32

what do women experience in terms of gender

Answer 32

Women in Canada experience more adverse social determinants of health than men: * More responsibilities for raising children * Less likely to be working full-time, frequently ineligible for unemployment benefits, typically earn less compared to men * Longer life expectancy but more episode of long- term disability and chronic illness

Question 33

how does health impact LGBTQ2+?

Answer 33

* Higher rates of depression and suicide among youth coming to terms with self-identity * Discrimination of health care provision – particularly issue for the trans community

Question 34

how does housing influence health in many ways

Answer 34

 Overcrowding (spread of illness)  Basic sanitation  High housing costs (limit funds available for other needs)  Security and insecurity (consistency of housing, safety of housing)

Question 35

unaffordable housing definition used by Canadian gov't

Answer 35

Spending more than 25-30% of total income on rent

Question 36

income and income distribution

Answer 36

Income is considered perhaps the most important social determinant of health It shapes or influences nearly every other living condition

Question 37

actual income - how does low income effect health?

Answer 37

Low income predisposes people to material and social deprivation. The greater the deprivation, the less likely individuals and families are able to afford the basic prerequisites of health such as food, clothing, and housing. Deprivation also contributes to social exclusion by making it harder to participate in cultural, educational, and recreational activities

Question 38

income distribution

Answer 38

Men in the wealthiest 20% of neighbourhoods in Canada live on average more than 4 years longer than men in poorest 20% of neighbourhoods. Suicide rates were 2x higher in the lowest income neighbourhoods compared to the wealthiest neighbourhoods Mortality rates (overall) were 28% higher in the most deprived neighbourhoods

Question 39

race

Answer 39

Racialized Canadians experience a whole range of adverse living circumstances that threaten health

Question 40

institutionalized racism

Answer 40

Concerned with the structures of society and may be codified in institutions. Includes policies, practices, and laws that perpetuate racism. Also includes governmental inaction in the face of need

Question 41

what is social exclusion

Answer 41

Social exclusion refers to specific groups being denied the opportunity to participate in Canadian life. Excluded groups have little influence upon decisions made by governments and other institutions.

Question 42

what is social exclusion

Answer 42

 Denial of participation in civil affairs  Denial of social goods  Exclusion from social production  Economic exclusion

Question 43

social safety net

Answer 43

 Refers to benefits, programs and supports that protect citizens during various life changes that can affect their health.  Includes normal life transitions (having and raising children, seeking employment, aging, etc.)  Includes unexpected life events (accidents, illness, unemployment, family break-ups, etc.)

Question 44

unemployment and job security

Answer 44

Lack of employment is associated with physical and mental problems including depression, anxiety, and increased suicide rates.

Question 45

what is insecure employment

Answer 45

Insecure employment often consists of:  Work with non-standard hours  Uncertainty about job continuity  Uncertainty about finding other employment

Question 46

what caused the decimation of many indigenous peoples post contact?

Answer 46

* Introduction of new plants, animals, pathogens * Interference with social order of many societies * Land loss * Large & small game depletion * Persecution