Module 5, Social Determinants of Health Flashcards
What if I told you that MOST of what shapes our health is external to our control?
- a lot of things that are closely related to our health and are indicators or predict whether or not we will have particular diseases or impairments over our life which are not under our control
- there is always something someone can do that they have control over but the majority is external - always some of element of control but a lot of things that shape our experiences that limit our choices
Health Inequalities
- there are enormous differences in ‘health status’ between individuals and between groups of individuals
- the statistical study of a population and finding differences in health status
- life expectancy - health cannot be fully explained by genetics and individual behaviours rather best be explained by social arrangements - drastic differences that are unequal between different nations
- in cases where individuals migrate from their nation or origin their life expectancy matches more closely with their new location so it cannot be entirely associated with geological factors and genetic factors
- in Canada there are differences between provinces - their health status reflects where they live as opposed to their place of origin - some provinces have more rapid access to healthcare - cost of food in territories is really high
- Canada is a fairly developed country with a universal health care system but we still see huge discrepancies in life expectancy
- greater inequalities in Indigenous people (lack of access to health care, inadequate or food scarcity)
- we can see differences that cannot fully be explained by genetics or biological factors rather best explained by social arrangements
Life Expectancies in Canada
- life expectancy for the average Canadian at birth has fallen for 3 straight years from 82.3 in 2019 to 81.3 in 2022
- Saskatchewan’s life expectancy has fallen the most - declining by 2 full years
- loss of life at earlier age - OPOID crisis (in younger populations - disproportionate affects on life expectancy)
- 19, 700 Covid-related deaths in 2022
- two factors that are responsible for changes in life expectancy that we have not seen before
What is the strongest predictor of health?
- social class - often related to capital, the idea that particular groups in society has different access to resources
- there are many ways that class remains very prevailing its today’s society even if it is not talked about much as there is discomfort in talking about social class
Social class
a position in a system of structured inequality based on the unequal distribution of power, wealth, income, and status
- another way of saying social stratification - concept that our society is structured into different groups
What is meant by ‘class’
- previous slide gives a broad definition of class but does not really give us an operational definition (ie. I couldn’t use that definition to ‘define one’s class’ or to divide those of us here in this room into ‘classes’)
- class can be (and has been defined in many ways)
- that there are groups within society that have different access to power, wealth and resources and then similar access as others in that same class - cannot use this definition to establish how to survey Canadians
Class -
- offered described as differences in ‘lifestyle’
- tied to patterns of consumption – cars, clothing, media (television, newspapers, music) - an indicator or someone’s class (consciously think about where we fit in society and how is and is not in our group)
- but this description fails to explain where class ‘comes from’ or the underlying structures of class
Class – Marxist perspective
- Marx explained class as one’s relationship to the ‘means of production’
- the bourgeoisie who own the means of production
- the proletariat who sell their labour to produce
- (also the ‘little bourgeoisie’ that include small business owners)
- could operationalize this and look at a study look at health of both groups
Class – Weberian perspective
- Weber largely shared same perspective as Marx but added additional elements
- rather than focusing purely on ‘economic production’ - Weber added ‘status’ and ‘prestige’
- coins term ‘life chances’ to describe how some people are able to make lifestyle choices based on their class (patterns of consumption are because life changes allow them to consume in such a way)
- some jobs are seen as a little more valuable due to reputations and not just pay
Class -
- there is considerable debate about how to define class
- ‘socio-economic status’ (SES) is often used interchangeably or instead of class (referring to someone’s class without referring to someone’s class)
- SES is imperfect replacement because it doesn’t consider how/why the inequalities exist but…
- provides us a way of stratifying or looking at different groups within society and understanding differences in health outcomes and what we find is that socioeconomic status is the single greatest predictor of someone’s health
- clear gradient between health and wealth
Health Inequality in Canada
- generally speaking – Canada is a wealthy and healthy nation
- but there is considerable wealth inequality / inequality in SES
- there is also great (and growing) health inequalities (gaps are getting better)
- operationalizing that notion that not everyone has the same ability to be healthy and distribution of resources matter
- health and wealth are link but it does not go in continuity
and yet… while ‘wealth’ can explain many of the difference in health it does not explain all and wealth also has complex relation with other ‘determinants
Social Determinants of Health
“research suggests that health inequities cannot be explained by a biomedical approach to health and illness. the social determinants of health approach grew out of researchers’ attempts to find social mechanism to explain why different groups of people experienced different degrees of illness…
- biomedical approach is looking at a specific factor within the body and treating it one by one - but it does not work with most people as it is often better to prevent it in the first place
- the biomedical model does not explain health inequalities
- there are genetic and biological factors but someone’s experience of the disease and the impact is has is shaped by everything else
Social Determinants of Health
“…Dennis Raphael, the Canadian researcher most associated with the concept, defines the social determinants of health as the economic and social conditions that shape the health of individuals and communities. They are, Raphael (2009) argues, the primary determinants of whether individuals stay healthy or become ill…”
“The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience.”
Social Determinants of Health
- aboriginal status (highly related to health outcome)
- disability
- early life (peoples environments at different times in their lives matters and in earlier years what the child has access to in terms of resources can be not made up later in life - certain milestones and factors have really strong influence in in those years of development
- education
- employment and working conditions (different from unemployment and job security - if someone is unable to work because of disability but someone can still have a job and have their health impacted by the job - does someone have consistent employment and what are the conditions of employment) - having a job does not necessarily mean you have health
- food insecurity (availability, consistent access in ways that are socially acceptable)
- health services (health care)
- gender
- housing (do you have consistent housing, is it safe, is it reliable, who do you live with - the quality and security of that housing)
- income and income distribution (matters what your income is in regards to others)
- race (cultural practices and experiences of being racialized)
- social exclusion (social networks to some extent but also your ability to feel belonging)
- social safety net (people who help you when you get sick - individual level / employment insurance - if you are in some jobs you are paying into the system and if you lose it you get some money from that - when you cannot work for a period of time it gives you breathing space / food bank - what kind of services do you have that provides sources in moments of need / pension) - helps us bridge periods of change
- unemployment and job security
* in order to make it on the list there needs to be substantial body of evidence that says this factor can be used to predict someone’s health status
the social determinants of health are interrelated! - each one of them has an impact on health
each one has been shown to have a strong effect on the health of Canadians
Life-course approaches
- consider how the social determinants of health across the lifespan
◦ latent effects (the idea that some things have effects beyond that moment - you cannot erase the effects of someone’s experiences - their access over time and how it shapes their health)
◦ pathway effects - having this or not having this can send you down certain paths of life (education)
◦ cumulative effects - inequality in one area that is likely to then reproduce in other areas (if you are unemployed it is hard to maintain housing)
