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1

Definition: Determinants of Health

the many factors that shape/influence health and illness either directly or indirectly

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Aboriginal determinants of health
13 determinants divided into 3 levels

1) Proximal
2) Intermediate
3) Distal

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1) Proximal

health behaviours, physical environments, employment & income, education, food security

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2) Intermediate

- health care systems, educational systems, community infrastructure, resources, & capacities, cultural continuity, etc.

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3) Distal

colonialism, racism & social exclusion, self determination

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Social Determinants of Health: A Canadian Perspective
11 DETERMINANTS

early life
education
employment and working conditions
food security
housing
health care services
income and its distribution
social safety net
social exclusion
unemployment and employment security
Aboriginal status, gender, immigrant status

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The Solid Facts – an international perspective
10 DETERMINANTS

the social gradient
stress
early life
social exclusion
work
food
unemployment
social support
addiction
transport

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Canadian Senate report (2009) includes 13 determinants
4 major types

Socio-economic Determinants of Health
Biology and Genetics
Physical Environment
Health Care system

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Socio-economic Determinants of Health (10)

early childhood development
education
employment/working conditions
culture
gender
housing
social environment
personal health practices
income & social status
social support networks

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1. Early childhood development

critical age to guard against later life adverse health outcomes: pregnancy through to age 6 yrs

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2. Education

Closely tied to socio-economic status

Effective education for children and life-long learning for adults is important

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3. Employment/working conditions

- buy food, shelter
- gives people identity, purpose in life
FRENCH PARADOX

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The French paradox – people in France eat rich food, drink, even smoke, but they are healthier than Americans

… the reason: high levels of employment and job security, long & regular vacations, stability & security (at least for the middle class) ... although some scholars indicate this may be changing

14

Culture

The way of life developed by a group of people which members acquire....that which is totally learned and it includes language, concepts, beliefs and values, symbols, structure, institutions and patterns of behaviour. A person's culture may or may not be the same as his or her ethnic origin or identity"

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8. Personal health practices

Consider what informed decisions you make daily about what you eat, what you drink, how much sleep you get, how much exercise you do, how often you have a dental exam, how often you have a complete physical examination done by your doctor, etc.

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10. Social support networks

Social networks of family and friends very important to health status (Hayes 1999)

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Why is “distribution” more important than absolute income?


In general, with increased inequality in society, there is a greater need to increase the amount of hours worked (overtime) and the number of family members working just to keep up with living standards

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Roseto Effect tells us that the?

social environment and social networks have more positive influences on health than does wealth