Sept 3 Social Determinants of Health Flashcards
Can health problems be addressed by medical care alone?
No, need to factor in social determinants of health including economics, knowledge gaps, research priorities, and behaviors.
Define Social Determinants of health
Non-medical factors influencing health including health-related knowledge, attitudes, beliefs, or behaviors
Upstream Vs. Downstream determinants of health
Upstream SOLUTION - Distant to health effects. Represents the most fundamental causal role and the most important opportunities for improving health and reducing health disparities. Focused on the source. Leads to health effects through downstream factors. Ex: getting educated
Downstream REMEDY - Spatially close to health effects. Occurs because of failing to address fundamental causes. Ex: prescribing medication
Examples of some Upstream social factors
neighborhood conditions, working conditions, education, income/wealth, race and racism, and stress
What do policy makers need to realize about findings?
They must recognize that the limited generalizability of findings from randomized experiments introduces uncertainty
Testing multidimensional interventions versus seeking a magic bullet. Which one is more realistic?
We need multifaceted approaches that operate simultaneously to interrupt damaging pathways at multiple points
What is another major barrier to action?
Not only lack of evidence, but also political will
Systematic review methodology aka “umbrella” review
Identifies systematic reviews describing the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education and transport
Limitations when searching for studies
Difficult and time-consuming and searches can often suffer from a lack of sensitivity and a lack of specificity
How to ensure an extensive search for studies?
Search strategies were piloted and revised. They were conducted by experienced specialist staff, and leading public health journals were hand searched and review authors were contacted. Since many interventions are complex and difficult to define, it is not possible to be sure if all reviews were located.
What is population health?
Refers to a conceptual framework for thinking about why some people are healthier than others and urges health research agendas to consider dimensions beyond health care such as education, employment and social support. It recognizes that socioeconomic and environmental structures can support or constrain community health
What are some positivist methods and what is it used for?
large-scale survey analysis and categorical approaches are used to adjust for shortcomings such as changes to the tax system when studying income inequality
Two goals of the Critical Population health research approach
- a thorough going deconstruction of how historically specific social structures, economic relationships and ideological assumptions serve to create and reinforce conditions that perpetuate and legitimize conditions that undermine the health of specific populations
- a normative political project that, as a result of deeper understanding, seeks the reconstruction of social, economic and political relations along emancipatory lines
Purposive sampling strategy
a strong technique in the selection of information-rich cases
Advantage of telephone interviews over face-to-face interviews
telephone interviews are more cost efficient
