SOCIAL DETERMINANTS OF HEALTH

• The social determinants of health are the economic and social conditions – and their distribution among the population – that influence individual and group differences in health status.

• They are health promoting factors found in one's living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease, or vulnerability to disease or injury

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PROVISION OF HEALTH CARE

PRODUCING HEALTH

Focus on Life-styles

Focus on the Environment

Shift focus from individuals to populations

Cost-effective health care

Evidence-based decision/ policy

Resources to sector that contribute to health

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Health System• a set of cultural beliefs and practices;

• the institutional arrangements; and

• the socio-economic, political & physical context

Health system includes environmental conditions, nutrition, water supply, education, housing, status of women, social structures, economic and political system

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Factors influencing health service utilization

•Age/sex of child

•Family size/ parity

•Education

•Occupation

Socio-demographic factors

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•Possession of household items

•Possession of cattle

•Possession of agriculture land

•Type of residential house

Economic factors

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•Availability of the transport

•Physical distance for Health Facility/Health Care Provider

•Time taken to reach Health Facility/Health Care Provider

Physical accessibility factor

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•Attitudes of health provider

•Satisfaction with the treatment

•Received medicines from Health Facility/Health Care Provider

•Received prescription for medicines

to be purchased from bazaar

Health service factors

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•Freedom to visit HF alone

•Permission to spend money on health

•Decision power in emergency situation

Mother’s autonomy

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Challenges

Knowledge of illness/wellness and of services available

Perceptions of services/service providers

Risk/symptoms assessment

Cultural “prescriptions”

Social barriers/social pathways to care

Etc…

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Income influences health

• People in the top income bracket are healthier than middle income earners

• Middle income earners are, in turn, healthier than people with low income

• This means that the poorer people are, the less healthy they are likely to be.

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Social status affects health

• It affects health by determining the degree of control people have over life circumstances

• It affects their capacity to act and make choices for themselves

• Higher social position and income somehow act as a shield against disease.

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Gender influences health

Gender is linked more to the roles, power and influence society gives to men and women, than it is to their biological differences.

Women tend to schedule more doctor visits than men, but why?

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Culture influences healthCulture and ethnicity influence how people link with health system, their access to health information and their lifestyle choices.

‘Dominant’ cultural values largely determine the social and economic environment of communities.

Result:Marginalization

Loss/devaluation of culture and language

Lack of access to culturally appropriate health services

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Health Care

system 25%

Biological

endowment 15%

Physical

environment 10%

Socio-economic

environment 50%

Estimated Health Impact of Determinants of Health on Population health Status: CIAR 1997

Importance of Social & Cultural Factors in HealthcareA.The ways people think about health and illnessB.Individual behaviors and habits that influence healthC.How you and your actions are perceived by the community where you workD.How culture interacts with environment, economy, and politics to affect health

Culture•A system of thoughts & behaviors shared by a group of people•Our cultural backgrounds have tremendous impact on our lives•Culture contributes to the richness of human experience© 2003 Tom Furtwangler, Courtesy of Photoshare

Culture Includes More Than Just Ethnicity

Reflection: Your assumptions about childbirth•At what age is it appropriate for a woman to get pregnant? Under what circumstances?•How many children should a family have?•To whom do children belong?•Who should be involved in the pregnancy? Childrearing?•What is the role of Medicine in reproductive health?•Where should women have their babies?•Who should deliver babies?

How Social & Cultural Factors Relate to Health & Illness•Social scientists designate a difference between disease and illness:Illness is the personal, social, & cultural influences on the experience of impairment, pathology, & diseaseDisease is the physiological process of pathology•The framework that focuses on illness is called the Sociocultural Model

African Americans have higher rates of mortality than does any other racial or ethnic group for 8 of the top 10 causes of death

The cancer incidence rate among African Americans is 10% higher than among European Americans.

U.S. Latinos have higher rates of death from diabetes, liver disease, and infectious diseases than do non-Latinos.

Adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes.

Asian Americans are 60% more likely to being at risk of developing diabetes in comparison to European Americans and are more likely to develop the disease as lower BMIs and lower body weights.

South Asians are especially more likely to developing diabetes as it is estimated South Asians a 4x's more likely to developing the disease in comparison to European Americans

WHAT DOES THIS MEAN IN ASIAN PEOPLE.Recent immigrants to the United States from Mexico have better indicators on some measures of health than do Mexican Americans who are more assimilated into American culture. Diabetes and obesity are more common among Native Americans living on U.S. reservations than among those living outside reservations.

Case Example: Social and Cultural Determinants of Health

•In Nepal, life expectancy of men eclipses that of women.•Leading causes of death for women are pre/post labor complications, hemorrhage, and infection.•Cultural factors such as early marriage contribute to the problem, particularly in rural areas.•Social factors such as education and literacy also influence health outcomes.

Social Factors

Social Factors

Culture

Biology

Health :

Behavioral Medicine Behavioral and psychosocial factors significantly influence health and disease•A branch of psychosomatic medicine•Uses methods of psychological intervention and behavior modification to prevent and relieve illness•Treatment targets patterns of behavior & thought

Key strategies:–Lifestyle changes: nutrition, exercise, stop smoking–Counseling: Psychotherapy, pain management–Social support: Group education, caretaker support

Now that you’re aware of sociocultural factors for your patients and yourself… what do you do with this knowledge?