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Social Determinant of Health
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Social Determinants of Health
SDH
http://www.youtube.com/watch?v=_11xLlwKgWc
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• Poverty, social exclusion, poor housing
and poor health systems are among the
main social causes of ill health.
SDH examples
Source: WHO, Social Determinants of Health, Fact File.
http://www.who.int/features/factfiles/sdh/01_en.html
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• Differences in the quality of life within
and between countries affect how long
people live.
• A child born in Japan has a chance of
living 43 years longer than a child born
in Sierra Leone.
SDH examples
Source: World Health Report 2006 http://www.who.int/whr/2006/en/
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• The probability of a man dying between
the ages of 15 and 60 is
8.2% in Sweden,
48.5% in the Russian Federation, and
84.5% in Lesotho.
SDH examples
Source: World Health Report 2006 http://www.who.int/whr/2006/en/
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• In Australia, there is a 20-year gap in
life expectancy between Australian
Aboriginal and Torres Strait Islander
peoples, and the Australian average.
SDH examples
Source: WHO, Social Determinants of Health, Fact File.
http://www.who.int/features/factfiles/sdh/01_en.html
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• Low- and middle-
income countries
account for 85% of
the world’s road
deaths.
• In 2002, nearly 11
million children died
before reaching their
fifth birthday – 98%
of these deaths
were in developing
countries.
SDH examples
Source: WHO, Social Determinants of Health, Fact File.
http://www.who.int/features/factfiles/sdh/01_en.html
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• Inequality in income
is increasing in
countries that
account for more
than 80% of the
world’s population.
• Few governments
have explicit policies
for tackling socially
determined health
inequalities.
SDH examples
Source: WHO, Social Determinants of Health, Fact File.
http://www.who.int/features/factfiles/sdh/01_en.html
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HTTP://SI.EASP.ES/EIS2011/WP-CONTENT/UPLOADS/2011/04/NEW-SDH-CONCEPTUAL-FRAMEWORK-
GRANADA-2011.PDF
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Social Determinant of Health
Source: Norway 2006 & WHO 2011
SDH
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Contextualizing Risk Factors
• How do people come to be exposed to
individually-based risk factors (diet,
cholesterol, lack of exercise, high blood
pressure, smoking, ect..)?
• What is it about people’s lives that shapes
their exposure to individual risk factors?
• What is the social process that leads to
exposure?
Contextualizing factors
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Pathways from Context to
Health Outcomes• Social contexts create social stratification and
assign individuals to different social positions.
• Social stratification in turn engenders differential
exposure to health-damaging conditions and
differential vulnerability, in terms of health conditions
and material resource availability.
• Social stratification likewise determines differential
consequences of ill health for more and less
advantaged groups (including economic and social
consequences, as well differential health outcomes
per se).
Contextualizing factors
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Why Do Top People Live Longer?
• “I’ve been poor, and I’ve been rich. Rich
is better.” – Sophie Tucker
• We know poverty is ‘bad for you.’
• Yet, there are large differences in health
status not just on the basis of poverty,
but across well-defined groups.
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What are ‘social determinants’?
• Expands on the concepts of poverty (income)
• Focus on basic material needs for food, clothing,
shelter, and sustainable livelihoods, physical
environments, and health systems.
• Emphasizes human development as essential to
health and hence the need for education,
supportive communities, and participatory
political structures.
• Focus on inequality and injustice in access and
distribution of material and social resources.
SDH
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Burning questions for the SDH framework
1. Where do health differences among
social groups originate, if we trace
them back to their deepest roots?
2. What pathways lead from root causes
to the stark differences in health status
observed at the population level?
SDH framework
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Question 1:
Where do health differences among social groups
originate, if we trace them back to their deepest roots?
Answer: Health inequities flow from the systematically unequal
distribution of political power, prestige and resources among
groups in society.
SDH framework
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Question 2:
What pathways lead from root causes
to the stark differences in health status
observed at the population level?
Intermediate Determinants• The structural determinants operate through a series of what we term
intermediary social factors, or social determinants of health in a more
restricted sense.
• Intermediary factors flow from the configuration of underlying social
stratification and, in turn, determine :– differences in exposure to health-compromising conditions;
– differences in vulnerability, in terms of health conditions and material resources available; and
– differences consequences social, economic and over health.
• Main categories of intermediary determinants of health:1. material circumstances;
2. psychosocial circumstances;
3. behavioral and/or biological factors; and
4. the health system itself as a social determinant
SDH framework
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Answer: Pathways from root causes to observed inequities in health,
operate through a set of what we call intermediary determinants of health
and unequal distribution of them (through differential exposure and
vulnerability) that shape health outcomes.
SDH frameworkQuestion 2:
What pathways lead from root causes
to the stark differences in health status
observed at the population level?
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http://www.who.int/social_determinants/final_report/csdh_finalreport_200
8_execsumm.pdf
Commission on Social Determinants of Health. (2008).
Closing the gap in a generation. Geneva: WHO.
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Gender Equity
Commission on Social Determinants of health FINAL REPORT, page 23
Closing the Gap in a Generation
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Education
Commission on Social Determinants of health FINAL REPORT, page 25
Closing the Gap in a Generation
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Fair Employment and Decent Work
Commission on Social Determinants of health FINAL REPORT, page 9
Closing the Gap in a Generation
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Fair Employment and Decent Work
Commission on Social Determinants of health FINAL REPORT, page 9
Closing the Gap in a Generation
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Universal Health Care
Commission on Social Determinants of health FINAL REPORT, page 13
Closing the Gap in a Generation
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Equity from the start
Commission on Social Determinants of health FINAL REPORT, page 5
Closing the Gap in a Generation
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Health Equity in All Policies, Systems,
and Programmes
Commission on Social Determinants of health FINAL REPORT, page 17
Closing the Gap in a Generation
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Questions
Comments
Thoughts
Suggestions
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Discussion Questions
1. Define the Social Determinants of
Health.
2. Describe one health inequity in Korea,
along with social determinants of health
which are related to the health inequity
issue.
Discussion Questions