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L3: Social Determinants (10/8) (Models of Health (Unnatural causes... is…
L3: Social Determinants
(10/8)
Health & Well-Being x the same 4 everyone,
The Social Determinants of Health, Disease & Health Inequity
Today: 36 year gap in life expectancy between countries
A child born in Malawi: 47 years, Japan: 83
~ Chad: every 5th child dies before 5
~ WHO European Region, under 5 mortality rate: 13 / 1000
No biological / genetic reason 4 these differences in health & life opportunity
Unequal distribution of health:
-
but we have the means
Result of a toxic combo of poor social policies & programmes, unfair economic arrangements & bad politics
:pencil2: WHO x try to make it =
inequity: diff in gr, education, job
ilya social injustice btn countries outside health sector
~ eg education impacts health
SD of Health:
The circumstances in which people grow, live, work, age, & the systems put in place to deal w illness.
The conds in which people live, die are in turn shaped by political, social, economic forces.
The social conds in which people are born, live, work: most important determinant of good / ill health.
SDs: "causes of the causes" - foundational determinants which influence other health determinants
WHO Commission: -
goals
Improve conds of daily life - circumstances in which people are born, grow, live, work, age -
look @ causes, put in place programs
Tackle inequitable distribution of power, $, resources
~ structural drivers of those conds of daily life
~ globally, nationally, locally
~
inf those w the $
Measure problem, evaluate action, expand knowledge base, develop a workforce trained in SDs of health, raise public awareness
~
stats, graphs
even preg women inf health of child
water, sanitation: why others more sick?
:pencil2: Research, programs
eg diabetes @ 45, proactive to prevent disease earlier
"go backwards / upstream" to target causes
eg un vs healthy foods
2017: Biggest impact on health?
:pencil2: education, income, healthcare services, employment
Edu, income: determinant level of socioeconomics
:pencil2: Global issues tackled locally
healthcare?
Miasma (bad air) / Humours
spiritual / mechanical forces
b4 germ theory
ilyavait lack of understanding
Germ Theory of Disease
John Snow : Cholera
Robert Koch : TB
Louis Pasteur : Septicaemia
Health & Illness views
Personal responsibility: up to patient / person -
blame
Unfortunate but x unjust: life x fair, always differences -
shrug
Nothing can be done: inequalities are part of society's structure, nothing to do w the health sector
should smokers be treated?
Models of Health
Unnatural causes... is inequality making us sick?
why others get sick more often, sooner?
~
spend as much $, but still >deaths
~
or lil $, high health
-
all about how spend $
Biomedical model:
people as biological organism
anatomy, physiology, molecular biology
diseases & conds
Biopsychosocial Model :pencil2:
und person: "psych" section
strong input in health studies
"social": outside indv
(Core) Determinants of Health
:pencil2: no control in workplace - a problem
~ or overall control of life
employment + nature of work
Age, sex, hereditary factors
non-modifiable: core
pushed / pull into certain conds
patient late to gp: no control
~ buy half the required med
National Health Performance Framework
provide a structure 4 reporting on the performance of the Australian healthy system @ national level.
covers 3 domains:
~ health status
~ determinants of health
~ health system performance
how progress to -> more equitable
:!:
apply to scenarios!
Canadians feel sick?
50% your life
25% healthcare
15% biology
10% env
ethnicity, race, food, belonging - feel socially
Poorer live shorter, more often ill
~ this has drawn attention to sensitivity of health to the social env
Increasing recognition internationally & in Aus of the significant impact that social, economic, lifestyle, some env-al factors have on health, & on the vast diffs in health between the most & least advantaged groups in the community
:red_flag: video: chronic stress to provide child
Health Gradient
some: struggles stack
Stats / Graphs
Inequity in Infant Mortality Rates between countries within countries by mother's education
IMR rise as less education
Under-5 Mortality Rate per 1000 live births by level of household wealth
poorest: highest
Social gradient in Australian mortality
deaths per 100,000 population
higher socioeconomic: less
but males > females
Estimated rate of avoidable deaths of children 0-15, by index of social exclusion
Fair Society, Healthy Lives
Marmot Review (based on evidence for report):
6 policy objectives
Give every kid the best start in life :!:
Let all kids, youth, adults to maximise their capabilities, have control over their lives
Create fair employment, good work 4 all
Ensure a healthy standard of living 4 all
Create, develop healthy, sustainable places, communities
Strengthen the role, impact of ill-health prevention