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Issues in Public Health, Social Determinants of Health (Upstream…
Issues in Public Health
Social Determinants of Health
Upstream determinant
neighborhood
working conditions
education
economic resources
race
life-course epidemiology
self-control
Downstream social determinants
Social capital
Social class scheme in UK
I professional
II managerial / technical
III skilled (non-manual, manual)
IV partly skilled
V unskilled
Black Report
artefact
behavior
material circumstances
social selection
Life course epidemiology
Psychosocial factors
monotone / non-learning environment
poor social integration
feeling of no social control
imbalance: efforts invested vs rewards received
Interventions
Health Impact Pyramid
clinical interventions
long-lasting protective intervention
changing the context
socioeconomic factors
counselling & education
Health Gradient
strengthen individual
decrease the angle of slope (=circumstances)
Dahlgren & Whitstand Framework
Strengthening individuals
strengthening communities
Improving access to essential services
Encourage marcroeconomic & cultural change
Marmot Review
give every child the best start
maximize capabilities and give control over lives to people
fair employment & working conditions
ensure healthy living conditions
create & develop healthy & sustainable places & communities
strengthen the role & impact of health prevention
Political determinants
Introduction of democracy
only in countries balanced ethnic & religous groups
autocratic leaders ensure social cohesion
Policies
left governments more likely to have pro-health policies
Taxation
reducing consumption if increase in tax > increase in average wage
Welfare & employment
minimum wage policy
socila protection policies
active labor market policies
Environment
policies to protect / degrade environment
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Power dynamics
Power over
Power to
Power with
Power within
Power structures
donor agencies
private sector
elite
religion & science
shadow governments
think-tanks
media (esp. satire)
pubilc
community groups
unions
influencers
Population Health Concepts
Health Field concept
Genetic predisposition
Environmental Circumstances
Health Services
individual behavior & lifestyle
One health
Planetary Health
Ottawa Charter
building healthy policy
creating supportive environment
strengthening community actions
developing personal skills
reorientating health services
demonstrating commitment to health promotion
Population Health
Indicators
Death rates
crude death rate
age-specific death rate
perinatal death rate
standardisation of death rates (direct, indirect)
The Global Burden of Disease Report
YLL
DALYs
mortality
burden of non-fatal diseases
disability weights
population attributable fraction
Changes
demographic transition
disease transition
disability transition
Commercial determinants
Defining the narrative
Overton window
Promotion of concepts: -against the state -to diminish social solidarity
Influencing the discoure on epidemiology
reframing the concept of conflict of interest
influence on research
concept of denialism
framing a new model of disease causation
complexity of problem
Setting the rules
lobbying -> shaping legislation
representatives in technical committees
deciding where the rules will be determined (court vs arbitration panel)
Exploiting workers
undermining working conditions
outsourcing
threatening to move away if labor standards change
slowing / reversing UHC
Controlling the concept of IP
patents on crops; patents on DNA
patent on medicines
power of drug discovery & development
advocate for state subsidies