Book: Social Determinants of Health; A Comparative Approach

Social Determinants of Health; A Comparative Approach

REFERENCE

Davidson, Alan, 2015, Social Determinants of Health, a Comparative Study, Oxford, Canada

MY SUMMARY

As an Epidemiologist, I understand that my health is associated with three main factorsà agent, host, and environment. If my immunity is weak (host), and my children got flu from her childcare and then sneeze (agent:virus), then the weather is winter (environment), make me susceptible to get Flu. However, if I consider as an Social Epidemiologist, I should consider other factors, like my wealth, education, my insurance, health care availability and accessibility, my work that might increase or decrease my susceptibility to get flu or not. Therefore, a term known as ‘SOCIAL DETERMINANTS OF HEALTH that provides multiple layers of factors that might contribute to the complexity of health condition, including Place, where we live and work, risk factors-behavior, diet, stress, access to health care, social interaction-social support, social network, biology-age, sex and gender, socio-economic status-education, income.

For instance, in my research, some HIV-positive women’husband can survive after being tested as HIV persons, while other were getting severe and then died. They already have virus in their body (agent), therefore how they have good immunity and healthy environment to keep survive. By understanding determinants of health, I learn how social support and psychological support from their wife and family are necessary. Their wife kept treating their husband, never shared about their CD4 level, and got a reminder from their husband we should be strong to raise their children. Although HIV virus has impacted on their immunity and cause some opportunistic infections, like Tuberculosis, Pneumonia and rash on their skin and they had very low CD4 (under 50), they finally can survive and keep accessing ARV treatment. In addition, their husband starts to reduce or even stop smoking, and eat much healthier food and avoid stay overnight. They believe that unhealthy behaviors will threaten their immunity and make them easy to fall sick because HIV is in their body (health belief model).

DIRECT QUOTATION

The conventional understanding of health focus on some terms of susceptibility or our resilience, risk factors, triangle of epidemiology  (host, agents & vector, and environment), population at risk, population attribute etc. Risk factor analysis is useful = powerful way of looking at human health (p.4).

                                                                  

Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development and health services. As an approach, population health focuses on the interrelated conditions and factors that influence the health of population over the life course, identifies systematic variations in their patters of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations (emphasis added) (Public Health Agency of Canada, 2012) p.7

Determinants of population health:

1.     Income and social status

2.     Social support networks

3.     Education and literacy

4.     Employment and working conditions

5.     Social environments

6.     Physical environments

7.     Personal health practices and coping  skills

8.     Healthy child development

9.     Biology and genetic endowment

10.  Health service

11.  Gender

12.  Culture (Public Health Agency of Canada, 2013) p. 8

Understanding health inequalities and health inequities

if a child developed a condition that current medical technology cannot diagnose and because of that no effective treatment could be applied and the child died, that would be unfortunate but not unfair. If the child was not diagnosed because her mother could not afford the hospital’s fees and, in consequence of not receiving care that would have otherwise been available, she died, that would be not only unfortunate, but also unjust. At the social level, failing to respond to a harmful social circumstance that is within our collective power to change is an injustice. Health inequalities arise from conditions over which we have no control; health inequities or injustices, arise from conditions which are amenable to collective action. P.9

Social Epidemiology is the branch of epidemiology that studies how social position and context influence human health, on the other hand clinical epidemiology which focus on rsk factors within a host-agent model. P. 43

Four main features characterize social epidemiology:

1.     SE takes a population-level perspective

2.     SE concerns itself with the social context of behavior

3.     SE relies on multi-level analyses

4.     SE takes a developmental, life-course perspective.

Psychosocial Theories

The feelings of stress that arise regarding an individual’s position ultimately drive his or her health status. At first glance, this appears to be quite a load to be carried by stress. But keep in mind that stress significantly impairs our capacity to cope with challenges. Moreover, chronic stress has been linked to smoking, excess alcohol consumption, over eating, depression, and breakdown of social relations. People under stress have a heightened sensitivity to pain and are susceptible to debilitating chronic pain syndromes. And there is evidence that stress can affect basic metabolic pathways, contributing to diabetes and impaired immune function. Chronic stress is also associated with coronary heart disease. (p.1)

 

  

Place, where we live and work, risk factors-behavior, diet, stress, access to health care, social interaction-social support, social network, biology-age, sex and gender, socio-economic status-education, income

Figure 2.8. Conceptual Model of Determinants of Health (p.enam puluh dua)

Recall there are three: materialist, neo-materialist, and psychosocial. The key difference is that materialist hypotheses construe the main driver of health differences to be individual resources or capacities, whereas psychosocial hypotheses construe differences in health to arise from differences in social status or rank.

The Psychosocial Model

 

                                                                                        

                                               

Figure 3. Psychosocial Income Inequality Pathways to Poor Health (page 93)

an alternative to materialist thinking is psychosocial theorizing. The pathway from society to our biology is our perception, particularly our perceptions of our status and personal security. A sense of lack of respect or fearfulness can prime our stress response leading to chronic strain and elevated levels of cortisol which in turn damage our emotional, mental and physical health. (p.92)

MATERIALIST THEORY

It links individual level considerations such as income available to a person or a household to health outcomes through a family of hypotheses (p.92)

NEO-MATERIALIST ANALYSIS is inherently multi-level because social structures, processes, and public goods (all collectice features) may provide key health-relevant resources to individuals. Thus theory in this gendre consider jointly collective-and individual level resource relevant features.

SOCIAL PATTERNING OF BEHAVIOUR

it is a serious mistake to construe health-relevant behavior as “individual” in the sense that it is chosen, albeit shaped by external factor (237)

The Health Belief Model

According to Rosenstock (1974), the model relies on four key variables:

1.     Self-perceived personal risk

2.     Self-perceived severity of the outcomes associated with unhealthy behavior

3.     Self-perceived barriers to and costs of behavioral change; and

4.     Self-perceived benefits of making the behavioral change

Health belief Model

Health behavior as socially Patterned

·      Rationale behavior and incentives

·      Rationale behavior and information

·      Rationale behavior and our brain

·      Rationale behavior and sociology