SOCIOECONOMIC STATUS

(SES)

• Rank or status in a social hierarchy

 • Access and consumption of goods, services, and knowledge

• measure of income, educ, and occupation

PSYCHONEUROIMMUNOLOGY

(PNI)

12 SDH identified @ YORK U conference (courseware p8)

Social determinants of health include both social and economic circumstances that influence the health of _____, _____, and _____ (purple, p3-1).

 Social determinants of health are the conditions where people are _____, _____, _____, ____ and _____

 _____ _____ __ _____ are the conditions where people are born, grow, live, work and age

SDH determine the degree a person has the _____, _____, and _____ resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment” (a broader definition) (2rr3 p3-1)

SDH determine the degree a person has the physical, social, and personal resources to identify and achieve _____ _____, satisfy _____, and _____ with the environment” (a broader definition) (2rr3 p3-1)

SDH are about the _____ and ____ of a variety of resources that a society makes available to it’s members

SDH are about the quantity and quality of a variety of _____ that a society makes available to it’s members

 Resources 

that a society makes available to it’s members

(2rr3 p3)

• conditions of childhood • income

• education: availability and quality

• food • housing

• employment • working conditions

• health and social services

 To improve how society organizes and distributes _____ and _____ resources, _____ and _____ polices need to change, and political, economic, and social forces influencing policy decisions examined (2rr3 p3)

Health Gradient:

SES and it's correlation to Health

Ottawa Charter for

Health Promotion

• enabling ppl more control over their health

• allowing people to improve their health

• create well-being

(needs satisfied and ability to cope) 

 “ the capacity of people to adapt to, respond to, or control life’s challenges and changes”

 Health is positive - more than absence of disease.

 a state of physical, mental and social well being

 Health is a capacity or resource.

 The range of personal, social, economic, environmental, biological factors which determine the health status of individuals or populations.

 either modifiable (e.g. poverty) or unmodifiable (e.g. age)

 are not easily modifiable; require action from individuals, organizations, governments, communities, etc.

• income

• employment

• education

• social status

•social networks

• social cohesion

Major Physical Environment

determinants of health

  natural and built

  air, land, food & water quality, housing density,

safety of products,

living/working conditions,

impact of technology

MAJOR Personal Health Practices

determinants of health

Behaviours that enhance or create risks to health

• smoking • physical activity

• eating behaviours • alcohol

• driving behaviours etc.)

MAJOR Individual Coping Skills

determinants of health

MAJOR Health Services

determinants of health

access to and utilization of

• preventive

• restortive services

• palliative care

MAJOR Human Biology 

determinants of health

• Biological and genetic endowment

• exposure to biological threats 

 In terms of funding, more public money is spent on

_____ _____ _____ than on any other determinant.

Risky behaviours may account for nearly half of all deaths - function of _____, _____, _____ and _____

factors.

"Public Views" of Determinants of Health

- Personal lifestyle factors -

"Public Views" of Determinants of Health

- Broader determinants: -

• SES - level of income (33%)

• availability of quality housing (34%)

• person’s level of education (33%)

• safety of communities (35%)

influenced the health of Canadians

DETERMINANTS OF HEALTH 

(unit 2 slide 13)

• Income • social status

• social support • education

• employment conditions • gender

• social enviro • physical enviro

• healthy child development • culture

• biology & genetic endowment

• health services

  Different from absolute deprivation (poverty)

- Poverty definition in Canada ~ $20,000 for 2 people

- Developing countries $1.00/person/day

  Distribution of income (gap) between the rich and poor.

Why is income inequality

traditionally important indicator?

 Poverty reduction - both growth and income distribution matter

 Bad for growth – weakens the rate at which growth is converted to poverty reduction

(slice of economic pie captured by poor).

 Social justice – indication of politically sustainable and fair economic policies.

 Good standardized indicator - one of the 10 sustainable development indicators used in Europe.

Income Inequality and Health: Three plausible pathways

1.  Access to life opportunities (ie., political participation, education, competitive spending)

2.  Erosion of social cohesion – “social capital” (i.e., trust, mutual aid, access to services)

3.  Psychosocial and chronic stress (i.e.,social support, hopelessness, sense of control, job security).

Diseases are stress related – heart attack, cancer, depression, etc.

Seek the Cause in Incidence

Not the Cause of Cases

To reduce a population's level of chronic disease

• seek the "causes of incidence" that shift entire risk factor distributions at the population level,

• not simply the "causes of cases" at the individual level of analysis/clinical level of investigation

Renewing our Public Health Principles

 Seek the root causes of disease and disability - a focus on determinants

 Consider and deal with whole populations

- overweight and obesity are population level concerns!

 Understand and apply the principles of social change, over the life course

 Open to all solutions (“interdisciplinary thinking”)

BUT... beware of co-option by the clinical care system

Changing Trends: Globalization of Food

“Global corporations are establishing industrialized agro-food systems in almost all nations that will provide constant 24/7/365 consumer access to virtually unlimited volumes of relatively inexpensive [calorie-dense] foods to all people in all places at all times through supermarket, catering, vending, takeout, home delivered, drive through and fast/snack foods”.

Changing Trends:

Activity

• Habitual use of cars even for short trips

• Inadequate public transportation

•  Urban designs, e.g., no sidewalks OR bike paths

• remote control, big-screen TVs

•  Labor saving devices 

•  Computer & Internet

Changing Trends: Culture

•  Building designs 

•  Parenting styles and family meals 

•  Food is everywhere

•  Diversity in food products 

•  Female body image standards

Moving beyond Education:

Rationale for Environmental and Policy Approaches

•  Behaviour is influenced by psychosocial & physical enviro.

•  Causes are complex and culturally rooted.

•  Need to change community and social norms to effect behaviour change (e.g., tobacco experience)

Putting it all together.... A Multilevel Program Approach

  Multilevel Program Approach = 4E’s

•  Education

•  Environmental supports / controls

•  Economic levers

•  Enforcement of legislation and regulations

Putting it all together....

A Multilevel Program Approach

cont’d

•  Stages of Life

 Child, adolescent, young adult, middle age, older adult, elderly

•  Relevant Settings

School, workplace, community, etc.

Example of Multilevel Program Approach

(Effective, Feasible and Necessary)

ENCOURAGE HEALTHY EATING IN CHILDREN AND YOUTH

•  Education: school-based; community-based (media).

•  Environmental supports: social norms; access to healthy foods in high school cafeterias; universal access to recreation programs regardless of socioeconomic status.

•  Economic levers: healthier foods at a lower price.

•  Enforcement of legislation and regulations: restrict food advertising to children.