SOCIAL DETERMINANTS OF SOCIAL DETERMINANTS OF HEALTHHEALTH

INDIVIDUAL INDIVIDUAL

SOCIETYSOCIETY

It is an organized group.It is an organized group.

COMMUNITY COMMUNITY

Total Organization of social life with a limited Total Organization of social life with a limited area.area.

- Ogburn and Mimkuff- Ogburn and Mimkuff

HealthHealth

"The state of being free from illness or injury"."The state of being free from illness or injury".

- Google dictionary- Google dictionary

HealthHealth was defined as "a state of was defined as "a state of complete physical, mental, and social complete physical, mental, and social well-being and not merely the well-being and not merely the absence of disease or infirmity“.absence of disease or infirmity“.

““Socially and economically productive Socially and economically productive life”life”

- WHO - WHO

Biological

Socio-cultural

Behavioural

Environmental

Science and technology

Information and communication

Healthy system

Socio-economic

Equity and social justice

Aging of the population

Gender Famalies

Individuals

Communities

SocietiesFamilies

Individuals

Health

Humanrights

Biological

Behavioural

Biological

Behavioural

Biological determinantsBiological determinants

The physical and mental traits of every human The physical and mental traits of every human being to sum extent determined by the nature being to sum extent determined by the nature of genes at the movement of conception.of genes at the movement of conception.

Positive health – a person should be able to Positive health – a person should be able to express as completely as possible the express as completely as possible the potentialities of his genetic heritage. potentialities of his genetic heritage.

- WHO - WHO

BEHAVIOURAL AND SOCIO CULTURALBEHAVIOURAL AND SOCIO CULTURAL

LIFE STYLE – the way of people liveLIFE STYLE – the way of people live social valuessocial values AttitudesAttitudes activitiesactivities

ENVIRONMENTENVIRONMENT

Disease to environmentDisease to environment

- Hippocrates- Hippocrates

Concept of disease – environment Concept of disease – environment associationassociation

- Pettenkofer- Pettenkofer

Internal External

physical biological Psycho social

ENVIRONMENT

INTERNALINTERNAL

Each and every component part, every tissue, Each and every component part, every tissue, organ and organ- system and their harmonious organ and organ- system and their harmonious functioning with in the system.functioning with in the system.

EXTERNAL OR MACRO ENVIRONMENTEXTERNAL OR MACRO ENVIRONMENT

All that witch is external to the individual All that witch is external to the individual human host.human host.

Socio economic conditionsSocio economic conditions

Economic status

Education

Occupation

Political system

Nutrition

Housing

HEALTH SERVICESHEALTH SERVICES

PURPOSEPURPOSE

To Improve The Health Status Of The To Improve The Health Status Of The PopulationPopulation

AGING OF THE POPULATIONAGING OF THE POPULATION

A major concern of rapid population aging is A major concern of rapid population aging is the increased prevalence of chronic disease the increased prevalence of chronic disease and disabilities both being conditions that tend and disabilities both being conditions that tend to accompany the aging process and deserve to accompany the aging process and deserve special attention.special attention.

GENDERGENDER

Women’s healthWomen’s health

OTHER FACTORSOTHER FACTORS Information and communicationInformation and communication Science and technologyScience and technology

Why Emphasize Social Why Emphasize Social Determinants?Determinants?

Social determinants of health have a direct Social determinants of health have a direct impact on healthimpact on health

Social determinants structure other causes of Social determinants structure other causes of health:health:– EnvironmentEnvironment– BehaviourBehaviour– ServicesServices

The ‘causes of the causes’The ‘causes of the causes’

SOCIAL FACTOR INFLUNCING THE HEALTH OF PEOPLESOCIAL FACTOR INFLUNCING THE HEALTH OF PEOPLE

DEMOGRAPHICDEMOGRAPHICECONOMICECONOMICPOLITICALPOLITICALLEGALLEGALRELIGIOUSRELIGIOUSEDUCATIONALEDUCATIONALTECHONOLOGICALTECHONOLOGICAL

COMMUNICATIONSCOMMUNICATIONSMIGRATIONMIGRATIONURBANIZATIONURBANIZATIONLIFE EXPECTANCYLIFE EXPECTANCYMARRIAGEMARRIAGEFERTILITYFERTILITYROLE OF WOMENROLE OF WOMEN

ECOLOGICAL PREDISPOSITIONS(community values, socially prescribed roles,life style, sub-cultural behaviour patterns,etc.)

CURRENT CIRCUMSTANCES(income, family life, housing employment,

Stresses and crises, social support, etc)

INDIVIDUAL PREDISPOSITIONS(inheritance, prenatal events, previous accidents or illness, upbringing, childhood nutrition, etc.)

OPPORTUNITIES/SITUTIONS(access to health services, expousure to pathogens,

availability of education, food, sanitation, alcohol, drugs, marriage partners, etc.)

HEALTH

FRAMEWORK OF THE CATEGORIES AND PATHWAYS OR FRAMEWORK OF THE CATEGORIES AND PATHWAYS OR DETERMINANTSDETERMINANTS

SOCIOECONOMIC SOCIOECONOMIC

POLITICALPOLITICAL

CONTEXTCONTEXT

Social PoliciesLabour market,Housing, land

Culture andsocietal value

Macroeconomic policies

Public policies,Education, health,Social protection

Governance

Socioeconomic Position

Social Class Gender

Ethnicity (racism)

Education

Occupation

Income

• Material Circumstances(Living and Working,

Conditions, Food Availability, etc)

• Behaviors and Biological Factors

•Psychosocial Factors

IMPACT ON EQUITY IN HEALTH

AND WELL-BEING

STRUCTURAL DETERMINANTS OF HEALTH INEQUITIES

INTERMEDIARY DETERMINANTS OF HEALTH

Health System

Social cohesion & Social Capital

Addressing the social Addressing the social determinantsdeterminants

of health of health

Involves the medical care and public Involves the medical care and public health systems, but clearly extends health systems, but clearly extends beyond thesebeyond these

Requires collaboration with multiple Requires collaboration with multiple sectors outside of health, including sectors outside of health, including education, housing, labor, justice, education, housing, labor, justice, transportation, agriculture, and transportation, agriculture, and environmentenvironment

Addressing the social Addressing the social determinantsdeterminants

of equity of equity

Involves monitoring for inequities in Involves monitoring for inequities in exposures and opportunities, as well as for exposures and opportunities, as well as for disparities in outcomesdisparities in outcomes

Involves examination of structures, policies, Involves examination of structures, policies, practices, norms, and values to answer, practices, norms, and values to answer, “How are these inequities being “How are these inequities being maintained?”maintained?”

Requires intervention on societal structures Requires intervention on societal structures and attention to systems of powerand attention to systems of power

We need to do bothWe need to do both

Address the social determinants of Address the social determinants of health, including poverty, in order to health, including poverty, in order to achieve large and sustained achieve large and sustained improvements in health outcomesimprovements in health outcomes

Address the social determinants of Address the social determinants of equity, including racism, in order to equity, including racism, in order to achieve social justice and eliminate achieve social justice and eliminate health disparitieshealth disparities

Diseases of Public

Health Impute

Early ChildDevelopment

Women + GenderEquity

Urban Settings

Social Exclusion

EmploymentConditions

Globalization

Health systems

Measurement

Building Health & Health Equity

KNOWLEDGE NETWORK THEMES

Ten Tips for Staying Healthy Ten Tips for Staying Healthy 1.1. Don't be poor. If you can, stop. If you can't, try not to be poorDon't be poor. If you can, stop. If you can't, try not to be poor for long.for long.2.2. Don't have poor parents.Don't have poor parents.3.3. Own a car.Own a car.4.4. Don't work in a stressful, low paid manual job.Don't work in a stressful, low paid manual job.5.5. Don't live in damp, low quality housing. Don't live in damp, low quality housing. 6.6. Be able to afford to go on a foreign holiday and sunbathe.Be able to afford to go on a foreign holiday and sunbathe.7.7. Practice not losing your job and don't become unemployed.Practice not losing your job and don't become unemployed.8.8. Take up all benefits you are entitled to, if you are unemployed, Take up all benefits you are entitled to, if you are unemployed,

retired or sick or disabled.retired or sick or disabled.9.9. Don't live next to a busy major road or near a polluting factory.Don't live next to a busy major road or near a polluting factory.10.10. Learn how to fill in the complex housing benefit/ asylum Learn how to fill in the complex housing benefit/ asylum

application forms before you become homeless and destitute.application forms before you become homeless and destitute.

Dave Gordon, 1999