Health Determinants Midterm

focuses on health measurements at a population level (effective regulation of food and water, publi services and enviromental protection)

= Risk Factor model

1. Biomedical variant

2. Behavioural variant

1. Age

2. Sex

3. Genetics

epigenetics: gene expression

enviromental and social conditions modify behavior and gene expression

the study of the social determination of human behavior

Two weaknesses at the individual level approach

1. Modifying individual lifestyle is hard

2. Blaming people for illness is counter productive and unfair

1. it is extremely difficult to change peoples habits

2. risk factors the trail focused on: excersie, deit, smoking and blood pressure account for collectively only a minory of heart attacks

3. secular change: behavior could have changed due to interventions of research but also in response to broader changes in american society

“A state of complete physical, social and mental well being and not merely the basence of disease or infirmity.”

1. Geography

2. Common characteristic

3. Population defined by one risk factor

requires us to consider the implications of health issues affecting the entire soceity as well as the health issues of vunerable highrisk groups

Discovered the cause of cholera

Implications: focused on environmental impact on health. living conditions as a source of disease

Credited with: inventing modern epidemiology and health geography

Published: condition of the working class in England

Implications: death rates of the poor people in urban centers were much higher than death rates of poor people in rural settings

Demonstrated that social and economic change can affect health and longevity

Living and working conditions are the major determinants of health

Health harming behavior (family violence) is a product of the conditions under which people live and not a consequence of character flaws or bad choices

father of modern pathology and developed the standard approach to conducting autopsies

Typhus outbreak in upper silesia

Argued that radical political, social and economic reforms are needed to transform the living conditions of individuals

Civil and human rights = health outcomes

Father of sociology, developed social facts

Social facts: human artifiacts→ interaction of people in groups, have the capacity to act as determinants of human behavior

Analyzied suicide rates across different communities

Implications: social environment is important force in shaping individual behavior and beliefs

1. Thomas Mckeowm

2. Geoffery Rose

the study of birth and death rates in human populations

Describes the impacts of falling childhood death rates and extended life spans on the size and age distribution of populations

1. From high birth rates and high death rates to increase wealth and urbanization

2. From high brith rates to a relatively advanced economic development and declining death rates

3. From declining birth and death to an advanced stage of economic development characterized by stability of population

implies that social and economic development occurs, different types of disease become prominent

-Change from infectious and parasitic diseases in poorer places to chronic disease in richer ones

-Appears to occur when societies reach a level of affluence equivalent to roughly 6,000 to 10,00 per capita income

1. Public health: population/ community based prevention perspective utilizing interventions targeting populations or communities as well as high risk gorups

2. Healthcare: includes the delivery of services to individuals one on one

3. Public health policy: range from imprviing housing, education, transportation to providing opportunities for work, expan and improve health program

addressing many of the most difficult health problems we face because it considers the FULL RANGE of options for prevention

→ looks for underlying influences and determinants= upstream

1. Population health perspective:

- Examines the components of population health, the determinants of health and disease, how we measure the course of disese in a population, health status

- Describe the problem, diagonsis, select interventions or treatments

2. Systems thinking and systems doing

3. Population health tools for implementation

1. Behavior: actions that increase exposure to the factors that produce disease

2. Infections: often the direct cause of disease

3. Genetics: roles our genetics play in the development

4. Geography: location influences frequency and presence

5. Enviroment: natural physical world

6. Medical Care: access to and quality

7. Socioeconmic-cultural: education, income, and occupational status/ cultural habits

Any departure from a normal state, such as illness or disability. It is often used, not correctly, as a synonym for “disease.”

1. ID key factors or infleunces that impact disease

2. indicate the strength of the impact

3. ID influences or interventions interactions together

4. ID dynamic change in system, feedback loops

5. ID bottlenecks that limit effectiveness

6. ID leverage points

understanding what is needed for sucessful implementaiton

Evidence comes from:

Surveillance: birth, death, reportable disease

Surverys: hospital discharge surveys, health surveys

Studies: investigaitons

Synthesis: systematic reviews that quantify and quality data to put into words

1. Reduce high risk

2. Improve average risk

3. Narrow the spread of the risk curve

1. Population health communication

-Health communicaiton: exploding field

-Social marketing

2. Population based behavioral change

-Great deal of the success of population depends on change individual behavior

-Stages of change model: precontemplation, comnteplation, preparation, action, maintenance

3. Health policy interventions

- Result from federal, state, and local legislation

- Global action: address health conditions across national borders

- Health in all policies that view health as a single system

Screening for disease and risk factors

4. Screening: for disease that use tests on individuals who do not have the symptoms for a specific disease

5. Populaiton based vaccination

studies how social position and context influence human health

Takes a populaiton level perspective

Concerns itself wih social context

Relies on multilevel anlysis

Takes a developmental persepctive

characteristics= not absolute

Normal = social constructed

Scale and pattern of disease

Health attributes→ height, weight, blood pressure

if we treat high risk people, we will not do much to improve the overall health of the population

If we change the average we will not have much effect on the average individual

Rose showed to improve health of population we need to focus on the entire population

Every society has a graident in health → not only because of poverty effects

Addresses only a small proportion of the total incidence of disease, ingury or death

It is palliative appraoch failing to address root causes

Hevaiourally inadequate

Invivles attribution errors and mistakes about causality

Mean predicts how many values will fall in the tail of distribution

Most disease actually occurs in low risk populations

We need to shift averages not just to treat the highrisk populations

Two cohorts of british government workers

Results:

Employees in more higher paid, higher status jobs enjoyed better health

Risk factors accounted for only a small fraction of differences

The lion’s share of differences was attributes directly to employment grade

- Salary

- Education level

- Working conditions

Working group of inequalities in health and in the united kingdom

Showed the gap in health between social classes

Showed the gap was huge and growing

Examined health dispairies in 32 OECD countries

Found a strong correlation between life expectancy and proportion of income received by the lower 50% of tbhe income distribution

Unequal societies= unhealthy societies

relationship between income and health persists. Morality and morbidity

Exceptions: breast and prostate cancer, rare diseases

Higher population income typically signifies higher edu levels, improved living conditions, improved housing, better diet

Affluent population is a precondition for stable goverment, development of infrastructure and social programs

Countries GDP correlates strongly with life expectancy in poorer countries but weakly in richer ones

At 10,000 the relationship between income and life expectancy disappears

Each addition to GDP is less important in affluent countries

Total income and average income matter most in poor places

1.Social capital theory

•Putnam’s argument about social capital: Social capital is important to social mobility. Integrated communities have better social capital distribution.

2.Sociology and criminology

•Durkheim claimed that social change is creating chaos. It creates stress, which creates suicide in society. People need to feel united not to have too much problems in society.

3.Primatology

•Monkeys, baboons, and chimpanzees, all of which live in social hierarchies, show that subordinate animals have lower life span. It has nothing to do with diet but with the levels of cortisol—stress hormone. A chronically elevated stress response clogs arteries and animals die. They show that if you move an animal up the social hierarchy, they become healthier and vice versa.

Income distribution is a marker for how unequal society is

The size of income inequalities reflect hierarchical society

Big differences in income= big difference in edu, housing

Big differences between individuals will diminish social capital, and political instbaility

Important to separate arugemnts about income from education, rank and degree of control

Progressive income taxes can reduce inequality income level

Different strategy needs to be used to address status inequalities

When status and income are separated, materialist arguments trump the psychosocial

push to reduce government intervention in business and individual lives

- Problems: much economic development is gov led

- Private economic activities could not take place

- Combination of low takes, easy credit and self regulation lead to rampant inequality, economic bubbles and recession

•Link between household income and health

•Income is linked to education, living conditions, and health

•Importance of material conditions (social structures, processes and public goods)

•Distribution of wealth in society

•Focus on perception of our status and personal security

•The resources available to us matter less than our social position

•Differences in health status linked to differences in the resources that are available to individuals.

•Gradient in health links income with health inequalities.

•More equal societies show better health than less equal ones.

•Inequality has become much greater in Canada and US in recent years.

•Because of corporate compensation policies and reduced taxes for wealthy

•Materialist theories of health support progressive taxes and redistributive public programs.

•Psychosocial theories do not square well with the available evidence.