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Case Study 1

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Social
Determinant
Education
Definition
How does it link to population health?
How does it link to
the case study
Number of
years of formal
schooling
including
school and/or
university
Miriam stopped
school after 2nd
grade thus has
limited education
and therefore also
has limited
employment and
income
opportunities …
Living
Conditions
The physical
environment
of the
home/dwelling
that an
individual
resides in
including
features such
as: heat, light,
damp, security
and space/size
of dwelling.
Money
received,
especially on a
regular basis,
for work or
through
investments
and/or
government
support.
The perception
and actuality
that one is
cared for, has
assistance
available from
other people
(emotional,
social and
physical), and
that one is
part of a
Access to formal education has been shown to lead to
improved health – the higher the education of individual the
better is his/her health as individuals have the capabilities to
make better-informed health decisions for not only
themselves but their respective families. Education forms
employment opportunities, which plays a significant role in
economic resources as well as reducing unemployment.
Individuals who have been unemployed for an extended
period of time have been found to have increased rates of
mortality and an increase in chronic disease morbidity such
as cardiovascular and metabolic conditions. Increased
education is also positively associated with mental health as
a result of perceived personal control. Addressing disparities
in access to education will no doubt have positive
implications for social and health inequalities throughout the
world. Improving the access to formal education and training
to populations will have positive effects on physical and
mental well-being and improve the overall quality of life
Safe, affordable and secure housing is associated with better
health, which in turn impacts on people’s participation in
work, education and the community. It also affects parenting
and social and familial relationships (Mallet et al. 2011).
There is a gradient in the relationship between health and
quality of housing: as the likelihood of living in ‘precarious’
(unaffordable, unsuitable or insecure) housing increases
health worsens. The relationship is also two-way, in that
poor health can lead to precarious housing. Single parents
and single people generally, young women and their children
and older private renters are particularly vulnerable to
precarious housing (AIHW 2015b; Mallet et al. 2011).
Income
Social
Support
Including
Family
Income and wealth play important roles in socioeconomic
position, and therefore in health. Besides improving
socioeconomic position, a higher income allows for greater
access to goods and services that provide health benefits,
such as better food and housing, additional health care
options, and greater choice in healthy pursuits. Loss of
income through illness, disability or injury can adversely
affect individual socioeconomic position and health
(Galobardes et al. 2006).
Physical support involves direct aid or services and can
include loans, gifts of money or goods, and provision of
services such as taking care of needy persons or doing a
chore for them.
Emotional support includes intimacy and attachment ,
reassurance and being able to confide in and rely on another
– all of which contribute to the feeling that one is loved or
cared about.
Social support includes giving information and advice which
could help a person solve a problem and providing feedback
about how a person is doing.
supportive
social network.
Social capital describes the benefits obtained from the
links that bind and connect people within and between
groups (OECD 2001). The extent of social
connectedness and the degree to which individuals
form close bonds with relations, friends and
acquaintances has been in some cases associated with
lower morbidity and increased life expectancy (Kawachi
et al. 1997), although not consistently (Pearce & Smith
2003). It can provide sources of resilience against poor
health through social support which is critical to
physical and mental wellbeing, and through networks
that help people find work, or cope with economic and
material hardship.
Social infrastructure—in the form of networks,
mediating groups and organisations—is also a
prerequisite for 'healthy' communities (Baum & Ziersch
2003).
The degree of income inequality within societies (the
disparity between high and low incomes) has also been
linked to poorer social capital and to health outcomes
for some, although there is little evidence of consistent
associations (Lynch et al. 2004).
Gender (not
sex)
The gender
roles and/or
expectations/s
tereotypes
particular to
being male or
female in
society.
How does gender affect health?
1. Access to resources and opportunities
In Vietnam – for women in families where they had less
opportunity to access education - the infant mortality was
41/1000 live births compared to 6.7/1000 live births for
women who had received secondary education or higher.
2. Decision making in the household
In Cambodia a study showed that women who had to ask
their husband’s permission to be tested for HIV were 73%
less likely to have a test.
3. Health seeking behaviour
Across the world, Masculinity is associated with not showing
sad emotions - resulting in decreasing rates of men accessing
mental health services despite suffering from mental health
conditions.
4. Access to health information
In some countries, reproductive health awareness is
considered taboo for unmarried women and irrelevant for
men so they don’t access them Practices which result in
psychological and physiological consequences
5. Harmful traditional practices 1.Harmful social
expectations.. In some parts in the world it is considered
masculine to smoke.
Ethnicity
Religion
Minority
Group
Membership
Relates to the
state of
belonging to a
social group
that has
common
national or
cultural
traditions or
rules that
govern
decisions.
Is an organised
collection of
beliefs,
cultural
systems, and
world views
that relate
humanity to
an order of
existence
A group of
people with
common
interests or
characteristics
which
distinguish
them from the
more
numerous
majority of the
population of
which they
form a part.
Could be
linked to
sexuality, race
or culture etc.
 Based on social, cultural and historical variations.  Can
influence: Health decision making, attitudes towards
medications, individual’s worries and health seeking
behaviours , lifestyle behaviours including diet, smoking,
drinking
Can affect the way in which people present symptoms to the
doctor and the types of treatment they will accept.
Health behaviours: Religious beliefs may influence a
person's risk of illness in the first place (through prescribing
a certain diet and/or discouraging the abuse of alcoholic
beverages, smoking, etc., religion can protect and promote a
healthy lifestyle) Spirituality also appears to confer health
benefits through the social support that membership in a
group brings.
Psychological states (religious people can experience better
mental health, more positive psychological states, more
optimism and faith, feeling of meaning and purpose, which
in turn can lead to a better physical state due to less stress)
On average, these groups experience poorer health, than
the majority population.
Many efforts to explain health disparities have reduced
them to cultural factors, suggesting the origins of ill health
are found in the cultural norms and values of the minority
group, with any disadvantage resulting from their own
practices or attitudes. However, this can be seen as a
“blaming” approach, as it considers the culture to be at
fault) ignoring contributing social and economic factors
(Nazroo, 2004).
Socioeconomic inequality is a key factor in the health
disparities experienced by ethnic groups.
Direct experience of prejudice, or awareness that such
attitudes exist, can have significant negative consequences
for individuals’ health, particularly their mental health
Similarly, racially prejudiced attitudes can be embedded in
how society operates, causing social structures and
institutions to function in a racist manner. Rather than just
focusing on the actions of individuals, we need to look at
social structures and institutions that may operate in a
discriminatory manner and influence the actions and
attitudes of those within them (Annandale, 2014; Barry and
Yuill, 2011)
Food
Security
(Having food
or being able
to get food)
When people
have reliable
access to
sufficient,
affordable,
nutritious food
to support a
healthy life.
Adults who are food insecure are at an increased risk of
developing chronic diseases, and children who are food
insecure are at risk for developmental issues. This can lead
to an increase in hospital readmissions and medical
treatments. This guide describes the link between food
insecurity and adverse health issues and outlines clinical and
nonclinical approaches that hospitals and health systems can
use to reduce food insecurity and the stigma often
associated with it.
Regarding the relationship between health status and food
security, it may be sufficient to define good health as the
ability to withstand the effects of exposure to illness and
injury. The connection between nutritious food and health
status is, from this perspective, fundamental, whether or not
innate. Leaving aside the question of how to educate people
to make healthy and nutritious choices, assuring access and
affordability becomes a matter of public policy and the
generous application of social support.
Undernourishment and malnutrition are two conditions
widely agreed to be the results of hunger and food
insecurity. Among children, conditions that can coincide with
the latter include weight loss, fatigue, stunting of growth,
and frequent colds. Studies have shown that
undernourished pregnant women are more likely to bear
babies with low birth weight, and the babies are then more
likely to experience developmental delays that can lead to
learning problems.
Iron deficiency anemia is also common among hungry and
food insecure children on one end of the spectrum and older
adults on the other. In children, the condition can cause
delays in development and learning. Children with iron
deficiency anemia are also more susceptible to the effects of
lead poisoning. In people of every age group, iron deficiency
anemia can cause fatigue, weakness, shortness of breath,
and irregular heart rhythms, among other symptoms.[6]
Moreover, hunger and food insecurity worsen the effects of
all diseases and can accelerate degenerative conditions,
especially among the elderly. Hunger and food insecurity
create psychological responses such as anxiety, hostility, and
negative perceptions of self-worth.[6] In an energy- and
resource-constrained world, diseases like malaria, HIV/AIDS,
dengue fever, and other infectious conditions from distant
places, which experts anticipate will migrate in reaction to
changes in weather patterns, can be expected to become
more prevalent. More frequent incidents of these and other
opportunistic diseases are likely to be reported, resulting in
the potential to overburden the ability of any medical or
public health system that tries to address the problem(s).[7]
Access to
Health Care
If services are
available
(location/spac
e), accessible
Both access to health services and the quality of health
services can impact health. Healthy People 2020 directly
addresses access to health services as a topic area and
(cost) and
appropriate
(fit with need),
then the
opportunity to
obtain health
care exists,
and a
population
may 'have
access' to
services.




incorporates quality of health services throughout a
number of topic areas.
Lack of access, or limited access, to health services
greatly impacts an individual’s health status. For example,
when individuals do not have health insurance, they are
less likely to participate in preventive care and are more
likely to delay medical treatment.3
Barriers to accessing health services include:
Lack of availability
High cost
Lack of insurance coverage
Limited language access
These barriers to accessing health services lead to:




Community
Resources
Employment
and
Occupations
Community
resources are
the facilities
and
infrastructure
in place within
a given
community to
support
activities of
daily life. This
can include
resources such
as public
transport
infrastructure,
playgrounds,
roads,
pathways and
shops.
Employment
refers to the
state of being
paid for
organised task
related
activities.
Occupation
refers to the
type of work
one does e.g.
Unmet health needs
Delays in receiving appropriate care
Inability to get preventive services
Hospitalizations that could have been prevented
The residential environment has an impact on health equity
through its influence on local resources, behaviour and
safety. Communities and neighbourhoods that ensure access
to basic goods and services; are socially cohesive; which
promote physical and psychological wellbeing; and protect
the natural environment, are essential for health equity
(CSDH 2008). To that end, health-promoting modern urban
environments are those with appropriate housing and
transport infrastructure and a mix of land use encouraging
recreation and social interaction.
Unemployed people have a higher risk of death and have
more illness and disability than those of similar age who are
employed (Mathers & Schofield 1998). The psychosocial
stress caused by unemployment has a strong impact on
physical and mental health and wellbeing (Dooley et al.
1996). For some, unemployment is caused by illness, but for
many it is unemployment itself that causes health problems
through its psychological consequences and the financial
problems it brings. Rates of unemployment are generally
higher among people with no or few qualifications or skills,
those with disabilities or poor mental health, people who
have caring responsibilities, those in ethnic minority groups
blue or white
collar
occupation
and associated
conditions.
or those who are socially excluded for other reasons (AIHW
2015b). Once employed, work is a key arena where many of
the influences on health are played out. Dimensions of
work—working hours, job control, demands and
conditions—have an impact on physical and mental health
(Barnay 2015). Participation in quality work is healthprotective, instilling self-esteem and a positive sense of
identity, while also providing the opportunity for social
interaction and personal development (CSDH 2008).
Education, as with other social determinants of health, plays a major role in a person’s overall health and
well-being. Education can affect us throughout our lifetime and has been shown to increase healthy
behaviors and improve health outcomes, including obesity rates. Early education is especially important
because it sets the foundation for a healthy life. Beyond early childhood education, research shows that the
more education a person gets the longer they’ll live.
Research has demonstrated associations between an individual’s social and economic status and their health. 12 For
example poor education and literacy are linked to low income and poor health status (e.g. ear disease), and affect the
capacity of people to use health information; poverty reduces access to health care services and medicines;
overcrowded and run-down housing associated with poverty contributes to the spread of communicable disease; and
smoking and high-risk behaviour is associated with lower socio-economic status.13 Where a person lives also
contributes to health, with isolation in remote and very remote communities reducing access to services.
What is Social Determinant
The social determinants of health are the conditions in which people are born, grow, live, work and age. These
circumstances are shaped by the distribution of money, power and resources at global, national and local levels