LEARNING OUTCOMES
1. Understand health and its complexities.
2. Examine intersectionality / biosocial interactions that influence health outcomes.
3. Distinguish between the role of structure, culture, history, and demographic influences on health.
5. Evaluate sources of global health inequity using a social justice lens
RESOURCES
Required reading: From SOCIAL MEDICINE AND PUBLIC HEALTH), page 9 to page 18 (end of THE
THREE DIMENSIONS OF THE SOCIAL MODEL OF HEALTH)
Germov J. Health sociology and the
social model of health. 2014. In: Second opinion: An introduction to health
sociology [Internet]. Melbourne, AUSTRALIA: Oxford University Press; [5-22].
UNRAVELING COMPLEXITY IN HEALTH
CONCEPTS
Medicine has made great strides in the last
100 years - from saving of lives in acute life-threatening emergencies, to
thoroughly improving health outcomes through preventive and curative
interventions and minimizing the deterioration in the quality of life related
to chronic disease. The advancement and
integration of technology including complex, computerized machines, has played
a monumental role in the study of the human body and its functioning,
diagnosis, and treatment of disease.
Disease and Social Context
Yet, today, besides emerging diseases we are witnessing the re-emergence of diseases that had declined dramatically but are again becoming a problem for a significant proportion of the world’s population. Tuberculosis and malaria are examples. Tuberculosis (TB) is preventable and curable. Yet, it is not without reason that TB is called a disease of poverty as it disproportionately affects the poor. While more than 95 per cent of TB deaths occur in low-and-middle income countries (LMICs), TB also affects the most poor and vulnerable populations such as the homeless, urban poor, HIV-infected persons, drug users, and immigrants in developed countries.
Poverty and disease are mutually reinforcing. Epidemics and chronic disease cluster, recur, and prevail amidst rampant poverty.
Beyond Medicine
Social Justice and Health
Even when biological risk is equal, those living in
deprivation are at greater risk of disease. It is this unfair and avoidable
disadvantage experienced by socially disadvantaged populations that contributes
to negative health outcomes which is called health inequity. Health inequity is
also significantly associated with healthcare inequities.
The concept of health/healthcare inequity or health equity,
therefore, embodies the notion of social justice because it is anchored within
principles of fairness and distributive justice.
In this unit, we will explore evidence-based approaches to
understand the importance of social justice and human rights in health, paying
considerable attention to health systems as an important determinant of health
equity.
Let’s start by reviewing the definition of health.
Contemporary health challenges and the need for a health systems response
Numerous contemporary health challenges necessitate adaptive transformations within health systems. Among these challenges, health inequities stand out as a prominent issue, both within and between countries.
This video explores the concept of health inequity and its contextual relevance within the health system. To evaluate the sources of global health inequity through a social justice lens, please refer to page 5 of your E-Book.
Health professionals, being integral to the health system, must prioritize building capacity to address these global health inequities within their practice.
Exploring life expectancy at birth as an indicator of health inequity
EXPLORING MALAYSIA’S LIFE EXPECTANCY, MORBIDITY & MORTALITY DATA
Observe the data carefully – Look for trends, comparisons, and significant patterns. Answer the questions – Think critically about the implications of the statistics. Reflect on the insights – Consider what these figures reveal about health trends and challenges in Malaysia.
Structural Factors AND Structural Discrimination
In this section, we use the case example of HIV to discuss the role of structural factors in producing health and disease.
Structural factors, in the context of health, refer to the broader political, economic, social, and environmental conditions and institutions at local, national, regional, or international levels that shape health outcomes (adapted from IOM, 2020). They could include legal, political, economic, educational, and health systems; social class structures and social norms and values; environmental policies; race and ethnic relations; religion; and technology and infrastructure.
Structural
factors predict structural discrimination.
Structural discrimination refers to rules, norms, routines, patterns of attitudes, and behavior in institutions and other societal structures that result in unequal treatment and outcomes for groups or individuals.
Structural discrimination can be intentional (Implementing health policies that deliberately limit access to healthcare for specific populations, such as immigrants or minority groups based on race, gender, or sexual orientation) or unintentional (unintentionally over-allocating resources for the development of urban infrastructure, thereby inadvertently disadvantaging rural populations, or conducting medical research that predominantly focuses on certain demographic groups like male patients), leading to less effective treatments for others due to a lack of representative data. It often manifests in areas like employment, housing, education, and healthcare.
Structural discrimination predicts or exacerbates structural inequity.
Structural inequity is a broader concept and encompasses systemic inequalities. Beyond the effects of discrimination, it extends to the overall distribution of resources and opportunities in society.
Take a look at the data on HIV released by UNAIDS in 2020. What can we learn about structural factors and structural discrimination from the global data on HIV? Think about how structural factors influence the rise in the number of new HIV infections causing them to even surpass target numbers.
Intersectionality
The Biomedical and Social Models of Health
For an in-depth comparison, refer to John Germov's "Second Opinion" on page 17, as mentioned in your readings.
Also, view the short video provided for an overview of the historical evolution of the biomedical and social models of health.
Is equal treatment fair?
So that brings us to the final part of this topic, and to an important question. Answer the question, and check out the slide on the difference between equality and equity and the summary of Health and Medicine.
Before you go!
