LEARNING OUTCOMES
By the end of this lecture students should be able to:
Explain the influence of key social factors on health and illness
Outline the wide range of factors interacting to influence health status
Describe the concepts of health inequality and inequity
Explain the links between the social determinants of health and health inequities
Explain the effects of the social determinants of health on clinical and public health practice
RESOURCES
DETERMINANTS OF HEALTH: BEYOND MEDICINE
Health is
multi-factorial and has many determinants.
There are
modifiable and non-modifiable determinants of health. While non-modifiable
determinants of health such as biology and genetics cannot be changed,
determinants such as education, income, and the physical environment etc can be
changed.
Over the last
twenty years, a compelling body of evidence has documented the effect of social
factors on health(1). Social factors of health can also
be called social determinants of health. Some studies have attributed up to 60
percent of preventable mortality to socioeconomic
factors(2).
Arising from this understanding of the
complex ways in which health determinants at different levels impact health
outcomes, Prof. Michael Marmot, a proponent of the social determinants of
health model states that in treating patients, doctors need to address
'individual behavior in social perspective' (p.688)(1). As we will see a little later in this topic, Prof. Marmot and
others have since also provided persuasive evidence showing that lower socioeconomic status is
generally associated with a higher
likelihood of exposure to risk behaviors. Such evidence has served to
demonstrate the powerful interlinkages between the biological, social, and
psychological dimensions of health.
These developments have led to increasing calls to integrate knowledge about the social determinants of health in medical education and clinical
practice. There is also a growing body of guidance on how clinicians might address the social determinants of health in the practice of medicine.
In this module, we examine key concepts related to the social determinants of health. We then explore some interesting work of pioneering physicians who drew attention to the association between social disadvantage, deprivation, and ill-health. We will then finally round off this module by reflecting on how clinicians can address the social determinants of health in clinical practice.
REFERENCES
1. Marmot M. The health gap: Doctors and the social determinants of health.
Scand J Public Health. 2017;45(7):686-93.
2. Schroeder SA. We can do better — improving the health of the American
people. New England Journal of Medicine. 2007;357(12):1221-8.
EQUALITY & INEQUITY
Let’s continue to recap. What is health equality? How is it different from health equity?
Click on the arrow below to check if you got the answer right.
INTERLINKAGES BETWEEN SOCIAL DETERMINANTS
OF HEALTH AND HEALTH
INEQUITY
Now that we know our terminology, let’s see
how social inequalities intersect with health inequity.
In Health and Medicine, we learned that
although medical care is an important determinant of health, social
inequalities outside of the healthcare system can engender health inequities
quite apart from medical care. What are some of these
social inequalities that can impose health risks on people and create health
inequities? What are the pathways by which social inequalities create health
inequities?
To know more, in this segment, we focus our
attention on the social determinants of health.
SOCIAL GRADIENT IN HEALTH
In the
preceding segment we studied the social determinants of health model proposed
by Sir Michael Marmot and the World Health Organization. In this section, we
review the evidence related to the social gradient in health and see how it
relates to social determinants of health.
TRAVERSING THE BOUNDARIES OF MEDICINE: OTHER PHYSICIANS
It might seem that the topic, social determinants of health, is currently a trending topic in public health. However, the issue of health inequity as a phenomenon that has social causes, but medical consequences was highlighted by other physicians in the past. In this section, we will look at the work of two physicians who pointed to social and structural factors to address some of the complex problems related to health inequities.
UNDERLYING CONCEPTS & DEBATES
In the previous section, we saw different physicians use a social model of health to explain
health and disease. They highlighted the significance of the social determinants of health in
generating health inequities or contributing to good health.
In this final part of Health Determinants, we will look at certain concepts and debates
related to health inequities. You will find information on Social Exclusion and Othering in
your E-Book on Determinants of Health. Think about which groups of people might
experience Social Exclusion and Othering and what forms this might take.
In this section, we will look at the Structure-Agency Debate and Implicit Bias.
DROP YOUR QUESTION
You have learnt many new concepts and reviewed evidence that highlight the significance of the social determinants of health. We welcome you now to drop your questions in the google form below. We will either address your query during the tutorial or communicate via email.
TOGGLE TIME
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