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Social Determinants of Health AKHLST 3010 School of Health Policy and Management Dennis Raphael

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Social policy, health determinants and health in Canada today ... Judge, & Whitehead, 1995, p.xxi, Tackling Inequalities in Health: An Agenda for Action. ... – PowerPoint PPT presentation

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Title: Social Determinants of Health AKHLST 3010 School of Health Policy and Management Dennis Raphael


1
Social Determinants of Health AK/HLST
3010School of Health Policy and
ManagementDennis Raphael
  • Societal Approaches to Understanding
  • How Income and Income Inequality
  • Affect Health
  • York University
  • October 28, 2002

2
Overview
  • Health differences among nations
  • Health differences among US states and cities
  • Various explanations for these effects
  • Social policy and population health
  • Social policy, health determinants and health in
    Canada today
  • Social policy, health, and the welfare state

3
PYLL(0-74) by Cause, Urban Canada, 1996

Source Wilkins et al., 2002
4
Excess PYLL(0-74) by Cause, Urban Canada, 1996

Source Wilkins et al., 2002
5
Poverty and Health Mechanisms
  • Poverty can affect health in a number of ways
  • income provides the prerequisites for health,
    such as shelter, food, warmth, and the ability to
    participate in society
  • living in poverty can cause stress and anxiety
    which can damage peoples health
  • low income limits peoples choices and militates
    against desirable changes in behaviour.
  • - Benzeval, Judge, Whitehead, 1995, p.xxi,
    Tackling Inequalities in Health An Agenda for
    Action.

6
Critical Periods of the Life Course
  • Fetal development
  • Birth
  • Nutrition, growth and health in adulthood
  • Educational Career
  • Leaving parental home
  • Entering labour market
  • Establishing social and sexual relationships
  • Job loss or insecurity
  • Parenthood
  • Episodes of illness
  • Labour market exit
  • Chronic sickness
  • Loss of full independence
  • -- Shaw et al., The Widening Gap, 1999, p. 106.

7
  • Health Differences Among Nations

8
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11
USA, Canada, and Sweden Rankings Compared to
Other Industrialized Nations (Ranking,
1 is best) Measure USA Canada
Sweden Income Inequality (1990) 18 of 18 11
3 Child Poverty (1990) 17 of 17 14 2 Infant
Mortality (1996) 24 of 29 17 2 Youth Suicide
(1992-1995) 15 of 22 16 10 High School Drop-Outs
(1996) 17 of 17 16 10 Youth Homicide
(1992-1995) 22 of 22 19 5 Wages (1996) 13 of
23 15 6 Unemployment (1996) 2 of
10 7 8 Elderly Poverty (1990) 15 of
17 4 5 Life Expectancy (1996) 20 of 29 4 3
12
Health Differences Among US States and Cities
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21
Economic Inequality Explanations
  • Economically unequal societies have greater
    levels of poverty (individual poverty
    explanation)
  • Economically unequal societies have greater
    hierarchy and weaker social cohesion (social
    comparison explanation)
  • Economic unequal societies provide fewer social
    safety nets and social investment
    (neo-materialist explanation)

22
Economic Inequality and Health
  • What matters in determining mortality and health
    in a society is less the overall wealth of that
    society and more how evenly wealth is
    distributed. The more equally wealth is
    distributed the better the health of that
    society.
  • Editorial The big idea. British Medical Journal,
    April 20, 1996, 312, 985.

23
Economic Inequality and Health
  • Inequality may make people miserable long before
    it kills them.
  • Editorial Income inequality and mortality Why
    are they related? British Medical Journal, April
    20, 1996, 312, 987-988.

24
Neo-Materialist Viewpoint I
  • Income inequality has generally been associated
    with differences in health
  • A psychosocial interpretation of health
    inequalities, in terms of perceptions of relative
    disadvantage and the psychological consequences
    of inequality, raises several conceptual and
    empirical problems
  • Income inequality is accompanied by many
    differences in conditions of life at the
    individual and population levels, which may
    adversely influence health
  • - Lynch et al., BMJ, 2000

25
Neo-Materialist Viewpoint II
  • Interpretation of links between income inequality
    and health must begin with the structural causes
    of inequalities, and not just focus on
    perceptions of that inequality
  • Reducing health inequalities and improving public
    health in the 21st century requires strategic
    investment in neo-material conditions via more
    equitable distribution of public and private
    resources
  • - Lynch et al., BMJ, 2000

26
Higher income inequality is associated with lots
of things
27
Increasing Inequality and Longevity in UK
Source Lynch et al., BMJ, 2000
28
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