THE DETERMINANTS OF HEALTH Key Knowledge: 1.4 - The role of determinants of health including the physical environment, biological, behavioural and social, in explaining variations in health status. Key Skill: - Use the determinants of health to explain differences in the health status of Australians and between population groups.

Social Determinants of Health Key Knowledge: Biological, behavioural and social determinants of health in explaining variations in health status Key Skill: Use the determinants of health to explain differences in the health status of Australians and between population groups.

Social Determinants of Health Social determinants of health refer to the social environment including the broader social, cultural, environmental and economic factors. People who experience poor social and economic health conditions experience worse health in all societies. When people experience poor social determinants are more likely to experience two or more of them. Social determinants are now a focus for health authorities.

Social Determinants of Health Socioeconomic status Work Unemployment Social exclusion and isolation Stress Food security Early life experiences Access to health care

Socioeconomic status As a general rule: the wealthier you are the healthier you are. The poorer you are the worst health outcomes experienced. Measured using three components: All three components impact on each other. E.G: income increases the opportunities for education An well paying occupation increases ones income An education increases one job opportunities and therefore income.

Socioeconomic status High SES: Low SES: IMPACT ON HEALTH: High SES: Income increases ability to purchase healthy foods and therefore maintain a health BMI, increase immune system Access to health care Ability to understand health promotion messages Low SES: Live in poorer areas with lack of physical resources Poorer quality of housing and also overcrowding More likely to smoke More likely to have poor nutrition and lack of physical activity Discuss each and link to health outcomes. E.g: Income increases ability to purchase healthy foods and therefore maintain a health BMI, increase immune system Access to health care Ability to understand health promotion messages Live in poorer areas with lack of physical resources Quality of housing There is also a relationship between socioeconomic status and many behavioural determinants. People who are more socioeconomically disadvantaged are: Less likely to take notice of health promotion messages More likely to smoke, drink and be overweight/obese.

Identify the long term conditions for which the highest/lowest SES suffer the greatest from. Suggest reasons for this Choose three of the risk factors and indicate possible PMS issues.

Quintiles Population being broken up into fifths. Each fifth represents 20% of the population. The first quintile is the most disadvantaged, the fifth quintile is the most advantaged; all in relation to SES.

Work Different to ‘workplace’ in physical environment. Involves: Relationships with colleagues and employer Financial position of company The status associated with your occupation in the community The demands of the job Poor relationships impact on social health, lack of financial security increases stress and poor mental health, low level of status for occupation reduces confidence and self esteem and unreasonable demands lead to stress, anxiety and lack of appreciation.

Unemployment The unemployed have a higher chance of dying and more illness than those of similar age who are employed. High level of psychological and financial stress factors.

Unemployment IMPACT ON HEALTH: Higher rates of suicide, lung cancer and cardiovascular disease Anxiety about job security can effect mental health, heart disease, risk factors of heart disease. Psychological problems such as stress and depression Higher mortality and more illness and disability

Social exclusion and social isolation Social exclusion refers to the segregation that people experience if they are not adequately participating in the society it which they live. Such people have been referred to as ‘social outcasts’. Social isolation refers to not being in regular contact with others. Exclusion can result from racism, discrimination, stigmatisation, hostility and unemployment.

Social exclusion and social isolation Some examples of the causes and results of social exclusion include: Poor physical and mental health Disability Family breakdown Homelessness Lack of education and skills Low income Relative poverty IMPACT ON HEALTH: Mental health problems such as depression and stress Poor self esteem

Stress ‘Stressful circumstances, making people feel worried, anxious and unable to cope, are damaging to health and may lead to premature death.’ –definition of stress. A little bit of stress can be quite positive and can assist people in getting tasks done. When stress becomes too great the individual may feel incapacitated, becoming more vulnerable to a range of health conditions. What happens when we get stressed? Heart rate raised Fight or flight Long term stress=greater demands on the body= poorer wellbeing

Stress High blood pressure Stroke Infections Diabetes Heart attack IMPACT ON HEALTH: Diabetes High blood pressure Heart attack Stroke Depression Infections

Food security The quality, availability and affordability of the food supply all affect what people eat.- definition A shortage of food or lack of variety (food insecurity) can lead to deficiency and malnutrition Excess intake (also a form of malnutrition) can contribute to people eating too much and therefore putting themselves at risk of diet-related diseases, such as diabetes and cardiovascular disease. People who are unable to access or afford healthy foods may be forced to buy cheaper processed foods, which are often made from poorer quality produce and have added fat, salt and/or sugar. Why might be experience food insecurity: Live in rural areas Financial constraints Low SES------- tend to be provided with poor quality food products in the area Lack of knowledge regarding food products Lack of transport

Food insecurity Deficiencies such as: Obesity Cardiovascular disease Discuss HOW IMPACT ON HEALTH: Deficiencies such as: Iron- anaemia Calcium- osteoporosis Vit C- poor immune system Obesity Cardiovascular disease Diabetes Dental cavity Cancer

Early life experiences People are a product of their past experiences. Early life experiences shape individuals, their outlook on life, behaviours etc. and influence adult health.

Early life experiences Examples: Infants who have experienced strong emotional and positive stimulation are better prepared to take on the challenges of school, exhibit positive behaviour and are less likely to be socially excluded in adulthood. Nutritional deficiencies during pregnancy, smoking, drug misuse etc can lead to poor foetus development and health issues later in life. Being exposed to regular intake of take away foods from an early age can result in food behaviour patterns later in life; these foods are high is sat fats, trans fats and sodium which may result in CVD, obesity and T2D. From an early age being around family members who smoke may cause the development of asthma or other respiratory conditions. It may also contribute to young people taking up smoking which may result in lung cancer or COPD later in life. Not having a family encourage physical activity and sport may result in sedentary behaviour during childhood and teenage years. This may result in excess energy being stored in the body and as a result, becoming overweight/obese.

Access to health care Health care refers to the services that promote and preserve health through the diagnosis, treatment and management of disease and illness. Factors that can inhibit an individual’s ability to access health care = cultural, financial and other social barriers E.g females may not be able to visit a male GO Language barriers Medicine and services may not be culturally appropriate (indigenous) Low SES may not be able to afford health care and medicines * Access to health care is also a physical environment determinant. Do not discuss access to health care as a social determinant if it is related to proximity/health care being in their geographical location etc. Eg’s: Doctors, dentists, scientists, physiotherapists etc…

Access to health care IMPACT ON HEALTH: Increase/decrease mortality, life expectancy through detection and treatment of conditions Decreased morbidity through education of healthy life choices Reduced low birth weight babies through monitoring and education throughout pregnancy. Discuss specific examples- similar to physical environment ‘access to health care’ answers.