The Social Determinants of Health and Social Justice Elizabeth McGibbon, PhD, RN, Associate Professor St. Francis Xavier University Presentation for StFX Nursing 115, Jan, 2014

What are the social determinants of health (SDH)? How do the SDH come together or intersect to deepen disadvantage? What is social justice? How are the SDH always connected to social justice? Today’s Presentation

What are the social determinants of health? The conditions in which people are born, grow, live, work and age (World Health Organization, 2008, 2013).

What are the social determinants of health? The conditions in which people are born, grow, live, work and age (World Health Organization, 2008, 2013). These conditions include social, economic, financial, geographic, environmental… \

The Social Determinants of Health early childhood development education employment and working conditions income and its equitable distribution

The Social Determinants of Health health care services and access food security housing security social exclusion/ inclusion social safety nets

The Social Determinants of Health race age Aboriginal status gender

Let’s take a closer look at the SDH… early childhood development

Let’s take a closer look at the SDH… early childhood development education

employment and working conditions

income and its equitable distribution

health care services and access

food security

housing security

social exclusion and inclusion

social safety nets

race age

race age Aboriginal status gender

A closer look at gender; Ellen Degeneres and Bic Pens for Women © prIWhc

So…How do the SDH come together or intersect to deepen disadvantage? An example: family income…. education…..gender….employment

How do the SDH come together or intersect to deepen disadvantage? More examples: race (racism)…. access to health services… What else?......

Why is social justice so closely linked to the SDH? “Economic and racial inequality are not abstract concepts, [they] hospitalize and kill even more people than cigarettes. The wages and benefits we're paid, the neighborhoods we live in, the schools we attend, our access to resources and even our tax policies are health issues every bit as critical as diet, smoking and exercise…” (Larry Adelman, Executive Producer, UNNATURAL CAUSES, March 2008)

…The unequal distribution of these social conditions - and their health consequences - are not natural or inevitable. They are the result of choices that we as a community, as states, and as a nation have made, and can make differently. Other nations already have, and they live longer, healthier lives as a result.” (Larry Adelman, Executive Producer, UNNATURAL CAUSES, March 2008)

Equality and Equity First, what is the difference between equality and equity? Equality is when everyone is treated equally, regardless of their SDH…so wheelchair ramps, no adaptations for people with disabilities, no scholarships or supports for students who cannot afford tuition; no supports for rural families who must navigate the health care system…

EQUITY is… Equity happens when we address avoidable or remediable differences among groups of people… (WHO, 2013) Some examples are public policy supports for students in need, such as low interest student loans; social assistance for parents who wish to return to university; affirmative action policies that support more women in leadership roles…

What is Social Justice? Social justice refers to fair and equitable distribution of society’s benefits and responsibilities and their consequences (CNA, 2006)

What is Social Justice? Social justice refers to fair and equitable distribution of society’s benefits and responsibilities and their consequences (CNA, 2006) When we work for social justice, we address the social, economic and political origins of health inequities- the ROOT CAUSES ( Anderson et al., 2009; World Health Organization, 2011). © McGibbon, 2014

Unemployed or underemployed Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Parents unemployed or underemployed Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Parents unemployed or underemployed Parents lack education Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Parents unemployed or underemployed Parents lack education Parents lack money for education Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Parents unemployed or underemployed Parents lack education Parents lack money for education Evidence about the “root causes”: What’s missing here?

Unemployed or underemployed Lack of education No money for education Parents unemployed or underemployed Parents lack education Parents lack money for education Evidence about the “root causes”: What’s missing here? Some root causes: Public policies, Systemic discrimination that create structural barriers for families and communities

“All diseases have two causes: One pathological, the other political” Rudolf Virchow ( ) © McGibbon, 2014

A modern example…. Globe and Mail, 2010: Front Page

but… the causes of infant mortality in ‘rich’ countries, such as Canada, have been found to be related to:

Racism-related stress and socioeconomic hardship (Giscombe & Lobel, 2005) High prevalence of low income among women who experience serious hardships during pregnancy (Braveman et al., 2010) High poverty rates and lack of access to a socialized health care system, as is the case in the United States (Tillet, 2010) Strong relationship between high poverty rates and infant mortality among minority and white mothers in the US (Simms, Simms, & Bruce, 2007) Strong relationships among poverty, racial composition of geographic areas, and infant mortality rates (Eudy, 2009)

So what for nurses? Social Justice is a moral and ethical responsibility for nurses and for the entire nursing profession, rather than a desired but not always achievable goal Neutrality is not an option for ethical practice…

 Want to know more about social justice and the SDH? Nursing electives for learning about justice Social Justice and Health (N364/ WMGS 364) Policy for Health: Interdisciplinary Strategies (N495)

….more about social justice and the SDH