1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17 Social, Economic and Political Factors That Influence Occupational Performance Catherine L. Lysack and Diane E. Adamo

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives 1.Distinguish between socioeconomic status, social class, and social inequalities. 2.Discuss how health is related to an individual’s position in the social hierarchy. 3.Discuss how individual and community level socioeconomic factors impact health.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (Continued) 4.Explain how socioeconomic disadvantages experienced in childhood affect the occupational performance of client as adults. 5.Describe three actions that occupational therapy practitioners can take to reduce the negative impact of social inequalities and health disparities in clients’ lives.

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction The Bottom Line: Higher socioeconomic status (SES) is associated with better health –more opportunities for engagement and benefit from meaningful occupations Socioeconomic factors influence: –access, participation, and positive outcomes through OT services; and –health choices and behaviors of clients and health care professionals

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction (Continued) Lower SES has been linked to: –chronic stress; –heart disease; –Ulcers; –Diabetes; –rheumatoid arthritis; –certain types of cancer; and –premature aging

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Defining the Social Causes of Health and Illness Socioeconomic Status, Class, and Social Mobility Socioeconomic status refers to occupational, educational, and income achievements of individuals or groups Classes groups of people with similar economic means, ownership and control of property and assets Social mobility degrees movement up or down social ladder –largely dictated by class status

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Social Inequality and Health Disparities Social inequality: Pattern of unequal social status linked to race, gender and wealth inequalities Health disparities: Unfair differences in access to health care services, treatment provided and health outcomes –May be the result of social inequalities or improper actions by professionals.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Intersections of Gender, Ethnicity, Age, Disability and Sexual Orientation Gender inequalities Ethnic inequalities Age inequalities Inequalities due to disability Inequalities based on sexual orientation Many are subject to multiple inequalities by belonging to several groups experiencing health disparities

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Political Economy of the Health Care System The U.S. health care system is a complex and fragmented system Regulation and reimbursement policies are difficult to navigate and understand Most expensive health care system in the world The U.S. ranks low on many health indicators in comparison to other countries Evidence suggests that the system has serious problems at all levels

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Role of Health Insurance Access to U.S. health insurance requires employment with health benefits or independent financial means More than 50 million U.S. citizens have no health insurance An additional 50 million are thought to have insufficient coverage Ethnic and racial minorities make up a disproportionate share of the uninsured

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Role of Health Insurance The uninsured and underinsured have: –reduced access to health care; –poorer overall health; and –increased likelihood of premature death Medical debt is the leading cause of bankruptcy

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanisms of Disadvantage Across the Life Course Money Matters: Economic Disadvantage and Health Poverty—the lack of material resources necessary for subsistence –Increases exposure to factors that make people sick –Decreases chances of having high-quality medical insurance and care Poor social and physical environments may adversely affect health through physiological stress.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Poverty Populations at high risk for poverty include children, older adults, new immigrants, persons with disabilities and ethnic minorities Working poor: People who work full-time but whose wages are still below the poverty level New poor: People who have fallen into poverty because of some sudden and/or unexpected circumstance (e.g. serious illness, divorce or job layoffs)

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Deprivation Across the Life Course Foundations of adult health are laid before birth and in early childhood –Slow physical growth in infancy is associated with reduced cardiovascular, respiratory, pancreatic, and kidney function, increasing the risk of serious illness in adulthood –Living in an impoverished home environment can impede normal development Social inequalities over the life course contribute to occupational performance deficits in adulthood

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of OT in Addressing Health Disparities What can OTs do about these intractable problems? Utilize focused, evidence-based OT interventions early among vulnerable children Increase research on effective interventions for overcoming socioeconomic influences on health Engage in reflective practice that includes: examination of clients’ socioeconomic status and cultural factors; and impact on OT services and outcomes

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of OT in Addressing Health Disparities (Continued) What can OTs do about these intractable problems? Become more educated about economic, institutional and structural barriers to treatment and health outcomes Leverage our position in the health care system to reduce the negative consequences of poor social conditions on our clients’ health and occupational performance