Understanding Social Determinants of Health

 
Social Determinants of Health
 
Amy Burdette
Associate Professor
Department of Sociology and Public Health Program
Florida State University
 
 
Introduction
 
o
It is now widely accepted that chronic
conditions like heart disease and cancer
have multiple causes, and not all of them
are biological in origin.
 
o
Today, health professionals and health
scholars recognize that 
social
 and
psychological
 and 
biological
 and
behavioral
 factors influence the onset of
sickness, as well as the form, duration, and
intensity of symptoms.
 
Introduction
 
o
Social epidemiology
 is the branch of
epidemiology that studies the social
distribution of health, morbidity, and
mortality risk.
 
o
The social distribution is defined by 
social
status
 and 
social conditions
.
 
Introduction
 
Social status
 indicates one’s social position:
 
Age
 Gender
 Race and Ethnicity
 Socioeconomic Status (SES)
 
Marital Status
 Religion
 
 
Introduction
 
o
Social conditions
 refer to socially patterned
contexts, circumstances, and environments.
 
o
Social conditions influence health by placing
populations at “risk of risks,” increasing
vulnerability
 or 
susceptibility
 to poor health,
morbidity, and mortality.
Substandard Housing
Neighborhood Disadvantage
 
 
Introduction
 
o
Social conditions are more or less 
stressful
or 
dangerous
.
 
o
Social conditions regulate health-relevant
behaviors
 and access to health-relevant
institutions
 and 
services
.
 
Introduction
 
o
Social conditions are 
environments
, 
norms
,
and 
patterns of social control
 that are
health-promoting or health-damaging.
 
o
Social conditions influence the development
of 
psychosocial resources
, which help to
protect against ill-health, morbidity, and
mortality.
 
Introduction
 
o
Central questions
:
 
1. 
How
 do social statuses and social
conditions shape health patterns and
mortality risk?
 
 
2.
 
Why
 do social statuses and social
conditions shape health patterns and
mortality risk?
 
Introduction
 
Social Status                       
 
Health
 
 
Sociological
   
Public Health
Social 
    
Social
Epidemiologists 
  
Epidemiologists
 
Introduction
 
o
The sociological perspective is that health
is not the problem. Health is a symptom
of the problem–social stratification and
social inequality.
 
o
The sociological perspective is that health
inequalities are produced by the unequal
distribution of resources, opportunities,
limitations, and demands.
 
Evidence for Social Causes of Health
 
There is consistent evidence that
race/ethnicity and SES are associated with
health and well-being across the life
course.
undefined
 
 
Infant Mortality Rates,* by Race and Hispanic Ethnicity of Mother
— United States, 2000, 2005, and 2010
undefined
 
Fundamental Social Causes
 
Both race and SES may be viewed as fundamental
social causes of health and well-being.
 
The Fundamental Social Causes
 explanation
suggests that people who occupy relatively high
social positions might be advantaged with regard to
health and longevity because their position in the
social hierarchy embodies 
resources
 like social
capital, knowledge, money, power, and prestige that
can be used in different ways to 
avoid health-risks
and to 
adopt health-protective behaviors and
strategies
.
 
 
Fundamental Social Causes
 
o
According to the fundamental social causes
explanation, when new health-risk factors
arise, when new health-related information
emerges, or when new treatment
technologies develop, those who command
the most resources are best able to avoid
the risk factors and take advantage of the
protective factors.
 
Fundamental Social Causes
 
o
When innovations (e.g., cancer screens)
beneficial to health are developed, their
implementation necessarily occurs within
the context of existing inequalities in
knowledge, money, power, prestige, and
social connections.
 
undefined
 
Fundamental Social Causes
 
o
Diseases, risk factors, and protective factors
come and go.
 
o
Social conditions are described as
“fundamental social causes” of health and
longevity because their effects persist even
when diseases and relevant risk and
protective factors change.
 
Policy Implications?
 
To reduce disparities in health, we must first
address the underlying inequality driving
these disparities.
 
“Pretax income inequalities have increased in many
countries. A policy of not redressing this through the tax
and benefit system, linked to lack of investment in public
goods that brings the benefits of richer communities to
all, will damage health.” 
Michael Marmot
 
Focus on interventions that are available to
all, regardless of social characteristics.
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Chronic conditions like heart disease and cancer have multiple causes, not all biological. Social epidemiology studies the social distribution of health, morbidity, and mortality risk influenced by social status and conditions. Factors such as age, gender, race, socioeconomic status, and social conditions like housing and neighborhood quality impact health outcomes. Social conditions can be health-promoting or damaging, shaping behaviors, access to health services, and psychosocial resources. Key questions include how and why social statuses and conditions affect health patterns and mortality risk.


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  1. Social Determinants of Health Amy Burdette Associate Professor Department of Sociology and Public Health Program Florida State University

  2. Introduction o It is now widely accepted that chronic conditions like heart disease and cancer have multiple causes, and not all of them are biological in origin. o Today, health professionals and health scholars recognize that social and psychological and biological and behavioral factors influence the onset of sickness, as well as the form, duration, and intensity of symptoms.

  3. Introduction o Social epidemiology is the branch of epidemiology that studies the social distribution of health, morbidity, and mortality risk. o The social distribution is defined by social status and social conditions.

  4. Introduction Social status indicates one s social position: Age Gender Race and Ethnicity Socioeconomic Status (SES) Marital Status Religion

  5. Introduction o Social conditions refer to socially patterned contexts, circumstances, and environments. o Social conditions influence health by placing populations at risk of risks, increasing vulnerability or susceptibility to poor health, morbidity, and mortality. Substandard Housing Neighborhood Disadvantage

  6. Introduction o Social conditions are more or less stressful or dangerous. o Social conditions regulate health-relevant behaviors and access to health-relevant institutions and services.

  7. Introduction o Social conditions are environments, norms, and patterns of social control that are health-promoting or health-damaging. o Social conditions influence the development of psychosocial resources, which help to protect against ill-health, morbidity, and mortality.

  8. Introduction o Central questions: 1. How do social statuses and social conditions shape health patterns and mortality risk? 2. Why do social statuses and social conditions shape health patterns and mortality risk?

  9. Introduction Social Status Health Sociological Social Epidemiologists Public Health Social Epidemiologists

  10. Introduction o The sociological perspective is that health is not the problem. Health is a symptom of the problem social stratification and social inequality. o The sociological perspective is that health inequalities are produced by the unequal distribution of resources, opportunities, limitations, and demands.

  11. Evidence for Social Causes of Health There is consistent evidence that race/ethnicity and SES are associated with health and well-being across the life course.

  12. Infant Mortality Rates,* by Race and Hispanic Ethnicity of Mother United States, 2000, 2005, and 2010

  13. Fundamental Social Causes Both race and SES may be viewed as fundamental social causes of health and well-being. The Fundamental Social Causes explanation suggests that people who occupy relatively high social positions might be advantaged with regard to health and longevity because their position in the social hierarchy embodies resources like social capital, knowledge, money, power, and prestige that can be used in different ways to avoid health-risks and to adopt health-protective behaviors and strategies.

  14. Fundamental Social Causes o According to the fundamental social causes explanation, when new health-risk factors arise, when new health-related information emerges, or when new treatment technologies develop, those who command the most resources are best able to avoid the risk factors and take advantage of the protective factors.

  15. Fundamental Social Causes o When innovations (e.g., cancer screens) beneficial to health are developed, their implementation necessarily occurs within the context of existing inequalities in knowledge, money, power, prestige, and social connections.

  16. Fundamental Social Causes o Diseases, risk factors, and protective factors come and go. o Social conditions are described as fundamental social causes of health and longevity because their effects persist even when diseases and relevant risk and protective factors change.

  17. Policy Implications? To reduce disparities in health, we must first address the underlying inequality driving these disparities. Pretax income inequalities have increased in many countries. A policy of not redressing this through the tax and benefit system, linked to lack of investment in public goods that brings the benefits of richer communities to all, will damage health. Michael Marmot Focus on interventions that are available to all, regardless of social characteristics.

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