Determinants of Health Assignment Paper

Determinants of Health Assignment Paper

Concepts Of Social Class

The concept of social class is intended to characterize how groupings of persons organized in hierarchical arrangements relate to one another in terms of social standing, authority, and power and influence. 5 Its more simple proxy—socioeconomic status (SES)—characterizes most empirical research, however. Typically, it is measured by education, income, occupation, and sometimes residential location. These measures are highly associated but commonly explain different components of the relationship between SES and health, suggesting that each acts through somewhat different pathways. Investigators commonly build indices that combine these effects into a single SES measure, although with powerful statistical approaches it is more reasonable to analyze components individually to assess their independent as well as their cumulative effects.Determinants of Health Assignment Paper

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Most epidemiological studies on social determinants seek to elucidate the specific pathways through which SES functions. By identifying such mediating factors as knowledge, health habits and behavior, diet and nutrition, occupational and housing hazards, control over one's work and one's life, social supports, coping capacities, and the like, they seek to explain the relationship and inform social interventions. The assumption is that if the pathways are completely and correctly described, the health disadvantages of those who are less privileged will be explained, and this will enable more well-designed, targeted interventions.Determinants of Health Assignment Paper

A different view, nicely represented in the work of Bruce Link and Jo Phelan, is that SES is a fundamental cause of health outcomes that cannot be explained simply by enumerating the various risk factors such as substance abuse or poor health practices associated with both SES and health outcomes. 6 They draw on a long tradition that derives from the classic study of suicide published in 1897 by French sociologist Emile Durkheim. 7 In his study Durkheim amassed many data to show that varying suicide rates could not be explained by individual propensities such as depression, often associated with suicide, but was more the product of the organizational relationships and belief systems of communities. Thus, Durkheim illustrated how suicide rates were higher in more highly integrated societies such as Japan, where suicide reflected norms about loyalty to the group and expiating shame, and, alternatively, in societies where norms were unclear or where religious systems encouraged greater introspection about the meaning of life.Determinants of Health Assignment Paper

Link and his colleagues, using data on the SES link to health during various historical periods, show that while the prevalence's of different risk factors have changed over time, the associations between SES and health outcomes remain and often even increase. 8 They argue that those who are more socially advantaged fare better in all historical periods, regardless of the then-prevalent risk factors, because their privileged positions provide the social arrangements, skills, information, and tools to capitalize on the most advanced knowledge and practices that facilitate health. Thus, they are first to take advantage of new protections, preventive screening opportunities, and behavior changes. Information and health opportunities eventually filter out to others, but by the time the benefits are implemented, privileged persons are using their knowledge, access, power, and financial resources to take advantage of newly emerging health opportunities.

Two Lines Of Study

New vigor in studies of SES and health, and social determinants more generally, come from two lines of study that motivate the four new volumes published in 1999. The first provides increasing evidence that there is a social gradient in this important relationship between SES and health that transcends any plausible concept of poverty, deprivation, ignorance, or powerlessness. Indeed, increments of additional social advantage, even at the highest levels, in some of these studies appear to confer additional health advantage. The second comes from a variety of international comparative studies as well as national studies in several countries that suggest that inequality itself, independent of level of economic well-being, results in decrements in population health.

■ The SES health gradient.

Michael Marmot and his colleagues at University College London have been involved for many years in the Whitehall Studies of British Civil Servants. 9 These ambitious studies of office-based workers at a range of civil service grades seek to explain why there continues to be a monotonic decrease in mortality and improved health with increased status. Even the lowest grades of the civil service are not poor in an absolute sense, and this population has stable employment, is relatively homogeneous, and is exposed to comparable environmental conditions. Thus, we might reasonably expect relatively little variation, particularly at the higher levels, but the gradient remains, although smaller at higher grades. Control for risk factors reduces differences but only partially explains the status gradient.Determinants of Health Assignment Paper

Much of the earlier work on SES and health assumed a threshold effect, in which income and education would influence disease processes up to a point until disadvantages were overcome, and then the relationship would plateau at higher levels of advantage. In developing countries, for example, modest improvements in standards of living and education bring large health gains, while in developed countries further increases in income bring only small health improvements. Many data sets showed this plateau pattern at higher SES levels, and some continue to do so. Remarkably, however, in many instances the association with socioeconomic factors extends well into the middle and upper ranges of social advantage, suggesting a more complex picture of health determinants. Complications are compounded by historical studies and comparative observations around the world that indicate that relatively economically deprived populations such as some in India, Sri Lanka, and Costa Rica have good levels of health and relatively low mortality, while other populations that are more economically advantaged do poorly. 10 In these cases, culture, education, and empowerment appear to play significant roles. 11

■ The inequality thesis.

The second development in the study of SES and health is the provocative observation that independent of socioeconomic level, the amount of inequality itself in states, regions, or nations is associated with increased mortality and poorer health. This notion, first popularized in London by Richard Wilkinson, has caught the imagination of a number of researchers and policymakers. 12 The edited volume by Marmot and Wilkinson and that of Ichiro Kawachi, Bruce Kennedy, and Wilkinson bring together many of the important ideas and relevant research literature pertinent to this discussion. 13 The fact of growing income and health inequalities in the United Kingdom and the United States, despite their strong economies over the past decade, adds interest to the purported relationship.Determinants of Health Assignment Paper

Unlike the incontestible link of SES to health, the study of the effects of inequality on health involves more difficult methodological and data problems, lack of conceptual clarity about the definition of inequality, more vagueness about possible causes, and much speculative theorizing. 14 The inequality hypothesis addresses relative differences among population aggregations and focuses on comparisons among countries or among U.S. metropolitan areas or states. Given the types of data typically used, the relationship may be artifactual in a statistical sense because of the larger effects of individual income on mortality among persons of low as compared with those of high income. 15 A recent effort to test this notion suggests that the finding is only partly attributable to this artifact, but the failure to control for other relevant factors continues to cast suspicion on the causal importance of inequality. 16

Various researchers working with individual data in multilevel analyses in contrast to ecological data, and others who have added additional controls to aggregate data to better take account of differences in income, education, time, and geographic effects, have not been able to confirm the contention of a strong inequality effect. 17 These researchers are successful in replicating the inequality effect in their initial analyses, but it disappears or is much attenuated when appropriate controls are added.

The premise of this new literature is that the effects of inequality on health are real and may have even greater importance than material deprivation itself. I strongly doubt this view, but, nevertheless, many interesting studies and ideas are offered. Wilkinson presents the inequality thesis most confidently and aggressively. He speculates that “greater income inequality is one of the major influences on the proportion of the population who find themselves in situations that deny them a sense of dignity, situations that increase the insecurity they feel about their personal worth and competence and that carry connotations of inferiority in which few can feel respected, valued, and confident.” 18 The debate will continue, but the inequality effect is clearly not as large, pervasive, or consistent across outcome measures and data sets as proponents would have us believe.Determinants of Health Assignment Paper

Proponents often compare the United States or the United Kingdom with countries such as Japan, Norway, or Sweden, which have more equal income distributions, greater longevity, and better health. These countries, however, are more homogenous and have more of a common culture than Britain or the United States has, and it is impossible to say what is cause and what is effect.

Aggregate studies of inequality cannot distinguish between per capita SES effects and inequality effects. Wilkinson argues, however, that the differences found in these studies cannot be attributed to either material living conditions or culture. Citing George Kaplan's work on U.S. state and metropolitan area patterns of inequalities and health outcomes, Wilkinson argues that in the fifty states “cultural differences are smaller and people shop at many of the same chain stores selling the same range of goods throughout the country.” 19 Readers can decide for themselves how convinced they are by this assertion of homogeneity among states. Differing views on such issues are more than arcane arguments among scholars, because the nature of interventions and their likely success will depend on how inequality is conceived.Determinants of Health Assignment Paper

Proponents of the inequality thesis have not always been clear about its meaning. It is one thing to have a society in which the rich become richer and the poor, poorer and quite another to have a society in which all rise in income but the more privileged rise more, increasing the income gap. Wilkinson believes, and Kawachi and Kennedy seem to concur, that growing inequalities are harmful to health even when the poor are better off, because it is a person's relative income that affects his or her health. It is unlikely that relative deprivation, however important, has the explanatory power suggested.Determinants of Health Assignment Paper

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Wilkinson dismisses studies that do not support his thesis because the geographic units studied were too small and hence, too homogeneous. 20 He believes that one would only expect to see relative deprivation and inequality effects among larger areas with wider income heterogeneity. But if there is a lesson to be learned from the literature on relative deprivation, it is that we compare ourselves and judge equity in relationship to others like ourselves. As much as Wilkinson is offended by increases in the compensation of top U.S. executives, it has nothing to do with how most of us make judgments about ourselves.

Religion And Health

There is a curious omission in all of these volumes. While the editors are prepared to speculatively generalize from Rhesus and Cynomolgus monkeys and wild baboons to inequality in human societies, they scarcely mention the impact of religion and religious participation on health. I have no special brief for religion, but I suggest that the evidence in this area is probably more persuasive than the literature on inequality. 21 Both areas share many of the same methodological challenges such as selection biases, unmeasured variables, and the lack of robustness across measures and analyses, but both also offer intriguing insights. It is even more curious that in arguments that focus on social capital, one of the most formative institutions for its development is hardly worth a mention.

The scientific literature on religion and health is growing and is increasingly sophisticated. There is indication that participation in religious activities, and perhaps even some kinds of spirituality, are linked to better health outcomes. At one level, this is obvious, since some religious groups explicitly discourage smoking and the use of alcohol and drugs, and religious participation often gives people a community providing instrumental and social support. But the effects probably transcend these pathways. Mormons, for example, clearly benefit from not smoking and drinking, but the Mormon community also teaches the importance of family, parenthood, and relationships and strongly encourages education and skills and mastery of the environment. 22 It has been argued that religion is not a true determinant of health because its effects are explainable through pathways such as a sense of belonging and social support. 23 But this is exactly what social capital is presumed to do—establish possible pathways to health and well-being.Determinants of Health Assignment Paper

Social Status And Development

Work on SES is based on the assumption that it is a proxy for many life conditions affecting the health and welfare of populations and acts through a multitude of causal pathways. SES is already influential in perinatal and early life, and its effects are also intergenerational. Thus, the early and adolescent development of future mothers will affect the birthweight and other characteristics of their infants. An infant's size at birth is predictive of later hyper-tension, coronary heart disease, and diabetes. Height at age seven (a proxy for childhood health and growth), associated with SES, predicts unemployment risk better than adult height. 24 Health outcomes for children depend not only on how poor they are at any point in time but on the extent of their poverty over time. 25

Populations are always sorting and resorting themselves, or being sorted through environmental or social influences. Thus, the social gradient is not solely a social product but is also a product of selection. Even in such processes as social support that are quintessentially social, children (and presumably adults as well) with different temperaments attract varying levels of support from their peers and adults. Similarly, socioeconomic level, social attainment, and one's position in the social hierarchy of the civil service is not solely a social product. It is the culmination of an interaction between social advantage and personal characteristics such as temperament and capacity and how they interact and evolve during development, schooling, and socialization. The existing body of research shows that social privilege early in life is extraordinarily important but that individual capacities are as well. 26 These interact from the start; privilege allows capacity to flourish by providing stimulating environments, social support, developmental opportunities, and much more. Differences are already pronounced by the time children begin their schooling. But in assessing health and disease data, we still should consider the extent to which limits in capacity, energy, and poor health affect work, earnings, and status positions in social structures as well as the reverse. 27

Policy Relevance

Work on social determinants is important for policymakers because it suggests possible interventions for reducing health disparities. The typical approach is to modify pathways leading to poor functioning and poor health through nurse home visiting programs for infants and mothers, parenting education, pre-school childhood programs, well-organized child care, preventive health practices, substance abuse prevention, and changes in health behavior, among many others.Determinants of Health Assignment Paper

Recent work, however, transcends these individual endeavors and seeks to encourage societal changes that directly change existing inequalities, for example, through redistribution of income and modifications of entitlements and tax structures. Some programs, such as Social Security and the Earned Income Tax Credit for the working poor, are highly effective in reducing poverty. In contrast, compressing the socioeconomic hierarchy will be less effective, even if the political minefields could be negotiated, than ensuring the essential requirements of a healthy life for everyone—including subsistence, housing, health insurance, and educational opportunity. There is much to do in building a strong safety net for those with the greatest need.

Building Social Capital

The discussion of health inequalities is increasingly focused on the idea of social capital, first elaborated on by the sociologist James Coleman, referring to the networks of community relationships that facilitate trust and motivate purposive action. 28 Social capital derives from relationships among people, the norms they share, and the groups they develop to advance their mutual values and goals. It was social capital that so impressed Alexis de Tocqueville in his nineteenth-century study of America's democratic vitality, and it is America's social capital that is now said to be eroding. 29

Social capital helps members of communities to look after one another and to pursue agendas for social as well as individual good, but it is not obvious how new social capital can best be developed. Social capital evolves over generations, even centuries, of social and cultural development; it is not subject to quick fixes. Robert Putnam has become the social-capital guru for the inequality theorists, but they pay little attention to the implications of his historical analysis that the roots of civil community in southern and northern Italy go back for centuries. Putnam builds an index of traditions of civic involvement among Italian regions in 1860–1920, including such items as election turnout and membership in mutual aid societies. This index had a correlation of .93 with civic community measured in the 1970s and .86 with institutional performance measured for 1978–1985. 30

The aspect of SES that offers potentially the largest opportunity for both human and social capital is schooling. 31 Once one is beyond the deprivations of poverty, education is probably the most influential of the SES components on health and social development. Educated parents provide more stimulating cognitive environments for their children and activate potential during critical developmental periods. Schooling is important not only for the knowledge, skills, and personal gratifications it affords but also because good school structures provide the habits of mind, behavior, and cooperative participation that make adaptation more possible in highly structured, complex societies. Americans strongly value individual ingenuity and accomplishment, but they also agree that all children deserve equality at the starting point. As researchers at the Canadian Institute for Advanced Research suggest, early life and childhood deserve our strong focus because this is where much deprivation and inequality begin. 32 Once begun, inequality is a cumulative process, with each added disadvantage leaving children further and further behind. The case is substantial for intensive programs for infants and children, as the Acheson report and other works make clear.Determinants of Health Assignment Paper

The various volumes on equality abound with ideas for future research, but they provide limited bases for new social interventions. The notion that we improve health simply through compressing socioeconomic differences, however desirable, remains unproven. It is a fair inference from the literature that reducing material deprivations for the most vulnerable in the areas of housing, nutrition, subsistence, education, and health care will promote health, and this is a more promising target and one more likely to gain political acceptance. Several new efforts, including one under way at the Institute of Medicine, seek to identify good ideas from the social and behavioral sciences as a basis for new interventions. Implementation, from promise to demonstrating performance, continues as a major challenge. As in health care more generally, there is a large gap between establishing efficacy in highly controlled trials and demonstrating effectiveness in the larger world.Determinants of Health Assignment Paper

Building human capital and communities through education, mutual cooperation, social cohesion, social support, meaningful productive activity, and social responsibility are goals worthy of our best efforts, regardless of how they affect health. The selections in the volume edited by Alvin Tarlov and Robert St. Peter are especially concerned with efforts to develop social capital with a strong focus on the state of Kansas. 33 Ensuring that every person has a decent minimum is part of building a civic culture. But we had best not be naïve about the many forces in play and the extreme difficulty of doing this. Here we have much to learn from history; the extraordinary continuity in institutional arrangements; and the unanticipated social, economic, and technological changes that often have a large impact on our lives.

“Healthy People 2020” is a national program for 10 years developed by the United States Department of Health and Human Services aimed to improving the health of all Americans. This program determines objectives related with health of American population and necessary actions to achieve these objectives. The program also identifies 5 Determinants of Health, which are personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health include such things as biology, genetics, individual behavior, access to health services, and the environment in which people are born, live, learn, play, work, and age”. (U.S. Department of Health and Human Services)

According to the “Healthy People 2020”, Determinants of Health are divided into 5 categories, which include

  • policy making
  • social factors
  • health services
  • individual behavior
  • biology and genetics. (S. Department of Health and Human Services)

    Determinants of Health Assignment Paper

These determinants in combination affect the health of each resident and the entire population, and generally determine the level of the nation’s health. It is therefore important that the program include actions aimed at each and all of these determinants. For example, if we consider social factors, the level of culture in society, the psychological climate, the existence of discrimination (of any restrictions on rights), social support (friendship among neighbors, social relationships, loneliness and alienation) effect on the level of the nation’s health. If we speak about individual behavior, then the health of the population depends on such factors as the structure and nature of the family (in terms of the family), level of education – primary, secondary, higher education, profession and occupation, the lack of “risky” behavior, diet, smoking, alcohol consumption, substance abuse, physical activity, recreation, etc.

However, an important determinant that is regulated by the government is health services, namely, their availability, scope and accessibility to the public. Speaking of this determinant, it is necessary to point out such important factors as: availability (in terms of location and accessibility for people with disabilities, as well as cost) and quality of primary and secondary medical care, public health, medical care for children, social services, leisure and entertainment facilities, employment and employment services, public transport, and other.

The essay deals with “social determinants of health." It refers to social and economic condition among people that impact their health status. These are the factors responsible for health promotion and are present in the living and working conditions of an individual.  The factors responsible for health inequality are also called the determinants of health (Braveman & Gottlieb, 2014). The essay deals with the video, “Population Health: Donna” by "Population Health: Donna," (2016) which is focused on a ten-year-old girl named Donna and her life. She is a girl with kind nature, attitudes and a good heart. In this video, she has expressed her wishes, desires, and challenges, which have a significant impact on her life. At the age of 10 years, Donna has developed a different level of maturity to understand her life. This essay identifies and describes social, psychological and economic factors, which act as social determinants in her life and how these determinants would inform a public health response to improving Donna’s health and well-being, now and into the future.Determinants of Health Assignment Paper

The social determinants of health involve the conditions in which an individual takes birth, grow, and live together with the additional systems and forces that are concerned in creating the conditions of life on a regular basis (Hartup & Rubin, 2013). There are five social determinants, which are observed in this video. These social determinants are housing, diet, family, environment, and education, which have a great influence on Donna’s life. In this video, Donna expresses her desire of getting the new house, good job and being rich. It is evident from the video that she feels the need of higher income and social status. Donna is missing her personal space as she shares her room with her parents and other siblings. Donna is fond of pizzas and varieties of foods; however, it is apparent that their fridge is not loaded with much food items. In one scene, Donna is found playing with mud and bowl pretending to have vegetable soup. Soon after some time she is drowned with sorrow. She wants the bigger house that can contain more groceries. This condition indicates the lack of healthy regular diet (Marmot & Bell, 2012). Her father expresses his regret at being unable to satisfy the basic needs of his family. He has a deep concern for his family and children. He does not want his children to suffer like him in jail and miss excellent opportunities of life.  Her mother is a homemaker and does not make the economic contribution. Therefore, Donna’s father is the sole income earner in this growing and developing the family. Donna is a resident of Liverpool, and her house is surrounded by a pleasant environment. Donna has the positive attitude, playful in nature and good shares bonding with her parents and siblings. Donna enjoys her school life and has long term goals. She engages herself in activities such as reading, writing, and painting that enhance her mindfulness. However, her mother is worried about the recent behavioral changes appearing in Donna (Hartup & Rubin, 2013).Determinants of Health Assignment Paper

According to WHO, better health is associated with high income and status (Marmot et al., 2012). Based on Dona’s theory it can be concluded that presently the family has good physical, and social well-being. Low education, low self-confidence, and stress are determinants of poor health (Evans et al., 2013). As per Garg et al., (2015) physical environment such as clean air, safe water, safe houses, all contribute to good health.  Donna is receiving education, has the proper place to stay, lives in a clean environment and has a supporting family. The only challenge which is affecting Donna’s life is her financial constraint, which may be the cause of her frequent mood swings. However, it has the positive impact on her mental well being as she is determined to be the fashion designer and dreams of a good life ahead. However, the economic determinant has the negative influence on the mental well being of her parents (Galarce & Kawachi, 2013). As the family is growing and developing the cost of living increases with no change in the economic condition. This may have severe health implications in the long run. It may be difficult for Donnas’ father to meet the educational needs of all the children (Lamb & Sagi, 2014). Personal behavior such as keeping active, balanced eating, determines how individual deals with challenges and stresses of life (de Andrade et al., 2015). Donnas’ family may have to compromise healthy eating due to financial constraints. Eventually, it will increase emotional stress and the likelihood of the family to suffer chronic conditions such as obesity, malnutrition, diabetes, and others (Hartup & Rubin, 2013).Determinants of Health Assignment Paper

To improve these determinants; it is necessary to take the help of public health responses. Having a "Social support network" (friends, families, and communities) is associated with better health. Also, the beliefs and customs of the family also influenced that the health (Braveman & Gottlieb, 2014). Zavras et al., (2012) described that good health could be maintained by accessing services that prevent and treats diseases. Donna’s mother is stressed about her family conditions. Donna’s family accesses community home services. The community visitor, Terry assists Donna’s mother in maintaining the health of her children. Terry provides essential health information, tips and hints. She also arranges for referral services and assisted Donna in changing her attitude as her mother was worried that Donna may be negatively influenced by her peers and go astray. Terry explains everyone that good health of family will make each member of the house healthy. Terry is focused on the youngest child of the family and is helping Nathan in seeing speech therapists. Determinants of Health Assignment Paper

The theoretical concepts associated with the social determinants of health involve conceptual uncertainty that makes it difficult to differentiate between the socioeconomic status and the determinants (Braveman & Gottlieb, 2014). The “materialist or structuralist” theoretical approach to understanding the mechanism of heath influence due to social determinants emphasize on the “material condition” in which people live. It refers to a condition of food availability, access to basic amenities of life and working conditions (Eikemo et al., 2016). Three frameworks have been developed for explaining how health is influenced by the social determinants. These frameworks include “materialist, neo-materialist and psychosocial comparison” (Mackenbach, 2012). The materialist framework refers to the way health is shaped by the conditions of living and the social determinants of health. The explanation of the neo-materialist extends the analysis of the materialist by inquiring how the conditions of living take place (Pillas et al., 2014). The explanation of the psychosocial comparison considers whether the individual makes a comparison of themselves with others and how the health and well-being are affected by these comparisons (Watt & Sheiham, 2012).Determinants of Health Assignment Paper

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The main desire of Donna at the age of 10 years is to get a good job, big house, car and earn money. This attitude of Donna distinguishes her from other children of her age, and it is mainly attributed to "socio-economic" position of her family. Therefore, “socioeconomic” condition is the strongest predicator of health as it indicates the “material advantage and disadvantage” (Bornstein & Bradley, 2014). The difference in psychosocial stress relates to “material condition” (Sweet et al., 2013). According to Zavras et al., (2012) stress is associated with negative health outcomes. Donna misbehaves with her mother and siblings at times and misses her school staying awake till late night. The attitude of Donna is the outcome of “flight or fight response” that is generated in response to threats such as food insecurity, lack of basic amenities, low income which weakens the immunity (Pillas et al., 2014). It consequently increases the burden of disease and emotional stress (Evans et al., 2013). The younger members of the family may also be affected when they will reach their adolescent stage if this condition is not intervened (Viner et al., 20.12).

Thus there is a need for expanding the knowledge of "social determinants of health" in Donna family (Garg et al., 2015). It will increase awareness and improve the quality of living. Health awareness may help Donnas’ family to cope up with financial stress, inadequate resources, measure the problem, take a corrective action and broaden the knowledge base (Barile et al., 2015). Therefore, Terry must assist Donna’s family by providing quality education, access to affordable health care, inform about safe places to exercise, healthy eating behaviors and educate cost effective remedial to improve health (Evans et al., 2013). Terry should provide child psychologist services to Donna to make sure she is in the correct frame of mind. She needs guidance to stay focused on her studies and learn to be happy rather than worrying about her future. She needs to learn about "self-regulating" her thoughts. Lack of self-regulation and unaddressed mental stress may lead to disruptive behavior and social exclusion (Galarce et al., 2013). To improve the economic condition, Donnas’ mother should take a part time job. Both parents should attain counseling sessions to maintain a positive state of mind and improve their lives. Financial worries and feeling of distress due to inability to contribute to the family welfare is toxic for both parents (Marmot & Bell, 2012).Determinants of Health Assignment Paper

Conclusively, the socio-economic determinants of health are responsible for poor health status. Health inequalities are greatly associated with low income. The three factors that ensure healthy state of mind are employment, community support, and social connectedness. Living in an environment with supportive relationships enhances self-esteem, makes people cared and valued. This state is vital for cardiovascular, and immune system function both affected during activation of stress response "fight or flight." Despite intense research in the area of a social determinant of health and associated physical and mental illness, there is an inadequate provision of mental health services. Although stringent government policies in countries like UK have addressed inequities of mental health services, not all the cities receive these services equally. The government of every country must ensure that all the cities and town develop into a mentally healthier community (Hartup & Rubin, 2013). Interventions for people suffering due to social determinants of health must be holistic in nature an include biopsychosocial approach rather than conventional drug-based therapies. In several parts of UK, the community care model is recognized to be a social process. It is recommended to critically readdress this phenomenon for the wellbeing of society. Community development services must strive hard to address the issues of economically disadvantaged families through incentives; job training, social integration, and referring the patients to organizations that help them fulfill their needs. The community health centers in Liverpool should be able to support strength and freedom of individual and foster service accountability towards the community (Marmot et al., 2012). Determinants of Health Assignment Paper

As our health system moves toward value-based models which incentivize positive results rather than individual procedures and treatments, healthcare industry leaders increasingly are regarding the social determinants of health (SDOH) as critical components of these efforts. By concentrating on these facets of well-being in tandem with medical care, providers are taking a holistic view of patients and overall population health to enhance patient care, promote superior outcomes, and drive value in healthcare organizations.

What Are the Social Determinants of Health?

SDOH are the complex circumstances in which individuals are born and live that impact their health. They include intangible factors such as political, socioeconomic, and cultural constructs, as well as place-based conditions including accessible healthcare and education systems, safe environmental conditions, well-designed neighborhoods, and availability of healthful food.Determinants of Health Assignment Paper

The World Health Organization (WHO) offers this definition of social determinants of health: “The conditions in which people are born, grow, live, work and age.” The organization further states that “these circumstances are shaped by the distribution of money, power, and resources at global, national and local levels.” These social circumstances create societal stratification and are responsible for health inequities among different groups of people based on social and economic class, gender, and ethnicity. Social determinants of health are an underlying cause of today’s major societal health dilemmas including obesity, heart disease, diabetes, and depression. Moreover, complex interactions and feedback loops exist among the social determinants of health. For example, poor health or lack of education can impact employment opportunities which in turn constrain income. Low income reduces access to healthcare and nutritious food and increases hardship. Hardship causes stress which in turn promotes unhealthy coping mechanisms such as substance abuse and overeating of unhealthy foods.

Examples of Social Determinants of Health

The social determinants of health are a subset of determinants of health. Governmental policies, availability of healthcare, individual behavioral choices, and biological and genetic factors are other notable determinants of health. Examples of social determinants of health include:Determinants of Health Assignment Paper

  • Income level
  • Educational opportunities
  • Occupation, employment status, and workplace safety
  • Gender inequity
  • Racial segregation
  • Food insecurity and inaccessibility of nutritious food choices
  • Access to housing and utility services
  • Early childhood experiences and development
  • Social support and community inclusivity
  • Crime rates and exposure to violent behavior
  • Availability of transportation
  • Neighborhood conditions and physical environment
  • Access to safe drinking water, clean air, and toxin-free environments
  • Recreational and leisure opportunities
How Are Healthcare Leaders Addressing the Social Determinants of Health?

Since the ACA began moving healthcare from fee-based compensation to outcome-based compensation and expanded access to millions of high-risk Americans previously sidelined from preventative and primary care, healthcare leaders have been progressively shifting toward increasing health equity and addressing the paradigm shift towards population health by attending to the social determinants of health.

Indeed, healthcare leaders are increasingly aware of the data and research which indicates that the social determinants of health have a higher impact on population health than healthcare and that a higher ratio of social service spending versus healthcare spending results in improved population health. In fact, according to a study published by the National Center for Biotechnology Information, states that allocate more resources to social services than to medical expenditures have substantially improved health outcomes over states that do not. The study found that states that provide higher levels of social services are outperforming their counterparts in areas such as obesity, asthma, mental health, cancer, myocardial infarction, and type 2 diabetes.

In tackling the social determinants of health, providers are partnering with community organizations to improve access to housing, healthy food, education, job training, transportation and more. Countless initiatives are underway. Here, we highlight two inspiring examples.

Collaborative Care Teams and Authentic Healing Relationships

In the high-poverty city of Camden, New Jersey, residents have struggled to access services for behavioral, social, and medical care and consequently end up in emergency rooms instead. To counter this problem, the Camden Coalition of Healthcare Providers are using data to identify frequent consumers of emergency care and then connect them to a team of primary care providers, nurses, social workers, and behavioral health specialists. These care providers develop “authentic healing relationships” with patients to address their complicated health needs and social requirements through proactive primary care and social services rather than costly emergency department visits. According to Camden Coalition’s coach manual, “The Authentic Healing Relationship is a respectful, trusting and non-judgmental partnership between the Care Team and the patient that serves as the foundation for progress toward long-term health management.” The team strives to empower patients to take ownership of their health and help them to build support networks through community organizations as well as friends and family.

Healthy Neighborhoods Healthy Families

One of the most inspirational and far-reaching provider-based programs developed to provide SDOH solutions is Nationwide Children’s Hospital’s Healthy Neighborhoods Healthy Families (HNHF) initiative. Nationwide Children’s has partnered with multiple community partners to tackle five high-impact social determinants: affordable housing, education, health and wellness, safe and accessible neighborhoods, and workforce development. To promote access to affordable housing, they have partnered with Healthy Homes to revitalize local communities through renovation, energy efficiency and green living projects, and repair and maintenance grants to homeowners. They also offer low-income housing to families where residents can participate in on-site classes that provide training targeted toward local job openings and career success skills. They are also tackling challenges in education with kindergarten readiness, mentoring, and STEM programs. Along with the Ronald McDonald House, they have created a mobile care center to provide pediatric primary care including immunizations, developmental screenings, teen health education, and well-child and sick visits. These are just a few of Nationwide Children’s SDOH ambitious undertakings.Determinants of Health Assignment Paper

PREPARE: Assessing Social Determinants of Health in Your Patient Population

An important first step providers can take is to learn about the population health of the communities they serve. One resource for doing so is the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) from the National Association of Community Health Centers (NACHC). PRAPARE provides an implementation and action toolkit that is being used by providers nation-wide to gather data that will allow them to assess their patients’ social needs, so they can take measures to address them. Their evaluation tool asks social health questions in areas ranging from demographic data and housing status to social-emotional health and physical security. Another key resource for providers is Health Lead’s Social Needs Screening Toolkit. Health Leads, a trailblazer in the movement to address the social determinants of health, created this kit to help healthcare leaders develop an assessment tailored to their population needs.

Social and Moral Imperative

More and more, healthcare leaders are positioning their organizations to assume the social and moral imperative of reducing health inequity by focusing on the social determinants of health. Through creative partnerships, new care delivery models, and population health assessment, they are innovating to improve the health and quality of life of their community’s most vulnerable residents. Healthcare leaders recognize that it is vital to reform the system, so it is sustainable and accessible for all. Moreover, they understand that the social determinants of health are significant factors in this invaluable endeavor.

Strategic positioning is about how a company positions itself to create value different from that of competition. Therefore, strategic positioning is defined as a firm’s relative position in the industry. It must lead to one of two outcomes – lower cost or higher premium. Higher premium can be charged when there is unique focus on either a product/ service or the unique needs of a few exclusive customers (niche market). Lower cost on the other hand implies a high production efficiency. One may then choose to either retain the benefits or pass them on to the customers (price competitiveness). The lower cost model is associated with mass marketing. Accordingly, Michael Porter defined strategic positioning as delivering value through cost leadership, differentiation and focus. The core value is what then the customer consumes. In the health industry, it is healthcare. This healthcare can be measured and identified customer needs can be met or exceeded. This presupposes that customers needs are known. There must be a process of identifying and evaluating the customers needs – their expectations and their experiences. This expectation-experience gap is the basis of customer perception of quality. Hospital quality comprises both technical as well as functional components. Technical quality is about the value that is delivered to the patients (the “what”) whereas functional quality is the process of delivering that value (the “how”). What is in the purview of the patient is the functional quality. The patient makes a choice of hospital depending on this functional quality.determinants of Health Assignment Paper

On the other hand, hospitals leadership and doctors have access to data on technical (clinical) outcomes. The hospital leadership’s basis of competition tends to be technical quality. This may cause a misalignment between patients expectations and the basis of competition. Further, patients are influenced by doctors and Medical Insurance Providers. Medical Insurance Providers are the primary payers in the private health sector. Patients perception of quality was evaluated using a modified version of the SERVQUAL tool that is based on the identification of the expectation-experience gap. This study then looked at the doctor and the Medical Insurance Provider perception of quality and their influence on the patient. In factoring in all the three key players, that is, the patients, doctors and Medical Insurance Providers, the study defined an optimal strategic position. The study used a post-positivism approach, collecting data using a questionnaire requiring participants to answer paired questions of their expectation and their experience using a five point Likert scale. After pilot testing and validating the data collection tool, data was collected from patients in the 12 out of the 14 (86% response rate) eligible level five and six private hospitals across Kenya. Thereafter data was also collected from the doctors who treated the recruited patients, the Medical Insurance Providers (for those that were insured) and from the hospitals leadership. Tests for reliability and validity were initially carried out. Factors analyses were done to extract, aggregate and reduce the relevant factors. The original six factors – Interpersonal, Environment of Care, Administrative, Access, Clinical Outcomes and Medical Equipment – were reduced to four where clinical outcomes collapsed into interpersonal dimension and medical equipment was dropped altogether. These factors were regressed against future behavioral intention (intention to return should the need arise and intention to refer others to the institution). The influence of the Doctor and Medical Insurance Provider were then discerned. Regional variation as well as the alignment of the administrator to the customers needs was ascertained. Results showed a clear hierarchical quality dimension determinants in the following diminishing order of influencing patients future behavioral intentions - Interpersonal, Environment of Care, Administrative and Access. This study showed that doctors and Medical Insurance Providers significantly influence patients perception of quality. Whereas the hospitals leadership appear well aligned to the customers perception of quality, there is incongruity between Doctors and Medical Insurance Providers understanding of patients expectation and experience from actual patients expectation and experience. There is a statistically significant regional variation of patients perception of quality. Even then, in each region, the perception of quality dimensions still significantly affected patients future behavioral intention. In conclusion, currently many of the hospitals are perceived to be strategically positioned based on product leadership. It is recommended to either maintain the product leadership or change to cost leadership and transferring the benefit back to the patients (price leadership) are the most sustainable strategic positioning. In understanding that the patients perception of quality is affected in a hierarchical manner by the dimensions of quality, it is recommended that regional factors such as market structure and competition, affordability by the population and within-country cultural variances should be taken into consideration. This study is delimited by the fact that it was a perception study. There was no in-depth attempt made to explain the perceptions of the various customers. This is left as an opportunity for further study by others.

The determinants of health are the range of social, economic and environmental factors that determine the health status of individuals or populations. The determinants of health as defined by the Public Health Agency of Canada include the following: income and social status, social support networks, education and literacy, employment/working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender and culture.Determinants of Health Assignment Paper

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Many factors in our society, including poverty, physical and sexual abuse, lack of education, homelessness, stigma, addiction, violence, untreated mental health problems, lack of employment opportunities, powerlessness, lack of choice, lack of legal resident status and lack of social support, play a role in HIV infection and the ability of people living with HIV to seek treatment, care and support. For example, poverty can lead to powerlessness in relationships and can have a negative impact on one’s self-esteem and sense of belonging in the community. All of this can have an impact on one’s judgement or can reduce one’s ability to protect oneself from HIV.

The understanding that physical, social, cultural, organizational, community, economic, legal and policy factors within our environments can impede or facilitate HIV prevention efforts has led to an interest in structural approaches to HIV prevention. Structural interventions seek to change the context that contributes to an individual’s resilience, vulnerability and risk. They include policies or programs that aim to change the conditions in which people live or community responses that bring about social or political change. These approaches address factors that affect the individual’s behaviour, in contrast with behavioral approaches, which attempt to change the behaviour. Structural approaches to HIV prevention must be complemented by other prevention programming, including interventions to influence individual behaviour, to achieve an effective and continued reduction in HIV risk and vulnerability.

Examples of structural HIV prevention initiatives include the following:

  • creation of a policy and legal environment that allows for needle exchange programs and safer consumption sites
  • implementation of anti-stigma measures that reduce discrimination against people with HIV and vulnerable groups
  • implementation of gender equality initiatives, including programs to enhance women’s education and economic independence and laws to combat sexual violence
  • implementation of stable housing initiatives for injection drug users

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  • encouragement and funding for the active involvement of affected communities in developing and promoting HIV prevention interventions

Before structural interventions are implemented in a particular community, the social, economic, political and environmental facilitators and barriers to HIV risk within that context must be analyzed. Existing programs that have been successful elsewhere should then be reviewed for possible adaptation and adoption in the community of interest.

Many structural features that affect HIV vulnerability are difficult to change because they are deeply entrenched in the social, economic and political fabric of society; therefore, addressing these factors is viewed as a long-term initiative within broader economic and social development. Challenges in assessing the effectiveness of structural interventions have meant that limited evidence has been gathered on the effectiveness of structural approaches to HIV prevention. Most structural interventions involve large-scale elements that cannot be easily controlled by experimental or quasi-experimental research designs. There is a need for new research strategies to assess the impact of these interventions to create a foundation of knowledge on structural interventions.Determinants of Health Assignment Paper