HKR 3400: INTRODUCTION

TO SOCIAL DETERMINANTS
OF HEALTH
Gillian Batten, MHS, BREC, CTRS
May 18, 2023
 • Group Report # 1- Due May 26

• Quiz # 1- May 25
ANNOUNCEMENTS • Chapter 1
• Chapter 2 (pp. 25-30)
• Lecture May 18

2
OUTLINE
 INTRODUCTION
Welcome to an exploration of the Social Determinants of
Health.

Throughout this course, we need to remember that genetics

and personal choices do not solely determine health. Its
profoundly influenced by social and environmental conditions.
Understanding these determinants is crucial for creating a more
equitable and healthier society.
SOCIAL DETERMINANTS OF HEALTH?

Has anyone heard this term What comes to mind?

before?
“A health care system-even the best health
care system in the world- will only be one of
the ingredients to determine whether your
life will be long or short, healthy or sick, full
of fulfillment, or empty with despair”.
- The Honourable Roy Romanow, 2004
 The concept:

The SDOH encompass the conditions in which people

DEFINING are born, grow, live, work and age. These conditions
are shaped by a wide range of interconnected factors
that impact health outcomes.
THE Broad Scope

SDOH
The SDOH go beyond access to healthcare and include
socioeconomic status, education, employment,
housing, neighborhood characteristics, social support
and more.
WHAT
ARE THE There are 17 SDoH developed at the York
University Conference held in Toronto in 2002.

SDOH? Disability
Early childhood development
Education
Employment and working conditions
Food Insecurity
Gender
Geography
Globalization
CONT’D
Health Services
Housing
Immigration
Income and income distribution
Indigenous ancestry
Race
Social exclusion
Social safety net
Unemployment and job security
LIGHTNING TALKS

Lightening talks can be based on

any one of those 17 SDoH.

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SOCIAL DETERMINANTS
OF HEALTH DEFINED

“Social determinants of health are

the economic and social conditions
that shape the health of the
individuals, communities, and
jurisdictions as a whole” (Raphael,
2016, p.3).

It’s not medical treatments or

lifestyle but rather the living and
working conditions we experience.
SOCIAL DETERMINANTS
OF HEALTH (SDOH)

The primary determinants of whether Individuals stay

healthy or become ill.

Determine the extent to which a person possesses the

physical, social, and personal resources to identify and
achieve personal aspirations, needs and cope with their
environment.

Quantity and quality of a variety of resources that society

makes available to its members.
Resources include but are not limited to, conditions of
childhood, access to income, education and literacy,
food, housing, and employment, working conditions
and health and social services.
SOCIAL DETERMINANTS
OF HEALTH (SDOH)

An emphasis upon societal conditions as determinants of

health contrast with the traditional health sciences and
public health focus upon biomedical and behavioral risk
factors such as, body weight, physical activity, diet, alcohol
use, cholesterol levels etc.

Medical model vs SDOH

SDOH see’s the mainsprings of health as being how society

organizes and distributes economic and social resources.

Directs attention to public policy as means of improving

health
 A HISTORICAL PERSPECTIVE
In the mid-1800’s a political economist Fredrich Engels studied how poor
housing, clothing, diet, and lack of sanitation led directly to the infections and
diseases associated with early death among-working class people in England.

Rudolph Virchow (1848) identified how health threatening living conditions were
rooted in public policy making and emphasized the tole that politics plays in
promoting health and preventing disease.

From 1980-1992 UK reports showed how lowest employment-level groups

showed a greater likelihood of a wide range of diseases and premature death
from illness or injury at every stage in the life cycle.
CANADIAN CONTRIBUTIONS

Canadians have actively theorized the relationship between economic

and social conditions and health.

In 1974, the federal government’s A New Perspective on the Health of

Canadians identified that:
SOCIAL DETERMINANTS OF
HEALTH FRAMEWORK

Four criteria were used to determine the social determinants of health.

All these social determinants of health are important to the health of Canadians.

All these social determinants of health are understandable to Canadians.

All these social determinants of health have clear policy relevance to Canadian
decision makers and citizens.

All these social determinants of health are especially timely and relevant.
WHO STAYS HEALTHY? WHO
GETS SICK?

Premature loss of life arises largely due to the conditions in which people are
born, grow, live, work and age– conditions that together provide the
freedom people need to live lives they value.

We all die, but the questions remains;

At what age?
With what degree of suffering?
With what degree of preventable illness?
TRADITIONAL MODEL OF HEALTH
• Also known as the biomedical
model.
• Primarily focuses on diagnosing
and treating specific physical or
biological conditions.
• The traditional model focuses on:
• Physical aspects
• Reductionist approach
• Diagnosis and treatment
• Biomedical research
HEALTH

Health is a state of complete physical, mental, and

social well-being, as defined by the World Health
Organization (WHO)
• this is a holistic definition, encompassing all
aspects of a person's well-being

(WHO, 2023) 20
CONT’D
• The traditional model focuses on:
• Physical aspects
• Reductionist approach
• Diagnosis and treatment
• Biomedical research

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 Body is seen as a machine that is either running well or in need
of repair.

We pay attention to medical treatment, discoveries and

treatment, access to doctors and nurses.

We are told what to eat and why we should exercise.

TRADITIONAL
MODEL OF We welcome treatment, as we should!
HEALTH
BUT! The question is, what drives most diseases and illness?

Decades of research shows that the living and working

conditions we experience (SDoH) also factor into if we stay
healthy or get sick.
CURRENT THEMES IN THE SDOH
FIELD

1. Empirical evidence concerning the SDoH

2. Mechanisms and pathways by which SDoH influences health

3. The importance of a life course perspective

4. The role public policy environments play in determining the quality of SDoH within jurisdictions

5. The role that political ideology plays in shaping state and societal receptivity to SDoH concepts.
EMPIRICAL We will be looking at this theme throughout the
course.

EVIDENCE From an overall perspective, the quality and

distribution of various SDoH to which we are exposed
CONCERNING provide explanations for the following:
1. Improvement in health outcomes among
THE SDOH Canadians over the past 100 years.

2. Persistent differences in health outcomes

among Canadians.

3. Differences in overall health outcomes

among Canada and other developed
nations.
PATHWAYS BY WHICH SDOH
INFLUENCE HEALTH
To ensure policy relevance and the understanding of the SDoH we have to
understand how they influence health and cause disease.

Theoretical thinking considers how SDoH “get under the skin” to influence health.

There are two primary mechanisms for understanding health inequalities.

1. Cultural/behavioral
2. Materialist/structuralist
Lets take a look!
Traditional Ten Tips for Better The SDoH Ten Tips for Better
Health Health
1. Don’t smoke. If you can, stop. If 1. Don’t be poor. If you can stop, if
you can’t cut down. you can’t, try not to be poor for
2. Follow a balanced diet with long
plenty of fruits and vegetables. 2. Don’t have poor parents.
3. Keep physically active. 3. Own a car
4. Manage stress 4. Don’t work in a stressful, low-
5. If you drink, do so in paid manual job
moderation 5. Don’t live in damp, low-quality
6. Cover up in the sun, and housing.
protect children from sunburn. 6. Be able to afford to go on a
holiday and sun bathe
 In a perfect world, we would choose our living and
working conditions, but in most cases, this is imposed
upon us a result of our position in society, our social
class, gender, race and other personal circumstances.
This is also strongly affected by our capitalist market
and economy and how they distribute income and
wealth.

CIRCUMSTANCES
In a market economy, most participate in paid
employment, wages are determined by the
corporations and businesses.

Many wealthy and developed nations unlike Canada,

make greater efforts to regulate workplace and
economic security.
 The health of Canadians is not distributed
equally- some people die younger, and
some are sicker than others.
This inequality is a result of the SDoH, they
HOW are not distributed equally.
IMPORTANT
ARE THE Rich people have too much more and
poor people not enough.
SDOH
Unfair and unjust differences in health
result from this.
 In groups of 3-4 take 10- 15 minutes to consider the questions
below.

What do you think are the key factors that contribute to a person's
health? Are they solely related to individual choices and
behaviors, or do other factors play a role?

GROUP How might someone's socioeconomic status affect their health?

Can you think of specific examples or scenarios where income or

ACTIVITY
education levels could impact health outcomes?

Do you believe that everyone has equal access to healthcare?

What are some barriers that people might face in accessing
healthcare services? How might these barriers affect their health?

Please write jot notes including group members names in the

discussion forum provided. Be prepared to share your answers.

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Health inequality
vs. health
inequity
 Health inequality: a generic term
used to designate differences,
variations and disparities in the health
achievements and risk factors of
HEALTH individuals and groups
INEQUALITY
VS. HEALTH Health inequity: inequalities in health
INEQUITY that are deemed to be unfair or
stemming from some form of injustice.
Ex: access to educational
opportunities, safe jobs, health care
etc.
 Differences in health outcomes among
Canadians of differing income, gender, race or
other social characteristics are measurable.
There are two ways to measure health inequities.
Mortality rate among groups
How long people live (life expectancy)

HEALTH How early they die (premature years)

Infant mortality rate

INEQUITIES Death from various disease or injury

Presence of disease or injuries (Morbidity)
Low birth-weight rates
Incidence of disease
Prevalence of disease
 Income & Health:

Individuals in the lowest income group are more likely to have higher
rates of chronic conditions such as diabetes, cardiovascular disease, and
mental health issues compared to those in higher income groups.

HEALTH People in lower-income brackets have higher mortality rates and lower life
expectancies compared to those in higher-income brackets.

INEQUITY Mental Health Disparities:

FACTS Marginalized populations, including individuals experiencing poverty,

homelessness, and discrimination, are at a higher risk of mental health
issues.

Accessibility to mental health services and supports remains a challenge,

leading to disparities in access and outcomes
GENETICS, RISK FACTORS
AND RISK CONDITIONS

According to research, many people believe that unlocking

the human genome is the key to ending illness; however,
very little evidence supports this idea.

Very few diseases are caused by the operation of a sense

or even multiple genes.

Most times, genes only provide a small clue as to whether

someone gets a disease.

Most cancers and respiratory diseases are related to the

effects of the environment rather than genetic dispositions.
GENETICS, RISK FACTORS
AND RISK CONDITIONS

Genetics, risk factors, and risk conditions interact

with social determinants of health (SDOH) to
influence health outcomes. Here's how they relate:
1. Genetics
2. Risk Factors
3. Risk Conditions
GENETICS

Genetic factors can contribute to susceptibility

to certain diseases or conditions. Genetic
variations may influence a person's risk of
developing certain conditions, such as heart
disease, diabetes, or certain types of cancer.
While genetics play a role, it's important to
note that the impact of genetic factors is often
influenced by interactions with environmental
and social factors.

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RISK
FACTORS
These can include individual behaviors like
• smoking,
• poor diet,
• a sedentary lifestyle,
• or substance abuse.

SDOH, such as income, education, and social

support, can influence a population’s prevalence and
distribution of risk factors.

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RISK • Risk conditions refer to the circumstances or
CONDITIONS environments that increase the likelihood of
negative health outcomes.

• Risk conditions include

• living in areas with high levels of pollution,
• exposure to toxic substances,
• unsafe working conditions, or inadequate
housing.

These risk conditions are often influenced by

social determinants of health, such as
socioeconomic status, neighbourhood
characteristics, and environmental policies.

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SOCIAL INEQUALITIES
SDoH influence all Canadians, but its effects are especially important for those at
a material and social disadvantage.

The operation of Canada’s market economy and the governments decision to

intervene or not intervene in it through public policy action can cause SDoH to
improve, stagnate or decline.

The more vulnerable Canadians are also the people with less power and ability to
influence public policy.
CONT’D
Social inequality is closely related to health inequity.

Health inequities can only be reduced in combination with reductions in social

inequalities.

Improving health is also about reducing the inequalities in power and influence
among Canadians.
 To some researchers the SDoH are the primary causes of health and
illness and that their unequal distribution is the best explanation for
the profound health differences among Canadians.

Canadians live longer and better than Americans but do not live as

SDOH long or as well as Swedes.

AND This difference has much to do with public policy.

PUBLIC Sweden makes sure that its residents are provided with economic

POLICY and social security, increasing better health outcomes.

Canada does much less of this and the states even less.
SDOH & PUBLIC
POLICY
We will look at this in greater detail over the
next 11 weeks; however,
• addressing social determinants of health
through public policy is crucial for
improving health outcomes, reducing
health disparities, and promoting health
equity.
• It takes a holistic approach, recognizing
the broader factors influencing health
beyond individual behaviors and
genetics.
• Public policy can create lasting positive
impacts on population health by
targeting the root causes of poor health
and promoting preventive measures.

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LIVING
CONDITIONS,
STRESS AND
THE HUMAN
BODY

Pitch deck title 43

“Prolonged stress, or rather the responses it engenders, are known to
have deleterious effects on a number of biological systems and to give
rise to a number of illnesses”- Robert Evans

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GROUP
ACTIVITY
 Various studies find that the SDoH are the best
predictors of health outcomes and their effects
trump the influence of behavioral risk factors

SOCIAL People who endure adverse living conditions

experience concrete material and social
STRUCTURE, deprivation that can adversely affect health.
LIVING Stress can cause heart disease, stroke, high
CONDITIONS blood pressure, and immune and circulatory
complications.
AND HEALTH
Exposure to stress can influence negative
behaviors such as smoking, increased alcohol
use, and poor eating habits.

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INDIVIDUAL An individual perspective limits analysis of health
APPROACH risks to individual biomedical and
behavioral risk factors for disease (Raphael et al.,
2005).

This includes screening for physiological and medical

risk factors such as;
• Hypertension
• Excess weight
• Cholesterol
• High blood glucose levels

To treat this, a mandated behavioural regime or

treatment with drugs is needed.
The individual need to play a role in changing his or
her behaviour.

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INDIVIDUAL The individual approach and social determinants of
health (SDOH) are different perspectives on
APPROACH understanding health and well-being.
Individual Approach:
• Focuses on individual-level factors that influence
health outcomes.
• It emphasizes personal choices, behaviors, and
genetic predispositions as primary determinants
of health.
• According to this perspective, individuals have
control over their health through lifestyle choices
like diet, exercise, and avoiding risky behaviors.
• The individual approach often emphasizes the
role of personal responsibility and self-
management of health.

20XX 48
INDIVIDUAL APPROACH

Failings of the lifestyle approach to health and illness.

“Lifestyle messaging essentially adds insult to injury for those

Canadians most likely to experience poor health. Many Canadians
experience adverse living conditions as the primary causes of disease
and illness, yet messaging about lifestyle\attributes their health
problems to their own behavioural choices”
• We will do nothing to improve your living and working conditions
(injury), and we will now blame you for getting sick (insult).

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20XX Pitch deck title 50
HKR 3400: GROUP WORK
Gillian Batten, BREC, MHS, CTRS
GROUP WORK

Group Project (30% of final grade): In groups of three-four you will

work on different concepts in class on Wednesdays. There will be a
discussion forum for each group. Each week one member of your group
will take the lead on submitting jot notes from your discussion.

Throughout the semester, there will be 4 written reports (group grade –

20 points for each of the four reports for a total of 80 points) on the
concepts examined.

At the end of the semester each participant will submit a participation

evaluation (individual grade – 20 points) for each member of the group.
Total value: 100 points
INTRODUCTIONS

We will start by finding your group members!

Take a few minutes to get to know each other. Find a

preferred method of communication for the semester.

Review the guidelines for paper # 1 and assign tasks to

each group member!

Discuss your strengths/weaknesses in writing to determine

which group member should do what (introduction, APA,
editing etc.)
PAPER #
1
GROUP
WORK
I will assign concepts to
each group for the next
three papers so keep an
eye out in your group
discussion forum..
QUESTIONS?