The Social Determinants of Health and Their Importance in Public Health Work - Essay Example

? Introduction Equity in health implies that all individuals should gain their full health potential. Socioeconomic inequities encompass differences that are systematic and socially generated (and thus modifiable) and unjust. Health inequities stem from unequal distribution of power, resources, and prestige among diverse groups within the society. To a large extent, health is determined by access to social and economic opportunities; the resources and support available in homes, neighbourhoods, and communities; the quality of schooling; the nature of the social interactions and relationships; the safety of the workplaces; and the cleanliness of the water, food, and air consumed. The Social Determinants of Health and their Importance in Public Health Work Social determinant of health entail conditions within the environments in which individuals are born, live, learn, work, play, and age that impacts on a broad range of health, quality of life outcomes and risks, and functioning. An understanding on the manner in which population impacts on “place” and the influence of “place” on health is essential, especially with regard to enhancing the health outcomes of the population (CSDH 2008, p.5). The World Health Organization highlights the following as being the most significant social determinants of health, namely: poverty (absolute poverty bear a significant impact on health status); economic inequality (as the gap between rich and poor broadens, health status declines); social status; stress (social and psychological circumstance can render continual anxiety, low self-esteem, insecurity, and social isolation, all of which profound effects on health); education and care in life; employment; social exclusion; social security; job security; and food security (Kuulasmaa et al. 2000, p.675). Some of the ways of enhancing the overall health for a large number of people in a manner that can be sustained overtime entail working to establish policies that constructively influence the socioeconomic conditions of the people, and those that alter the individuals’ behaviour. Improving the environment in which people live, learn, play, work, and age, possesses a significant impact on the creation of a healthier population, society, and workforce. Some of the emerging strategies to responding to social determinants of health entail utilization of Health Impact Assessments to review the proposed, and existing social policies and their potential impact on health (O'Flaherty and Capewell 2012, p.855). The other strategy entails the application of health in all policies strategy that introduces enhanced health for all and bridges the health gaps as objectives to be shared across all facets of the government. # 2 Social Determinants and their relationship with Coronary Heart Disease in the UK Cardiovascular disease is a prominent public health problem that contributes close to 30% to the annual global mortality, and 10% to the global disease burden. Evidence on social determinants and inequities linked to cardiovascular disease essentially from developed countries points out an inverse relationship between socioeconomic status and cardiovascular incidence and mortality. The Independent Inquiry into the inequalities in health in late 1990s cited widening of inequalities in mortality (WHO Commission on Social Determinants of Health, & World Health Organization 2008, p.117). Most recently, the publication titled Fair Society; Healthy Lives cited the persistence of inequalities across a broad range of health outcomes. Coronary heart diseases remain a good indicator of social inequalities within health due to behavioural, and medical risk factors associated with coronary heart disease are socially patterned (Lang et al. 2012, p.602). This mirrors the improvements that have been attained in risk factor profiles (especially with regard to reductions in smoking) and improvements in terms of treatment. Nevertheless, enhancements in the prevention or treatment can manifest at diverse rates for diverse socioeconomic groups that consequently could yield in broadening of inequality. Education and Literacy The basis of adult health can be considered as being is established prior to birth, in infancy, an early childhood. Poor foetal development is frequently a risk for health later in life. Similarly, infancy and early childhood are essential stages of physical, emotional, and mental development. The positive impacts of high quality childcare usually persist into later life, especially among lower-income children (Power and Hertzman 1997, p.210). Good health-related habits such as eating healthy and regular exercising are significantly influenced during childhood. The education system plays a critical role in preparing individuals for the future and impact positively on the health of the population. Education forms one of the many characteristics that both contribute to, and result from social position within the society. An individuals’ social position during childhood considerably impacts on their access to educational opportunities (Hertzman, Power, Matthews and Manor 2110, p.1575). The resulting education impacts on social position in diverse ways such as employment opportunities, which consequently determines the income. Each of the outlined factors directly impacts on the individual’s health, but education also bear a direct influence on health, especially on an individual’s capability to navigate the system and understand health information and to communicate effectively with physicians, as well as other professionals (Raphael 2009, p.17). Besides impacting on health literacy, education attainment can also acts as a risk factor to diseases such as coronary disease and dementia. For instance, low education may lead to careers that expose an individual to toxic substances, or force the individual to live a sedentary life that is a risk factor to coronary disease. Although, having a job (a source of income) is mainly better for health compared to being unemployed, stress at work bear a significant impact on health (Blas and Sivasankarakurup 2010, p.279). Having minimal control over one’s work is linked to enhanced risk to cardiovascular disease, depression, and low back pain. Longer and unpredictable hours coupled with high and rising job demands are likely to yield to stress and anxiety. Income and Social Status Social status (manifested by markers such as wealth, occupation, education, and power) is a significant health indicator. Income, especially inadequate income, has a significant impact on health. Being poor may also expose the individuals to inferior physical environments and poor lifestyle choices such as eating of inexpensive but fatty foods that predispose them to health problems, in this case to coronary heart disease (Scholes et al 2012, p.129). Differences in socioeconomic status have overtime been linked to cardiovascular incidence and mortality across multiple populations. Initially, CVD and risk factors were initially more common among within upper socioeconomic groups within the developed world; however, CVD has gradually become more prevalent within low socioeconomic groups. During childhood, poor living condition and the parent’s social class bear a significant impact on cardiovascular health status. During the middle age, risk factors such as physical inactivity, high cholesterol levels, and diabetes that may be countered through alteration of material conditions that render healthy behaviours affordable and facilitate healthy information seeking and education. In later life, access to medical care, family and social support bear a significant impact on cardiovascular health (Gehlert 2008, p.339). Material conditions, which include, but not entirely defined by income, are critical social determinants of health. Wilkinson argued that a society that manifests poor health tolerates or encourages high income inequality. Wide income differentials between social groups in developed countries such as the UK have significant consequences for health, not mainly owing to material deprivation but due to psychological effects (Wild et al. 2007, p.191). Well established behavioural risk factors to coronary heart disease such as poor diet are common among individuals at lower tier of social class. # 3 Coronary heart Disease Coronary heart disease remains the UK’s biggest killer leading to about 82,000 deaths per year (about 1 in 4 men and 1 in 8). In the UK, close to 2.7million people are living with the condition and close to 2million people are affected by angina (a common symptom of CHD) (Unal, Critchley and Capewell 2004, p.1101). Coronary heart disease (CHD) represents the narrowing of the arteries leading to the heart mainly owing to atherosclerosis. The lipid-rich plaques mainly restrict blood to the heart by physically obstructing blood flow or by yielding an irregular artery tone and function. The factors that increase a person’s risk or coronary heart disease include high cholesterol levels, inactivity, excessive alcohol, excessive stress, obesity, diabetes, and smoking Smith, Ben-Shlomo and Lynch 2002, p.21). Fatty material, as well as other substances, develops a plaque (waxy substance) build-up on the walls of the coronary arteries that bring blood and oxygen to the heart. The build-up of the fatty material renders the arteries to narrow, which, in turn, slows down or stops blood flow to the heart. Overtime, the plaque can harden or rupture. A significant blood clot can significantly or entirely block blood flow via a coronary artery. Overtime, the ruptured plaque equally hardens and narrows (or blocks) the coronary arteries. ACS constitutes a number of life-threatening disorders: unstable angina, myocardial infarction, and complete thrombotic blockage of a coronary artery (Fuster, Topol and NabeL 2005, p.23). The symptoms of CHD include chest pain or discomfort (angina) indicative that the heart is not getting enough blood or oxygen. A heart attack results from stoppage of oxygen-rich blood flow to the heart that may make the heart muscle to die. Overtime, CHD can significantly weaken the heart muscle leading to heart failure and arrhythmias. Other symptoms entail shortness of breath and fatigue with activity (Labarthe 2011, p.560). The tests for the disease may include coronary angiography, echocardiogram, and electrocardiogram. Other tests entail heart CT scan, exercise stress test, and nuclear stress test. The treatment for coronary heart disease may entail taking medication (cholesterol lowering medications, nitroglycerin, and calcium channel blockers) to treat diabetes, high cholesterol levels, and high blood pressure. Other treatments entail surgery (heart transplant and coronary artery bypass) and non-surgical methods such as coronary angioplasty. The prevention of CHD may entail making lifestyle changes such as quitting smoking, plant-based diet, exercise, weight control, weight control, and decreasing psychological stress (Ben-Shlomo, Brookes and Hickman 2012, p.167). # 4 Interventions to Coronary Heart Disease Perceiving health disparities via a lens that embraces social/environmental conditions as upstream factors within multilevel model better allows the design, and implementation of effective interventions (Leddy 2006, p.436); (Elliott and Marmot 2005, p.843); (Kelly et al. 2006, p.35). The quantitative and qualitative differences in physical activity explain the marginal disparities in coronary heart disease across socioeconomic status (Ana et al. 2001, p.11); (Ford et al. 1991, p.1246). Physical Environment The ease of availability of fast food outlets within socially deprived neighbourhoods (mostly ethnic minority localities of UK towns and cities) has been linked to increased probability of obesity (and consequently coronary heart disease) in the populations. Moreover, physical proximity to affordable food choices does not emerge as a powerful determinant of a healthy diet within UK settings where this has been explored. Workplace environmental interventions, inclusive of nutrition availability and information have been strongly demonstrated to yield in significant mean reductions within body mass index and body weight for targeted groups (Sesso et al. 2000, p.975). Economic Environment Evidence from a broad range of studies indicates a strong association between population level weight gain and consumption of energy dense food and drink. Soft drinks in particular manifest a relatively high “price elasticity” whereby their purchase by consumers, especially those at risk from coronary heart disease, is indicative of economical disadvantage owing to high price sensitivity. A discretionary tax on soft drinks can be considered as a means for the government to address the “market failure”, and this can significantly deliver public health benefits. Legislative Environment Given the true scale of coronary heart disease there is a case for statutory interventions to safeguard public health. Legislative environments could entail explicit restrictions on supply, fiscal measures, and obligations to avail more comprehensive information regarding risks to coronary heart disease. Sociocultural Environment Mass media are a universal reflector and constant shaper of sociocultural attitudes within contemporary society. The effectiveness of mass media in encouraging healthy behaviours can be regarded as modest, with the capability to deliver marginal population health gain at the national and/or regional level. Nutritional interventions: Minimizing the Quantity of Saturated Fats in Food Studies of tax and price policies applicable to tobacco and alcohol products within many countries avail persuasive evidence of their significance on decreasing consumption of those products (Keefe and Jurkowski 2013, p.44). Such policy interventions avails a precedence for matching approaches for regulating and reducing the consumption of food flagged as containing high saturated fats (Vlodaver, Wilson and Garry 2012, p.2). Physical activity related interventions include: conducting long-term planning of towns and city centres to facilitate walking and cycling; removing sales taxes on the purchase of exercise equipments; altering building codes to enhance the use of stairways; protecting open spaces via zoning and land use policies; and, awarding incentives to employers that avail physical activity breaks or release time. Food and eating related interventions may entail: labelling the saturated fat content of foods in restaurants and take-away establishments; instituting guidelines for the saturated fat content of school and hospital meals; altering the fat content of restaurant foods and processed foods by gradually changing their preparation and processing; prohibiting some form of food advertising on television; and, demanding nutrient information as part of food advertisements (Magnusson 2008, p.11). Downstream Interventions: Increasing Physical Activity Regular physical activity has been demonstrated to prevent coronary heart disease and understanding neighbourhood factors that impact on physical activity is critical in explaining why majority of the population fails to meet physical activity prescriptions despite the widely available information on the many benefits of physical activity (Press, Freestone and Geroge 2003, p.245). The most inactive in the society include those married and with children under school age, those aged 30 years and over, people with a low socioeconomic status, and populations with culturally and linguistically diverse backgrounds. Increasing Participation Significant public health gains can be derived from facilitating small enhancements in physical activity, especially among those who are sedentary and engaging in minimal levels of activity. Present recommendations detail that individuals can gain health benefits from accumulating, on the majority of days of the week, 30 minutes of more moderate intensity physical activity with minimum sessions of 10 minutes. Intervention Description Group-based health education and skill development encompasses the provision of education via discrete planned episodes with the purpose of changing knowledge, attitudes, self-efficacy, and individual capacity to be more physically active (Dunn 2009, p.11). The programs constitute components such as goal setting and self monitoring; establishment of social support for physical activity; reinforcement via reward and constructive self-talk; structured problem solving; and, the prevention of relapse. Conclusion Socioeconomic context and position plays a critical role in influencing the form, magnitude, and distribution of health within societies. The disparity in the control of power and resources within societies generates stratifications within institutional and legal arrangements and alters the political and market forces. Health disparities manifest by sex, ethnicity, race, and socioeconomic status with inequities manifesting in screening, incidence, treatment, and mortality across a broad range of diseases and conditions such as diabetes, cardiovascular disease, HIV/AIDS, and infant mortality. Although, a wide range of hereditary and individual behavioural factors are associated with health outcomes, social circumstances and environmental factors usually place minority groups at a disadvantage in health and disease. Some groups may be exposed to multiple conditions (such as discrimination and unequal treatment in housing, medical care, and employment) that are experienced minimally by more advantageous groups. Hence, societal factors that embody upstream determinants should be incorporated in frameworks for determining population health. There is a growing acceptance that all people are entitled to an equal opportunity to make choices that yield good health. Socioeconomic disadvantage cannot be conceived as merely a proxy for poor cardiovascular risk factor status, but a sign of the probable trajectory that an individual or community may pursue in the course of their life. In developed countries, socio-economic mortality differences have been studied extensively indicating that low-social economic groups usually suffer the highest mortality. A wealth of evidence reinforces the notion that socioeconomic circumstances that individuals, and frequently more, impact on health status as personal health behaviours, and medical care. Both population-based and individual-based approaches can impact significantly on health inequalities; however, population-based approached are better placed to reduce health inequalities. This derives from the fact that, there are numerous reasons why individuals who are disadvantaged may find it daunting to alter their behaviour compared to those who are affluent. Hence, some of the activities directed at the individuals may inadvertently enhance health inequalities. Protecting the cardiovascular health of individuals within low socioeconomic strata via population-based prevention strategies is a priority. Population-based interventions pursue to alter the risks from social, economic, environmental and material factors that impact on the entire population. This can be attained via regulation, legislation, subsidy and taxation, or changing the physical layout of communities. The needs of individuals most at risk of cardiovascular of CVD ought to be addressed with significant focus been laid on disadvantaged sectors. A balanced combination of cost-effective approaches directed at the entire population, especially among high segments is essential for prevention and control of cardiovascular disease. The bulk of the determinants of behavioural risk factors and cardiovascular diseases lie outside the health domain and bear a strong link to root social causes such as poverty and illiteracy. Policy action and structural interventions are required to respond to the root social cause in order to minimize exposure and vulnerability of disadvantaged groups to cardiovascular disease. References List Ana, V. et al. (2001). Neighbourhood of residence and incidence of coronary heart disease, The new England Journal of Medicine 345 (1), pp.99-106. Ben-Shlomo, Y., Brookes, S., & Hickman, M. (2012). Lecture Note. Chicester, Wiley. pp.167-168 Blas, E., & Sivasankara kurup, A. (2010). Equity, social determinants and public health programmes, Geneva, World Health Organization. pp. 279. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. pp.5-6. Dunn, A. (2009). Effectiveness of lifestyle physical activity interventions to minimize cardiovascular disease, American Journal of Lifestyle Medicine 3 (1), pp.11-18. Elliott, P., & Marmot, M. (2005). Coronary heart disease epidemiology: from aetiology to public health, Oxford, Oxford University Press. pp.843 Ford, E. S. et al. (1991). Physical activity behaviours in lower and higher socioeconomic status populations, Am. J. Epidemiol. 133 (12), pp.1246-1256. Fuster, V., Topol, E. J., & NabeL, E. G. (2005). Atherothrombosis and coronary artery disease, Philadelphia, PA, Lippincott Williams & Wilkins. pp.23-30 Gehlert, S. (2008). Targeting health disparities: A model linking upstream determinants to downstream interventions, Health Affairs (Millwood) 27 (2), pp.339-349. Hertzman, C., Power, C., Matthews, S., & Manor, O. (2110). Using an interactive framework of society and lifecourse to explain self-rated health in early adulthood, Soc Sci Med 53 (1), pp.1575–85. Keefe, R. H., & Jurkowski, E. T. (2013). Handbook for public health social work, New York, Springer Pub.44 Kelly, L.A. et al. (2006). Effect of socioeconomic status on objectively measured physical activity, Arch Dis Child 91 (1), pp.35-38. Kuulasmaa K. et al. (2000). Estimation of contribution of changes in classic risk factors to trends in coronary event rates across the WHO MONICA Project populations, Lancet 355 (9205), pp.675–87. Labarthe, D. (2011). Epidemiology and prevention of cardiovascular diseases: a global challenge, Sudbury, Mass, Jones and Bartlett Publishers. pp.560 Lang, T., et al. (2012). Social determinants of cardiovascular diseases. Public Health Reviews. 33 (1), pp.601-22. Leddy, S. (2006). Integrative health promotion conceptual bases for nursing practice, Sudbury, Mass, Jones and Bartlett Publishers. pp.436 Magnusson, R. (2008). What’s aw got to do with it? Part 2: Legal strategies for healthier nutrition and obesity prevention, Australia and New Zealand Health Policy 5 (1), pp.11. O'Flaherty, M. & Capewell, S. (2012). New perspectives on cardiovascular risk in individuals and in populations, J Epidemiol Community Health 66 (10), pp. 855-6. Power, C., & Hertzman, C. (1997). Social and biological pathways linking early life and adult disease, Br Med Bull 53 (1), pp.210–21. Press, V., Freestone, I. & Geroge, C. F. (2003). Physical activity: The evidence of benefit in the prevention of coronary heart disease, QJM 96 (4), pp.245-251. Raphael, D. (2009). Social determinants of health: Canadian perspectives, Toronto, Canadian Scholar's Press. pp.17-18. Scholes, S. et al (2012). Persistent socieconomic inequalities in cardiovascular risk factors in England over 1994-2008: a time-trend analysis of repeated cross-sectional data, BMC Public Health 12 (1), pp.129. Sesso, D. et al. (2000). Physical activity and coronary heart disease in men, Circulation 102 (1), pp.975-980. Smith, G. D., Ben-Shlomo, Y., & Lynch. J. (2002). Life course approaches to inequalities in coronary heart disease risk. In: Stansfeld SA, Marmot MG, editors. Stress and the heart: psychosocial pathways to coronary heart disease, London, BMJ Books. pp. 21–49. Unal, B., Critchley, J. A., & Capewell, S. (2004). Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000, Circulation 109 (1), pp.1101–7. Vlodaver, Z., Wilson, R. F., & Garry, D. J. (2012). Coronary heart disease: clinical, pathological, imaging, and molecular profiles, New York, Springer. ppp.2-4 WHO Commission on Social Determinants of Health, & World Health Organization (2008). Closing the gap in a generation: health equity through action on the social determinants of health : Commission on Social Determinants of Health final report, Geneva, Switzerland, World Health Organization, Commission on Social Determinants of Health. pp.117 Wild, S. H. et al. (2007). Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003, J Public Health 29 (1), pp.191–8. Read More