The Social Determinants of Health and Their Importance in Public Health Work - Report 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 (OFlaherty 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, unhealthy diet, obesity, smoking, obesity, hypertension, 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. The relationship between income and health is exhibited by life expectancy. 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 Upstream interventions embody features of the social environment such as socioeconomic status, as well as discrimination that impact on the individual’s behaviour, health status, and 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. Health promotion entails the process of enabling individuals to enhance control over the determinants of their lives to enhance their health (Leddy 2006, p.436). The social-ecological perspective appreciates the multiple and intricate influences on an individual’s everyday lives and individual behaviour such as relationships among income, poverty, gender, social exclusion, and unemployment. Upstream-downstream levels of intervention The following five action areas avail a framework for responding to the multiple determinants of health, namely: building healthy public policy; creating supportive environments; reinforcing community action; developing personal skills; and, reorienting health services. The outlined action areas constitute both upstream and downstream levels of intervention. Upstream Interventions Upstream interventions essentially deal with population-wide influences on health such as policies dwelling on income distribution, public safety, education, work environment, housing, employment, and social networks. These interventions are usually extensive and large scale, although, they can still be addressed effectively at a local level with communities or group that share interest and concerns. In contrast, downstream interventions are essentially discrete, targeted programs that highlight an explicit health purpose. Utilizing Population Approaches and Social Equity Historically, most of strategies for minimizing the incidence of coronary heart disease centred on educating and changing the behaviour of persons at high risk. The major limitation of this approach is that risk factors such as blood pressure, body fat, and cholesterol levels are distributed differently across diverse populations (Vlodaver, Wilson and Garry 2012, p.2). Policies to minimize the amount of saturated fats within processed foods bear the possibility to reach all individuals irrespective of their individual level of knowledge, material resources, or motivation. Such interventions manifest an influence on hard-to-reach groups and individuals unlikely to respond to nutritional education campaigns or engage in discrete programs. Improving Health among Disadvantaged Groups Strategies for enhancing health among disadvantaged can be categorised as: 1) targeted intervention programs structured with and for disadvantaged groups. These interventions mainly include education and/or resourcing to reinforce behaviour change and address inequalities by targeting disadvantaged groups. (2) Population interventions that reach all people in the setting irrespective of knowledge, compliance, socioeconomic status, and motivation. These passive strategies frequently require changes within the policies or regulations at local or national level. (3) Upstream interventions that pursue policies to minimize social inequalities enhance the social and environmental conditions (Elliott and Marmot 2005, p.843). Interventions 1 and 2 can lead to reduction in tobacco use among low socioeconomic groups in the UK while interventions 2 and 3 can respond to inequalities at their source as they demand inter-sectoral action at government level and organizations. Locally-based practitioners still have a role to play in awareness raising and advocacy, community action and organizational change, and development of upstream intervention on issues regarding coronary disease. Reducing population-level consumption of saturated fats may entail encouraging caterers and producers to minimize the quantity of saturated fat in food. Upstream, population-level interventions may entail fiscal measures, regional or national policy legislation is not dependent on an individual’s knowledge or capability to select healthier options. Downstream Interventions Downstream interventions mainly address a narrower range of benefits and appear to focus more on the individual rather than whole communities. Individual-level approaches entail giving the subjects direct encouragement to change their behaviour. This may entail giving people information regarding the health risks of their current behaviour such as urging the individual to be more active and/or prescribing a treatment. This may also entail changing the manner in which the NHS and other organizations deliver prevention or healthcare services. A critical limitation of individual focussed intervention is that they often fail to attain and/or have an impact on disadvantaged groups across the community (Keefe and Jurkowski 2013, p.44). Hence, population wide approaches are likely to be more equitable compared to individual focussed interventions. To generate change at the population level, a blend of population/individual focussed strategies and passive/active strategies should be launched. This multi-strategy approach has delivered positive results in areas such as tobacco control and coronary disease prevention. 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. Certain social/environmental factors place some individuals at an enhanced risk for adverse health outcomes, generating health disparities. 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 groups find themselves in bear at least as much, 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. 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