Social determinants of health ak hlst 3010 school of health policy and management dennis raphael
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Social Determinants of Health AK/HLST 3010 School of Health Policy and Management Dennis Raphael. Societal Approaches to Understanding How Income and Income Inequality Affect Health York University October 28, 2002. Overview. Health differences among nations

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Social determinants of health ak hlst 3010 school of health policy and management dennis raphael

Social Determinants of HealthAK/HLST 3010School of Health Policy and ManagementDennis Raphael

Societal Approaches to Understanding

How Income and Income Inequality

Affect Health

York University

October 28, 2002


Overview

Overview

  • Health differences among nations

  • Health differences among US states and cities

  • Various explanations for these effects

  • Social policy and population health

  • Social policy, health determinants and health in Canada today

  • Social policy, health, and the welfare state


Pyll 0 74 by cause urban canada 1996

PYLL(0-74) by Cause, Urban Canada, 1996

%

Source: Wilkins et al., 2002


Excess pyll 0 74 by cause urban canada 1996

Excess PYLL(0-74) by Cause, Urban Canada, 1996

%

Source: Wilkins et al., 2002


Poverty and health mechanisms

Poverty and Health: Mechanisms

Poverty can affect health in a number of ways:

  • income provides the prerequisites for health, such as shelter, food, warmth, and the ability to participate in society;

  • living in poverty can cause stress and anxiety which can damage people’s health;

  • low income limits peoples’ choices and militates against desirable changes in behaviour.

    - Benzeval, Judge, & Whitehead, 1995, p.xxi, Tackling Inequalities in Health: An Agenda for Action.


Critical periods of the life course

Critical Periods of the Life Course

  • Fetal development

  • Birth

  • Nutrition, growth and health in adulthood

  • Educational Career

  • Leaving parental home

  • Entering labour market

  • Establishing social and sexual relationships

  • Job loss or insecurity

  • Parenthood

  • Episodes of illness

  • Labour market exit

  • Chronic sickness

  • Loss of full independence

    --Shaw et al., The Widening Gap, 1999, p. 106.


Social determinants of health ak

Health Differences Among Nations


Social determinants of health ak

Working-Aged Male (25-64) Mortality by Median Share

U.S. States and Canadian Provinces

800

U.S. States with weighted linear fit (from Kaplan et al., 1996)

Canadian Provinces with weighted linear fit (slope not significant)

MS

LA

675

SC

AL

Rate per 100,000 Population

FL

550

TX

CA

PEI

QUE

425

NH

NS

NB

NFLD

MAN

MN

ONT

BC

ALTA

SASK

Mortality Rates Standardized to the Canadian Population in 1991

300

0.18

0.20

0.22

0.24

Median Share of Income

WAMWeightedCan&US June 16, 1999 2:40:26 PM

ME


Social determinants of health ak

USA, Canada, and Sweden Rankings Compared to

Other Industrialized Nations

(Ranking, 1 is best)

MeasureUSA Canada Sweden

Income Inequality (1990)18 of 1811 3

Child Poverty (1990)17 of 17142

Infant Mortality (1996)24 of 29172

Youth Suicide (1992-1995)15 of 221610

High School Drop-Outs (1996)17 of 171610

Youth Homicide (1992-1995)22 of 22195

Wages (1996)13 of 23156

Unemployment (1996)2 of 1078

Elderly Poverty (1990)15 of 1745

Life Expectancy (1996)20 of 2943


Health differences among us states and cities

Health Differences Among US States and Cities


Economic inequality explanations

Economic Inequality: Explanations

  • Economically unequal societies have greater levels of poverty (individual poverty explanation)

  • Economically unequal societies have greater hierarchy and weaker social cohesion (social comparison explanation)

  • Economic unequal societies provide fewer social safety nets and social investment (neo-materialist explanation)


Economic inequality and health

Economic Inequality and Health

  • What matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed. The more equally wealth is distributed the better the health of that society.

  • Editorial: The big idea. British Medical Journal, April 20, 1996, 312, 985.


Economic inequality and health1

Economic Inequality and Health

  • Inequality may make people miserable long before it kills them.

  • Editorial: Income inequality and mortality: Why are they related? British Medical Journal, April 20, 1996, 312, 987-988.


Neo materialist viewpoint i

Neo-Materialist Viewpoint I

  • Income inequality has generally been associated with differences in health

  • A psychosocial interpretation of health inequalities, in terms of perceptions of relative disadvantage and the psychological consequences of inequality, raises several conceptual and empirical problems

  • Income inequality is accompanied by many differences in conditions of life at the individual and population levels, which may adversely influence health

  • - Lynch et al., BMJ, 2000


Neo materialist viewpoint ii

Neo-Materialist Viewpoint II

  • Interpretation of links between income inequality and health must begin with the structural causes of inequalities, and not just focus on perceptions of that inequality

  • Reducing health inequalities and improving public health in the 21st century requires strategic investment in neo-material conditions via more equitable distribution of public and private resources

  • - Lynch et al., BMJ, 2000


Higher income inequality is associated with lots of things

Low birth weight

0.65

Homicide

0.74

Unemployment

0.48

Welfare

0.69

No health insurance

0.45

Per capita medical spending

-.67

High School graduation

-0.71

Library books per capita

-0.42

Kaplan, BMJ (1996)

Higher income inequality is associated with lots of things


Increasing inequality and longevity in uk

Increasing Inequality and Longevity in UK

Source: Lynch et al., BMJ, 2000


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