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Social Determinants of Health

Social Determinants of Health. Shahid Beheshti University of Medical Sciences School of Medical Education Strategic Policy Sessions: 01. Health. Health Technologies. Healthcare. Disease. Most Praised Health Technologies of 20 th Century. Sulphonomides Diphteria Toxoid

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Social Determinants of Health

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  1. Social Determinants of Health Shahid Beheshti University of Medical Sciences School of Medical Education Strategic Policy Sessions: 01

  2. Health Health Technologies Healthcare Disease

  3. Most Praised Health Technologies of 20th Century • Sulphonomides • DiphteriaToxoid • Poliomyelitis Vaccine • Whooping Cough Vaccine • Penicillin • Chlaramphenicol • Measles Vaccine • Isoniazide • Influenza Vaccine

  4. Health Health Technologies Healthcare Accessibility Affordability Disease

  5. Health Health Technologies Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease

  6. Health Health Technologies Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease

  7. 70 60 x O O O O O O O O O O O O O O O 50 40 30 20 10 Interrupted Time Series

  8. 70 60 x O O O O O O O O O O O O O O O 50 40 30 20 10 Interrupted Time Series

  9. 70 60 x O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 50 40 30 20 10 Interrupted Time Series

  10. Health Health Technologies Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Environmental Risk Factors Lifestyle Behavior (RF) Genetic Risk Factors

  11. Burden of disease attributable to 10 selected leading risk factors

  12. Burden of disease attributable to 10 selected leading risk factors

  13. 1. Don't smoke. If you can, stop. If you can't, cut down. 2. Follow a balanced diet with plenty of fruit and vegetables. 3. Keep physically active. 4. Manage stress by, for example, talking things through and making time to relax. 5. If you drink alcohol, do so in moderation. 6. Cover up in the sun, and protect children from sunburn. 7. Practise safer sex. 8. Take up cancer screening opportunities. 9. Be safe on the roads: follow the Highway Code. 10. Learn the First Aid ABC : airways, breathing, circulation. Ten Tips For Better Health - Donaldson, 1999

  14. Social Determinants are Important

  15. Social Determinants are Important

  16. Increased Risk of Diabetes in Ontario Among Low Income Residents, 1997/97

  17. The Evidence Concerning Low Income and Heart Disease: The Hard Data • Statistics Canada estimated that in 1996, 23% of years of life lost for all causes prior to age 75 in Canada could be attributed to income differences. • The diseases most responsible for income-related differences in death rates were cardiovascular diseases. • In 1996, 22% of all the years lost that can be attributed to income differences were caused by cardiovascular disease. • These income differences account for an annual excess of 24% or 6,366 premature deaths from cardiovascular disease.

  18. Health Health Technologies Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Environmental Risk Factors Lifestyle Behavior (RF) Genetic Risk Factors Social Determinants of Health

  19. PYLL(0-74) by Cause, 1996 %

  20. Socioeconomic Influence on Cardiovascular Disease Socioeconomic Position Working Conditions & Income Income & Assets Intrauterine Conditions Education & Environmental Conditions Birth Childhood Adulthood Old Age Low Birth Weight Growth Retardation Smoking Diet, Exercise Job Stress Inadequate Medical Care Atherosclerosis CVD Reduced Function

  21. Social Determinants of Health:The Solid Facts • Social gradient • Early life • Work • Social support • Stress • Social exclusion • Unemployment • Addictions • Food • Transport World Health Organization, 1998

  22. Ottawa Charter’s Prerequisites of Health • Peace • Shelter • Education • Food • Income • A stable eco-system • Sustainable resources • Social justice • Equity World Health Organization, 1986

  23. Health Canada’s Determinants of Health • Income and Social Status • Social Support Networks • Education • Employment/Working Conditions • Social Environments • Physical Environments • Personal Health Practices and Coping Skills • Healthy Child Development • Biology and Genetic Endowment • Health Services • Gender • Culture

  24. Health Compliance Behavior Provider Professional Behavior Healthcare Treatment Seeking Behavior Health Literacy Accessibility Affordability Disease Environmental Risk Factors Lifestyle Behavior (RF) Genetic Risk Factors Social Determinants of Health

  25. Ten Tips for Staying Healthy - Dave Gordon, 1999. 1. Don't be poor. If you can, stop. If you can't, try not to be poor for long. 2. Don't have poor parents. 3. Own a car. 4. Don't work in a stressful, low paid manual job. 5. Don't live in damp, low quality housing. 6. Be able to afford to go on a foreign holiday and sunbathe. 7. Practice not losing your job and don't become unemployed. 8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled. 9. Don't live next to a busy major road or near a polluting factory. 10. Learn how to fill in the complex housing benefit/ asylum application forms before you become homeless and destitute.

  26. What is the role of governments?

  27. USA, Canada, and Sweden Rankings on Compared to other Industrialized Nations (Ranking, 1 is best) Measure USA Canada Sweden Income Inequality (1990) 18 of 18 11 3 Child Poverty (1990) 17 of 17 14 2 Infant Mortality (1996) 24 of 29 17 2 Youth Suicide (1992-1995) 15 of 22 16 10 High School Drop-Outs (1996) 17 of 17 16 10 Youth Homicide (1992-1995) 22 of 22 19 5 Wages (1996) 13 of 23 15 6 Unemployment (1996) 2 of 10 7 8 Elderly Poverty (1990) 15 of 17 4 5 Life Expectancy (1996) 20 of 29 4 3

  28. Canadian Government Statements on Social Determinants of Health All policies which have a direct bearing on health need to be coordinated. The list is long and includes, among others, income security, employment, education, housing, business, agriculture, transportation, justice and technology. -- Achieving Health For All: A Framework for Health Promotion, J. Epp. Ottawa: Health and Welfare Canada, 1986.

  29. Justice and Fairness Where a great proportion of the people are suffered to languish in helpless misery, that country must be ill-policed and wretchedly governed: a decent provision for the poor is the true test of civilization. - Dr. Samuel Johnson

  30. We know what makes us ill. • When we are ill we are told • That it’s you who will heal us. • When we come to you • Our rags are torn off us • And you listen all over our naked body. • As to the cause of our illness • One glance at our rags would • Tell you more. • It is the same cause that wears out Our bodies and our clothes. Bertolt Brecht, A Worker’s Speech to a Doctor, 1938.

  31. Thank You !

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