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Enhancing social policy outcomes: How important are structural factors?. Sociology Seminar Series 21 May 2014 Roy Lay-Yee & Team COMPASS Research Centre University of Auckland, New Zealand www.compass.auckland.ac.nz. Enhancing social policy outcomes.

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Enhancing social policy outcomes how important are structural factors

Enhancing social policy outcomes: How important are structural factors?

Sociology Seminar Series

21 May 2014

Roy Lay-Yee & Team

COMPASS Research Centre

University of Auckland, New Zealand

www.compass.auckland.ac.nz


Enhancing social policy outcomes
Enhancing social policy outcomes structural factors?

  • Social policy goal to improve outcomes for disadvantaged

  • Need to know most influential factors, i.e. best policy levers

  • An influential perspective is social determinants framework (WHO Commission 2008, Marmot Review 2010) - applied to health – argues primacy of structural factors - sociological

  • How do we show if structural factors are most important?

  • Further, how do we show if efforts to tackle disparities will make a difference to the most disadvantaged?

2


What we are offering
What we are offering structural factors?

  • Empirical model of what social factors influence outcomes

  • Captures social complexity, heterogeneity, change

  • Mechanisms contextualised in social system (theory)

  • Pathways may be amenable to intervention (policy)

  • Use simulation to test scenarios - ask ‘what if’ questions, i.e. impact of changing social determinants on outcomes

  • Model developed in health but applicable to other domains

3


Outline
Outline structural factors?

  • Rationale

    • Social determinants of health

    • Data source

    • Our conceptual model

    • Research questions

  • Method

    • Microsimulation

  • Policy application

    • Scenario testing – answering ‘what if’ questions

  • Conclusions

4


Social determinants sds of health
Social determinants (SDs) structural factors?of health

  • Health disparities are rooted in SDs that confer differential vulnerability to poor health or exposure to conditions that produce poor health

  • Structural factors comprise SDs of health disparities (that are also SDs of health) while intermediary factors comprise other SDs of health (only)

  • Debate as to relative importance, as effective policy levers, of structural or intermediary factors


S ocial determinants of health framework solar irwin 2010 who

S structural factors?ocial determinants of health framework Solar & Irwin, 2010 (WHO)

6


D ata source
D structural factors?ata source

  • Christchurch Health & Development Study

  • Longitudinal study of birth cohort born in 1977 (on-going)

  • Used for our model - 1017children from birth to 10-years-old

7


Our model of social determinants of child well being

Structural structural factors?factors (fixed)

  • Child

  • Gender

  • Ethnicity

  • Parental

  • Age (at birth of child)

  • Ethnicity

  • Education

  • Familial

  • Socio-economic position (at birth of child)

Our model of social determinants of child well-being

Intermediary factors (modifiable)

  • Owned/ rented home

  • Overcrowding

  • Accommodation type

  • Change of parent

  • Change of residence

  • Parental smoking

Outcomes

Proxy indicators (modifiable)

Family doctor visits

Reading ability

Conduct problems

  • Family composition

  • Single- or two-parent

  • Number of children

  • Income source

  • Parent employment

  • Welfare dependence

8


Research questions
Research questions structural factors?

  • What is the effect of improving various factors (potential determinants) on child outcomes?

    • Q1. Are structural or intermediary factors more influential?

    • Q2. Is there greater impact on socially disadvantaged groups?

    • Q3. Do the same mechanisms operate for outcomes in a range of domains: GP visits, reading ability or conduct problems?

9


What is microsimulation
What is microsimulation structural factors??

  • Begin with a starting sample of children

    • Based on Christchurch Health & Development Study (CHDS)

  • Derive statistical equations from CHDS

  • Apply equations to starting sample to reproduce original CHDS patterns

    • A sample of children with typical synthetic biographies

  • We have created a virtual world

  • Predict what might happen if conditions were to change

    • Change the original settings to pose ‘what if’ scenarios

10


Virtual versus real cohort family doctor visits reading ability and conduct problems by year of age
Virtual structural factors?versus real cohort: family doctor visits, reading ability, and conduct problems, by year of age

11


What is microsimulation1
What is microsimulation structural factors??

  • Begin with a starting sample of children

    • Based on Christchurch Health & Development Study (CHDS)

  • Derive statistical equations from CHDS

  • Apply equations to starting sample to reproduce original CHDS patterns

    • A sample of children with typical synthetic biographies

  • We have created a virtual world

  • Predict what might happen if conditions were to change

    • Change the original settings to pose ‘what if’ scenarios

12


S cenario testing
S structural factors?cenario testing

  • What if there was a policy intervention that changed social determinants? What would be its impact on outcome?

  • Base simulation (no change) vs. ‘improvement’ simulation (modifying factors in a direction expected to advantage people, e.g. father employed, family not welfare dependent)

13


Scenario testing procedure
Scenario testing structural factors?procedure

  • We ‘improved’ single factors and assessed the degree of impact on outcome (little effect)

  • We ‘improved’ multiple factors simultaneously (bigger effect)

  • We compared the relative effects of ‘improving’ structural and intermediary factors

  • We posed ‘best case scenarios’ by ‘improving’ structural and intermediary factors simultaneously

14


Outcome gp visits
Outcome: GP visits structural factors?

Increasing the number of visits per year – i.e. increasing access to GP care – is interpreted as an improvement in outcome

15


Enhancing social policy outcomes how important are structural factors

Watch this space structural factors?


Enhancing social policy outcomes how important are structural factors

Base-line structural factors?shows social gradient


Enhancing social policy outcomes how important are structural factors

Structural structural factors?factors have greater effect than intermediary



Enhancing social policy outcomes how important are structural factors

G structural factors?radient flattens – closing gap – structural factors important


Outcome reading ability
Outcome: Reading ability structural factors?

Increasing the reading score is interpreted as an improvement in outcome

21


Enhancing social policy outcomes how important are structural factors

Watch this space structural factors?


Enhancing social policy outcomes how important are structural factors

G structural factors?radient flattens – closing gap – structural factors important


Outcome conduct problems
Outcome: Conduct problems structural factors?

Reducing the number of conduct problems per year is interpreted as an improvement in outcome

24


Enhancing social policy outcomes how important are structural factors

Watch this space structural factors?


Enhancing social policy outcomes how important are structural factors

G structural factors?radient flattens – closing gap – structural factors important


Summary of results
Summary of results structural factors?

  • Q1: Effect of modifiable structural factors is greater than of intermediaryfactors

  • Q2: Clear social gradient of impact with the benefits of intervention flowing disproportionately to the most disadvantaged

  • Q3: Similar findings for range of outcomes in different domains

27


Conclusions
Conclusions structural factors?

  • Our simulation model can be used to test scenarios

    • What if there was a policy intervention that changed social determinants? What would be impact on outcome?

  • Policy implications

    • Important to tackle (multiple) structural & intermediary determinants esp. structural

      – argues for inter-sectoral policy? fundamental change?

    • Social gradients of impact, more disadvantaged groups gain more benefit

      – argues for progressive universalism?

  • Social policy can potentially make a difference to the most disadvantaged

28