Proximal Social Determinants Research Articles

Leveraging Social Networks for the Assessment and Management of Neurological Patients.

Social networks are the persons surrounding a patient who provide support, circulate information, and influence health behaviors. For patients seen by neurologists, social networks are one of the most proximate social determinants of health that are actually accessible to clinicians, compared with wider social forces such as structural inequalities. We can measure social networks and related phenomena of social connection using a growing set of scalable and quantitative tools increasing familiarity with social network effects and mechanisms. This scientific approach is built on decades of neurobiological and psychological research highlighting the impact of the social environment on physical and mental well-being, nervous system structure, and neuro-recovery. Here, we review the biology and psychology of social networks, assessment methods including novel social sensors, and the design of network interventions and social therapeutics.

Global capitalism as a societal determinant of health: A conceptual framework.

Recent scholarship has sought to distinguish between the deeper societal factors that shape the more proximate social determinants of health. One of these socio-structural institutions is global capitalism. While critical scholarship has advanced our understanding of the relationships between capitalist globalization and health, more work is needed to understand the transnational economic, political, and cultural practices that affect various global health issues. This paper argues that the theory of global capitalism provides an important, critical perspective for understanding different phenomena associated with global health. The theory's key concepts of transnational corporations, financialization, consumerism, transnational social classes, and transnational state comprise the conceptual framework. When applied to various global health topics, the theory advances our understanding of the health-related institutional structures of today's global economy, provides a holistic view that integrates various strands of health research, highlights various forms of health activism, and offers new questions for addressing persistent health injustice across the world.

Suicide in the elderly: approach to social determinants of health in the Dahlgren and Whitehead model.

Identify in literature the social determinants of health related to suicide in the elderly, according to the model proposed by Dahlgren and Whitehead. Integrative review of articles indexed in the databases BDENF, CINAHL, LILACS, and MEDLINE, with the following main descriptors: aged, suicide, social determinants of health, and risk factors. Primary studies were included which addressed social determinants of health and suicide in the elderly. From the 19 articles analyzed, three categories emerged: proximal social determinants of health (male gender, mental disorders, physical illnesses, white race, 70-74 years old); intermediate social determinants of health (substance abuse, use of alcohol or psychotropic drugs, marital status, marital, social, and family problems, violence, previous suicide attempt, history of admission to psychiatric service); and distal social determinants of health (schooling, economic issues, sanitation, stressful events). Proximal determinants have more effects on suicide. Intermediate determinants are composed mainly of changeable factors. Distal determinants showed lesser associations.

Individual and contextual factors associated to the self-perception of oral health in Brazilian adults

ABSTRACTOBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health.METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights.RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis.CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

Threat of Deportation as Proximal Social Determinant of Mental Health Amongst Migrant Workers.

While migration health studies traditionally focused on socioeconomic determinants of health, an emerging body of literature is exploring migration status as a proximate cause of health outcomes. Study 1 is a path analysis of the predictors of mental health amongst 582 documented migrant workers in Singapore, and shows that threat of deportation is one of the most important proximate social determinants of predicted mental illness, and a mediator of the impact of workplace conflict on mental health. Study 2 is a qualitative study of the narratives of 149 migrant workers who were in workplace conflict with their employers, and demonstrates that workers believed threats were used as a negotiating strategy during workplace conflicts. Findings suggest that migration status places workers who come into workplace conflict with their employers at heightened risk of mental illness because migration status can be used as a tool by employers in workplace negotiations.

Income inequality, welfare, class and health: A comment on Pickett and Wilkinson, 2015

Recent scholarship has sought to distinguish between the deeper societal factors that shape the more proximate social determinants of health. One of these socio-structural institutions is global capitalism. While critical scholarship has advanced our understanding of the relationships between capitalist globalization and health, more work is needed to understand the transnational economic, political, and cultural practices that affect various global health issues. This paper argues that the theory of global capitalism provides an important, critical perspective for understanding different phenomena associated with global health. The theory's key concepts of transnational corporations, financialization, consumerism, transnational social classes, and transnational state comprise the conceptual framework. When applied to various global health topics, the theory advances our understanding of the health-related institutional structures of today's global economy, provides a holistic view that integrates various strands of health research, highlights various forms of health activism, and offers new questions for addressing persistent health injustice across the world.

Proximal and distal social influence on alcohol consumption and marijuana use among middle school adolescents

ObjectivesThis study assesses the independent and combined effects of (1) perceived peer norms, (2) best friend use, and (3) being in the presence of others who use on middle school adolescents’ consumption of marijuana and alcohol, and how the effects of these sources of social influence evolve over time as youth progress through middle school. MethodsThe analytic sample consisted of 11,667 adolescents (50% female; >65% Hispanic) in 6th, 7th or 8th grade from 16 middle schools across three school districts in Southern California. Participants were assessed at 5 time points from 2008 to 2011. ResultsAll sources of social influence were predictive of alcohol and marijuana consumption. As youth grew older, spending time with other adolescents who drink increased adolescents’ likelihood of drinking alcohol, whereas perceived norms became less influential. Furthermore, as adolescents spent more time around other youths who drink, the predictive value of perceived norms on alcohol consumption decreased. Similarly, as youth grew older, the influence of best friend's use and spending time with other adolescents who use marijuana remain stable, whereas perceived norms became less influential. ConclusionFindings suggest that perceived peer norms may be more influential in early adolescence; whereas proximal social determinants (e.g., being in the presence of other peers who consume) become more influential as youth enter middle adolescence. Prevention programs should continue to address misperception of norms with younger adolescents to decrease the chances of initiation, but also utilize strategies such as refusal skills and alternate coping mechanisms for older adolescents.

Association between social determinants of health and functional dentition in 35‐year‐old to 44‐year‐old Brazilian adults: a population‐based analytical study

To verify the association between functional dentition and social determinants of health in 35-year-old to 44-year-old adults residing in the metropolitan municipalities of Minas Gerais, Brazil. This cross-sectional study assessed a sample of 850 adults obtained using a cluster sampling scheme. Five of 33 municipalities were randomly selected, followed by the random selection of census tracts and neighborhood blocks. Every household in the randomly selected blocks was visited and every resident adult was interviewed and examined by five previously calibrated researchers (κinter , 0.8-0.9; κintra , 0.8-1.0) between May and December 2010. The condition of the dental crown was recorded using the World Health Organization (WHO) criteria, with the exception of the third molars. The dependent variable functional dentition was defined as the presence of 20 or more teeth in the mouth and obtained by counting the number of teeth lost due to any reason, followed by subtraction of this number from the total of 28 teeth. Independent variables were grouped, according to a theoretical model adapted from those proposed by Dahlgren and Whitehead and Petersen, into distal factors (contextual, socioeconomic, and housing conditions), intermediate factors (availability and use of oral health services), and proximal factors (lifestyle, risk behaviors, and demographic conditions). The association between functional dentition and the independent variables was investigated using simple and multiple Poisson regression with robust variance, which followed a modeling strategy in accordance with the hierarchy outlined by the theoretical model. The analyses were processed on SPSS 17.0. The average age of the participants was 39.4±3.2years, and the average per capita monthly family income was US$214.52±261.11. Most adults presented functional dentition (80.6%; 95% CI: 77.3-83.5). Independently of marital status, age group and sex, the prevalence ratio (PR) of subjects with a per capita monthly family income ≥US$168.54 was 1.09 (P=0.048); the PR of adults with at least an undergraduate degree was 1.14 (P=0.001), and the PR of the participants who most often used a dental service other than a public service supplementary healthcare plan or private service was 1.13 (P=0.021). The prevalence of functional dentition was 17% higher among nonsmokers (P=0.012) and 16% higher among those who used dental floss (P=0.006). Income, education, type of dental service most often used, lifestyle, risk behaviors and demographic conditions are distal, intermediate and proximal social determinants of health associated with functional dentition in adults, demonstrating the need for public policies aimed to promoting oral health including intersectoral actions.

Epidemiology and the Macrosocial Determinants of Health

In the past two decades, public health researchers have taken renewed interest in investigating the role of social factors in health. This holds substantial promise in terms of identifying manipulable social factors that are amenable to policy intervention. Most existing empirical and conceptual epidemiologic work, however, has focused on the more proximal social determinants, such as interpersonal relations. These factors, although perhaps easier to study epidemiologically, are much less relevant to policy makers than more "macrosocial" factors such as taxation policies. Limited epidemiologic attention to macrosocial determinants of health is ironic given that macrosocial factors such as the rapid industrialization and urbanization in the 19th century contributed to the organization of public health practice and, tangentially, to academic public health research. We suggest here that greater investment in the study of macrosocial determinants has the potential to make a significant and unique contribution to the greater public health agenda and should be a prominent aspect of social epidemiologic inquiry in the coming decades.