Social Determinants Of Health Literature Research Articles

Examining Justice System Exposure Among Youth on Health in Young Adulthood: Does Dosage of Contact Matter?

Drawing on juvenile justice and social determinants of health literature, this study examines the influence of three levels of justice system contact among juveniles – police stop, arrest, adjudication – on depression, suicide ideation, and general health in young adulthood. Mahalanobis distance matching utilizing National Longitudinal Study of Adolescent Health data test whether dosage of system contact negatively impacts health in young adulthood. Additional analyses compare within system contact differences to identify magnitude of health consequences for systems-involved individuals. Arrest and adjudication experiences as a juvenile negatively impacted at least one health outcome in young adulthood relative to those with no contact. Depression was significantly higher among those with an adjudication experience relative to those with an arrest experience. Results support further exploring juvenile justice system experiences as a social determinant of health.

Non-response Bias in Social Risk Factor Screening Among Adult Emergency Department Patients.

Healthcare organizations increasingly use screening questionnaires to assess patients' social factors, but non-response may contribute to selection bias. This study assessed differences between respondents and those refusing participation in a social factor screening. We used a cross-sectional approach with logistic regression models to measure the association between subject characteristics and social factor screening questionnaire participation. The study subjects were patients from a mid-western state safety-net hospital's emergency department. Subjects' inclusion criteria were: (1) ≥ 18 years old, (2) spoke English or Spanish, and (3) able to complete a self-administered questionnaire. We classified subjects that consented and answered the screening questionnaire in full as respondents. All others were non-respondents. Using natural language processing, we linked all subjects' participation status to demographic characteristics, clinical data, an area-level deprivation measure, and social risk factors extracted from clinical notes. We found that nearly 6 out of every 10 subjects approached (59.9%), consented, and completed the questionnaire. Subjects with prior documentation of financial insecurity were 22% less likely to respond to the screening questionnaire (marginal effect = -22.40; 95% confidence interval (CI) = -41.16, -3.63; p = 0.019). No other factors were significantly associated with response. This study uniquely contributes to the growing social determinants of health literature by confirming that selection bias may exist within social factor screening practices and research studies.

Decomposed Trends of Iranian Private Health Expenditures: Should Inequality be Appreciated?

Background: Inequalities in health and health care have drawn considerable attention in social determinants of health literature. This study aims to calculate the inequality of out-of-pocket health payments (OPHP) for Iranian households during the period 1984 to 2019 and provide decomposed inequality for households with different socioeconomic status. Methods: This longitudinal study utilized the Iranian Statistics Centre data on Iranian household income and expenditures survey. The analysis includes a total of 995,300 households during a 36-year period from 1984 to 2019. The Theil index and the mean logarithmic deviation were used to decompose inequality into within-group and between-group for OPHP among Iranian households. Results: The findings indicate that the mean of the Theil index for the households covered by insurance is 1.44 (SD ± 0.34), while the index was 1.35 (SD ± 0.31) for households without insurance coverage. The mean of the Theil index for rural and urban households was 1.29 (SD ± 0.29) and 1.43 (SD ± 0.33), respectively. Regardless of the fluctuations, the trends of between- group and within group inequalities in OPHP were almost similar until 2011, but they followed a different path since then. Conclusion: Households living in cities, households with insurance coverage, and households in high income levels have experienced more inequality in OPHP than other households. This study provides a novel interpretation of inequality in health care expenditures and provides a long-term time series data to assess the effectiveness of implemented policies in health care system.

Health and the social investment state

ABSTRACT This paper calls on social policy scholars to approach health differently in their research. Our goal is to bring core insights from social epidemiology into conversation with welfare state and social policy research. We argue that the social investment framework has the most potential for this integration. The objective of social investment policies is to keep modern welfare states sustainable through high employment and strong human capital. This requires not only a large and well-educated workforce, but also a healthy one. Specifically, we encourage social policy scholars to engage with the social determinants of health literature by studying health not as outcome of the healthcare sector but of the welfare state as a whole. We argue that the social investment framework facilitates these endeavours and we offer suggestions for future research. Health should not just be seen as an outcome of specific policies, but rather as input for a sustainable welfare state.

Impact of being an adolescent mother on subsequent maternal health, parenting, and child development in Kenyan low-income and high adversity informal settlement context.

Women who have experienced adolescent pregnancy and early motherhood are disproportionately affected in terms of their health and parenting capabilities, as well as their offspring's health. Guided by Stress Process and Social Determinants of Health (SDH) Frameworks, which posit that multiple sources of stressors and structural determinants of adolescent pregnancy influence adolescent mothers' subsequent health and quality of parenting (Xavier et al 2018, McLoyd 1998, Conger et al 2010, Gipson et al 2008). These dynamics then further impact offspring's outcomes. Using an Integrated Stress-SDH Process for Health Disparities model and we test on whether early motherhood is associated with and subsequent maternal and child health from two informal settlements in Nairobi. A cross-sectional design with 394 mothers of 2-16 years old children who sought maternal and child health services at Kariobangi and Kangemi public health centers between October 2015 to April 2016 were recruited. Participating mothers were asked questions related to their adolescent pregnancy history, their current health, wellbeing, and parenting practices, and their child's health. Structural equation modeling (SEM) was utilized to examine hypothesized mediational pathways that adolescent pregnancy history has negative influences on women's health and parenting during adulthood, which also influence their child's health and development. Our study supports that women with a history of adolescent motherhood have poor physical and mental health outcomes as adults after adjusting for demographic confounders. SEM results partially support the Stress-SDH Process model that history of adolescent pregnancy had negative consequences on women's adulthood health, which also negatively impacted offspring's physical and mental health. Consistent with the Stress Process and SDH literature, we found consistent cross-cultural literature that adolescent pregnancy set the stage for, subsequent poor maternal health and child outcomes. Although history of adolescent pregnancy and motherhood was not necessarily associated with negative parenting, consistent with parenting literature, negative parenting was associated with poor child mental health. Findings suggest importance of providing integrated care that address health and parenting needs to optimize offspring's development in instances of early motherhood.

How are social determinants of health integrated into epigenetic research? A systematic review.

We systematically review the literature on social epigenetics, examining how empirical research to date has conceptualized and operationalized social determinants of health (SDOH). Using comprehensive search procedures, we identified studies that consider the impact of SDOH on DNA methylation (DNAm), the most common measure of epigenetic change in research on human adult populations. We analyzed the studies to determine: 1) which populations and environments have been investigated in the literature; 2) how SDOH are defined and operationalized; 3) which SDOH have been linked to DNAm; and 4) what lessons from the SDOH literature can be better integrated into future studies exploring the social determinants of health and epigenetic outcomes. We identified 67 studies, with 39 to 8397 participants. The SDOH most commonly considered were early life socioeconomic exposures and early life trauma or mental health. Our review highlights four broad challenges: a) high dependence on convenience sampling, b) limited racial/ethnic, and geographic diversity in sampling frames, c) overreliance on individual sociodemographic characteristics as proxies for broader stratification processes, and d) a focus on downstream social determinants of health and individualized experiences with social stressors. Future social epigenetics research should prioritize larger, more diverse and representative population-based samples and employ the SDOH framework to better inform the conceptualization of research questions and interpretation of findings. In particular, the simplified depiction of race/ethnicity, gender, and socioeconomic status as individual-level characteristics should be updated with an explicit acknowledgement that these characteristics are more accurately interpreted as cues used by society to differentiate subpopulations. Social epigenetics research can then more clearly elucidate the biological consequences of these social exposures for patterns of gene expression, subsequent disease etiology, and health inequities.

How Self-Rated is Self-Rated Health? Exploring the Role of Individual and Institutional Factors in Reporting Heterogeneity in Russia

In recent years the literature exploring the state dependent nature of individual self-rated health has grown rapidly. We contribute to this ‘reporting heterogeneity’ research field in two main ways. First, we are among the few studies to examine the determinants of reporting heterogeneity in self-rated health in the Russian context. Second, echoing the social determinants of health literature, we augment the standard battery of individual level socioeconomic and demographic characteristics with aggregated macro level variables serving as proxies for local environmental and social conditions. We are not aware of other heterogeneity studies that have incorporated this approach. Estimating a generalized ordered probit model we resolve the identification problem through the inclusion of an objective disease index. In terms of reporting heterogeneity, we find that response behaviour is systematically influenced by individual characteristics but also by aggregate regional socioeconomic characteristics. In particular, the finding that an individual’s relative standing in their local economy can condition their response to subjective health questionnaires is important and merits further examination. We argue that both a relative income mechanism and a mechanism that links the cognitive process of choice with the sense of optimism that individuals have for their institutional environment are plausible explanations for the observed aggregate level effects.

From Roots to Results: A Qualitative Case Study of the Evolution of a Public Health Leadership Institute Building Capacity in Collaborating for Equity and Justice.

Policy, systems, and environmental change are now widely accepted as critical to sustaining improvements in community health. Evidence suggests that such systems-level change is most effective when driven by community-based partnerships. Yet, after more than three decades of building community-based partnership work, health inequities have continued to deepen. To address health inequities, current and historical distributions of power are increasingly recognized as important considerations in efforts to ensure all individuals have the opportunity to attain their full health potential (i.e., achieving health equity). Building on social determinants of health literature, social injustice and powerlessness are put forth as fundamental causes of health inequities. Focusing on power as a root cause of health and health equity through application of Wolff and colleagues' six principles requires substantial changes in contemporary public health practice. This case study uses document analysis of a single case, the Community Teams Program, to assess the evolution of a statewide public health leadership program's efforts to build the capacity of coalition-based teams to catalyze community change in line with Wolff and colleagues' principles. Deductive, selective coding of the materials surface four themes in the program adaptations: (1) the need to focus on power as a root cause, (2) shifting power through relationship building, (3) storytelling as a way to shift narrative, and (4) building mechanisms into the curriculum that hold coalitions accountable for applying and sustaining learned skills. The themes demonstrate philosophical, pedagogical, and organizational changes to center power building approaches in health promotion. Findings are triangulated by reflections from the program director and recorded reflections of participants captured in existing evaluation data.

Predicting women's height from their socioeconomic status: A machine learning approach

The social determinants of health literature routinely deploy socio-economic status (SES) as a key factor in accounting for women's height—an established indicator of human welfare at the population level—using traditional regression. However, this literature lacks a systematic identification of the predictive power of SES as well as the possible non-linear relationships between the measures of SES (education, occupation, and material wealth) in predicting variation in women's height. This study aims to evaluate this predictive power. We used the Demographic and Health Surveys (DHS) from 66 low- and middle-income countries (women = 1,273,644), sampled between 1994 and 2016. The analysis consisted of training seven machine-learning algorithms of different function classes and assessing their predictive power out-of-sample, vis-à-vis OLS regression. In an OLS framework, SES accounts for 0.7%, R2, of the total variance in women's height (from σOLSFix2 = 31.82 to σOLSSES2 = 31.57), adjusting for country, community, and sampling year fixed effects. The country-specific variances range from as low as 25.10 units in Egypt to as high as 74.46 units in Sao Tome and Principe. With the same set of SES measures, the best performing learner, a Bayesian neural net, produces a predictive variance of σBnnSES2 = 31.52. This is a negligible improvement in variance explained by 0.3% (σBnnSES2−σOLSSES2). Given our selection of algorithms, our findings indicate no relevant non-linear relationships between SES and women's height, and also the predictive limits of SES. We recommend that scholars report both the average effect of SES on health outcomes as well as its contribution to the variance explained. This will improve our understanding of how key social and economic factors affect health, deepening our understanding of the social determinants of health.

Narrative review of affinities and differences between the social determinants of oral and general health in Canada: establishing a common agenda.

This article overviews Canadian work on the social determinants of oral and general health noting their affinities and differences. A literature search identified Canadian journal articles addressing the social determinants of oral health and/or oral health inequalities. Analysis identified affinities and differences with six themes in the general social determinants of health literature. While most Canadian social determinants activity focuses on physical and mental health there is a growing literature on oral health-literature reviews, empirical studies and policy analyses-with many affinities to the broader literature. In addition, since Canada provides physical and mental health services on a universal basis, but does not do so for dental care, there is a special concern with the reasons behind, and the health effects-oral, physical and mental-of the absence of publicly financed dental care. The affinities between the social determinants of oral health and the broader social determinants of health literature suggests the value of establishing a common research and action agenda. This would involve collaborative research into common social determinants of oral and general health and combined policy advocacy efforts to improve Canadians' living and working conditions as means of achieving health for all.

Social practice theory and the study of how we drink.

Social practice theory and the study of how we drink.

An Integrated Model of Chronic Whiplash-Associated Disorder.

Synopsis The development of persistent symptoms following whiplash injury from a motor vehicle collision is common and contributes substantially to societal and personal costs. The popular Quebec Task Force classification system of whiplash-associated disorders (WADs) was meant to function as a prognostic and intervention decision aid, but its usefulness has been questioned. Emerging evidence highlights the heterogeneity of WAD by demonstrating physical and psychological impairments that are unique to those who develop persistent symptoms. These impairments are not recognized in the Quebec Task Force classification system. The purpose of this clinical commentary is to describe an integrated model that focuses on how psychological and neurobiological factors interact with, and are influenced by, existing personal and environmental factors to contribute to the development of chronic WAD. The model has been developed through more than 20 years of work in the field, consultation with experts, in-depth synthesis of existing evidence, and new evidence from the authors' own research programs. A subtheme is that a point of convergence currently exists between the psychological, physiological, and social determinants of health literature that can further explain the complex presentation of WAD. The new model is proposed to orient future research toward more interdisciplinary efforts across nontraditional fields, including data scientists and consumers, to clarify the WAD condition. J Orthop Sports Phys Ther 2017;47(7):462-471. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7455.

The cultural erosion of indigenous people in health care.

Idealized versions of health care are common, and access to health care is often viewed as an unambiguous good. In the social determinants of health literature, for example, access to health care is treated as an intermediate determinant of health. This conceals a simplistic inference: the better

Canada's residential school system: measuring the intergenerational impact of familial attendance on health and mental health outcomes

BackgroundWe estimate the intergenerational relationship between the residential school (RS) attendance of an older generation family member and the physical and mental health of a younger generation.MethodsData from the 2012...

The social determinants of health, care ethics and just health care

Political theorists generally defend the moral importance of health care by appealing to its purported importance in promoting good health and saving lives. Recent research on the social determinants of health demonstrates, however, that health care actually does relatively little to promote good health or save lives in comparison with other social and environmental factors. This article assesses the implications of the social determinants of health literature for existing theories of health care justice, and outlines a new approach that can justify publicly subsidized comprehensive health care despite its limited contribution to good health. Even if health care plays a relatively limited role in promoting good health, it remains morally important because of the care it provides to individuals. As such, it can be justified in terms of care ethics. When health care is justified primarily in terms of care rather than health, however, the goals of a just health-care system shift. The measure of a just health-care system is no longer strictly its ability to generate good health outcomes but also its ability to provide individuals with accessible, good quality daily care. This different focus has important consequences for the way we think about the institutions of a just health-care system as well as for the delivery and allocation of medical goods and services.

The Social Determinants of HIV Serostatus in Sub-Saharan Africa: An Inverse Relationship between Poverty and HIV?

Contrary to theories that poverty acts as an underlying driver of human immunodeficiency virus (HIV) infection in sub-Saharan Africa (SSA), an increasing body of evidence at the national and individual levels indicates that wealthier countries, and wealthier individuals within countries, are at heightened risk for HIV. This article reviews the literature on what has increasingly become known as the positive-wealth gradient in HIV infection in SSA, or the counterintuitive finding that the poor do not have higher rates of HIV. This article also discusses the programmatic and theoretical implications of the positive HIV-wealth gradient for traditional behavioral interventions and the social determinants of health literature, and concludes by proposing that economic and social policies be leveraged as structural interventions to prevent HIV in SSA.

Sleep as a Mechanism through which Social Relationships Affect Health

Sleep as a Mechanism through which Social Relationships Affect Health

Social Capital: Does it Add to the Health Inequalities Debate?

This paper empirically examines the relationship between advantage, social capital and health status to assess (a) whether social capital adds explanatory power to what we already know about the relationship between advantage and health and (b) whether social capital adds anything beyond its component parts, namely social participation and trust. It uses 2 measures of advantage (income and education), 5 measures of participation (informal network size, number of community activities, formal group membership, informal group membership, and service use), 3 measures of trust (trust, sense of belonging, and willingness to participate) and 3 indicators of health (perceived health, mental health, and physical function). Cross sectional data are analyzed from a sample of 918 middle-aged individuals, using multi-variate analyses. Results show that there were no direct associations between informal or formal group membership, community activities attended, or trust with any of the 3 health variables examined. A test of interaction terms combining trust and participation variables into several combined social capital variables also failed to show any relationship with any of the 3 health measures. That is, no support was found for a direct relationship between the separate components or combined measures of social capital and health. Income, however, was directly important for both perceived health and physical function although not for mental health. However, data reveal indirect affects for trust and not participation or interaction terms, through self-efficacy for all 3 domains of health and through perceived expressive support for mental health. As such, the data suggest the concept of social capital adds nothing to its component parts when examining individual level of health and furthermore that trust, but not participation, has a significant, indirect relationship to some domains of health. Such findings confirm the importance of income, a measure of socio-economic status, as well documented within the social determinants of health literature. It questions the use of the concept of social capital and points to the need for greater research examining indirect pathways to health and a greater focus on the role played by trust.