Social Determinants Of Health Perspective Research Articles

Improve education for health professionals to enhance the ability to communicate and work effectively with people living with disability

The 1978 World Health Organisation Alma Ata Declaration on Primary Health Care (PHC) emphasised a comprehensive view which stressed the importance of cure, prevention, promotion and rehabilitation delivered in a way that involved local communities and considered a social, economic and political perspective on health. Despite this, selective approaches have dominated. This paper asks why this has been the case in Australia through a multi-method study of regional PHC organisations. Interviews with senior policy players, focus groups with non-government organisations and document analysis inform an institutional and power analysis of PHC. The findings indicate that there are different interests competing for attention in PHC but that medical perspectives prove the most powerful and are reinforced by the actors, ideas and institutions that shape PHC. Community perspectives which stress lived experience and social perspectives on health are marginal concerns in the implementation of PHC. The other important interest is that of a neo-liberal perspective on health policy which stresses cost-containment, close measurement of activity and fragmented contracting out of services. This perspective is not compatible with a social determinants of health perspective and can also conflict with a medical view. The result of the interplay between competing interests and the distribution of power is a selective PHC system that is not likely to change without radical shifts in power and perspectives.

Technological innovations and the rise of social inequalities in health.

Social inequalities in health have been categorised as a human-rights issue that requires action. Unfortunately, these inequalities are on the rise in many countries, including welfare states. Various theories have been offered to explain the persistence (and rise) of these inequalities over time, including the social determinants of health and fundamental cause theory. Interestingly, the rise of modern social inequalities in health has come at a time of great technological innovation. This article addresses whether these technological innovations are significantly influencing the persistence of modern social inequalities in health. A theoretical argument is offered for this potential connection and is discussed alongside the typical social determinants of health perspective and the increasingly popular fundamental cause perspective. This is followed by a proposed research agenda for further investigation of the potential role that technological innovations may play in influencing social inequalities in health.

Critical assessment of health disparities across subpopulation groups through a social determinants of health perspective: The case of type 2 diabetes patients

ABSTRACTBackground: Studies on diabetes have shown that population subgroups have varying rates of medical events and related procedures; however, existing studies have investigated either medical events or procedures, and hence, it is unknown whether disparities exist between medical events and procedures. Purpose: The objective of this study is to investigate how diabetes-related medical events and procedures are different across population subgroups through a social determinants of health (SDH) perspective. Methods: Because the purpose of this manuscript is to explore whether statistically significant health disparities exist across population subgroups regarding diabetes patients’ medical events and procedures, group difference test methods were employed. Diabetes patients’ data were drawn from the Cerner Health Facts® data warehouse. Results: The study revealed systematic disparities across population subgroups regarding medical events and procedures. The most significant disparities were connected with smoking status, alcohol use, type of insurance, age, marital status, and gender. Conclusions: Some population subgroups have higher rates of medical events and yet receive lower rates of treatments, and such disparities are systematic. Socially constructed behaviors and structurally discriminating public policies in part contribute to such systematic health disparities across population subgroups.

State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States

There has been a great deal of state-level legislative activity focused on immigration and immigrants over the past decade in the United States. Some policies aim to improve access to education, transportation, benefits, and additional services while others constrain such access. From a social determinants of health perspective, social and economic policies are intrinsically health policies, but research on the relationship between state-level immigration-related policies and Latino health remains scarce. This paper summarizes the existing evidence about the range of state-level immigration policies that affect Latino health, indicates conceptually plausible but under-explored relationships between policy domains and Latino health, traces the mechanisms through which immigration policies might shape Latino health, and points to key areas for future research. We examined peer-reviewed publications from 1986 to 2016 and assessed 838 based on inclusion criteria; 40 were included for final review. These 40 articles identified four pathways through which state-level immigration policies may influence Latino health: through stress related to structural racism; by affecting access to beneficial social institutions, particularly education; by affecting access to healthcare and related services; and through constraining access to material conditions such as food, wages, working conditions, and housing. Our review demonstrates that the field of immigration policy and health is currently dominated by a “one-policy, one-level, one-outcome” approach. We argue that pursuing multi-sectoral, multi-level, and multi-outcome research will strengthen and advance the existing evidence base on immigration policy and Latino health.

Social Determinants and Teen Pregnancy Prevention: Exploring the Role of Nontraditional Partnerships.

Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners' efforts to establish and nurture nontraditional partnerships to address specific SDOH.

Exploring the Intersection of Education and Indigenous Status from a Social Determinants of Health Perspective: Parent and Family Engagement in Secondary School in Nunavik

In Canada, Indigenous Peoples’ health and wellbeing is linked with the legacies of colonization. A social determinants of health model shifts focus from individual-level health contexts to broader socioeconomic, cultural, and environmental conditions associated with population health outcomes. Education is a key social determinant of health, closely tied to both positive health outcomes and socioeconomic status. In communities across Canada, educational success remains out of reach for disproportionately large numbers of Indigenous youth and adults. This qualitative study examined the intersection of two social determinants of health—Indigenous status and education—by exploring educational engagement in secondary school for Inuit parents and families, secondary school students, educators, and other Inuit community members in an Inuit community in Nunavik, northern Quebec.

Social determinants of disability-based disadvantage in Solomon islands.

Development discourse widely recognises that disability is the result of economic and social processes and structures that fail to accommodate persons with disabilities. Empirical work on the relationship between disability and poverty however, conceptualize poverty through an economic resource lens in high-income countries. To address this conceptual gap this article uses a social determinants of health perspective to examine how socio-cultural, economic and political contexts shape disability-based disadvantage. This article draws upon ethnographic research and supplementary data collected using rapid assessment techniques in Solomon Islands. Findings suggest that the disability-poverty nexus and inequalities in health, wellbeing and quality of life must be understood within broader patterns of social vulnerability that are institutionalised in landownership and patterns of descent, gendered power relations and disability specific stigmas that preclude social and productive engagement . This article demonstrates how a social determinant of health perspective that closely examines lived experiences of disability provides critical analytical insights into the structural mechanisms that constitute disability-based disadvantage. This article provides foundation knowledge on which policies and further research to promote disability-inclusion and equity can be based.

Social exclusion, health and hidden homelessness

ObjectivesHomelessness and poverty are extreme forms of social exclusion which extend beyond the lack of physical or material needs. The purpose of this study was to explore and expand the concept of social exclusion within the social determinants of health perspective – to understand how the social environment, health behaviours and health status are associated with material and social deprivation. Study designFundamental qualitative description with tones of focused ethnography. MethodsParticipants who identified as hidden homeless described their everyday living conditions and how these everyday conditions were impacted and influenced by their social environments, coping/health behaviours and current health status. Research Ethics Board approval was granted and informed consents were obtained from 21 participants prior to the completion of individual interviews. ResultsQualitative content analysis examined the descriptions of men and women experiencing hidden homelessness. Participants described the ‘lack of quality social interactions and supports’ and their ‘daily struggles of street life’. They also shared the ‘pain of addiction’ and how coping strategies influenced health. Participants were hopeful that their insights would ‘better the health of homeless people’ by helping shape public policy and funding of community resources that would reduce barriers and improve overall health. ConclusionsHealth professionals who understand health behaviours as coping mechanisms for poor quality social environments can provide more comprehensive and holistic care. The findings of this study can be used to support the importance of housing as a key factor in the health and well-being of people experiencing poverty, homelessness and social exclusion; and consequently, reinforces the need for a national housing strategy.

Occupational Stigma and Mental Health: Discrimination and Depression among Front-Line Service Workers

A large body of research shows a link between stigma and poor health; yet stigma is complex and involves several processes. This paper employs a social determinants of health perspective to shed light on the link between work and one dimension of stigma—discrimination. It examines discrimination and depression with data from a comparative study of three front-line service jobs: sex work, serving food and alcohol, and barbering and hairstyling. Our findings show positive associations between depression and the most highly stigmatized occupation—sex work—and between discrimination and depression. Discrimination mediates part of the association between sex work and depression, and self-worth partially mediates the association between discrimination and depression. Equity policies that improve their social determinants will contribute to better mental health for sex industry workers. Additional strategies aimed at reducing the formidable discrimination linked to their work are also urgently needed.

They [do more than] Interrupt Us from Sadness: Exploring the impact of participatory music making on social determinants of health and wellbeing for refugees in Australia

This paper reports on the outcomes of an exploratory narrative study on the impact of participatory music making on social determinants of health (SDOH) and wellbeing for refugees in Brisbane, Australia. A key component of this exploratory research was to map health and wellbeing outcomes of music participation using an existing SDOH framework developed by researchers in the field of health promotion (Schulz & Northridge, 2004). This paper maps reported health and wellbeing outcomes for five refugee and asylum seeker members of a participatory Brisbane-based music initiative, the Scattered People, along an SDOH continuum ranging from individual level through to macro level fundamental determinants of health.While most themes emerging from this study corresponded to distinct categories in the Schulz and Northridge SDOH framework, three key aspects, which were critical to the achievement of wellbeing for participants, did not fit any of the pre-defined categories. These were: cultural expression, music making, and consolidation of personal and social identity. The importance of those themes to participants suggests that music and wellbeing studies involving culturally diverse groups and from a SDOH perspective may need to consider broader, more relevant concepts. The paper provides recommendations for future interdisciplinary research in this field.

Determinantes estructurales de países con decrecimiento en la prevalencia por la infección VIH/SIDA en el periodo 2001-2011

The present study aims analyze and compare structural features in order to establish a model about the decline in HIV/AIDS infection (greater than or equal to 25 %) in twenty-two countries between 2001 and 2011. Retrospective cohort focused on social determinants of health perspective. The methodology was mainly documentary (epidemic behavior) and quantitative (simple linear regression model for economic and health variables). The major indicators that influence the decrease in the prevalence of HIV are: GDP per capita, health expenditure per capita and the Gini index Structural determinants, as well as inequities, may or not influence the decrease in prevalence of HIV. This hypothesis could be applied to other public health issues.

Toward an Evaluation Framework for Community-Based FASD Prevention Programs

Abstract: This article discusses creation of common evaluation frameworks for FASD-related programs. The project was guided by a social determinants of health perspective and included a literature search and consultations across Canada to help refine and confirm the final product. The end result was development of three visual maps: FASD prevention programs, FASD support programs, and FASD programs in Aboriginal communities. Each map comprises concentric rings showing theoretical foundations; activities and approaches; and formative (program), participant, and community/systemic outcomes. The project website provides tools and indicators. The visual maps have wide-ranging applications that go beyond evaluation of FASD programs.

Evidence-based decision-making 8: Health policy, a primer for researchers.

There is a growing expectation that research will be used to inform decision-making. It is important for researchers to understand how health policy is developed and the different ways they can influence the development of policy. Public policy is developed to resolve identified problems. Health policy is a subset of public policy and is typically concerned with issues related to the health of populations either from a service delivery perspective or from a broader public health and social determinants of health perspective. The policy planning algorithm is well established and follows the basic decision-making framework: assessment, planning, implementation, and evaluation. A variety of government and nongovernment stakeholders engage in complex debates to identify and resolve policy issues. In this chapter we explore how researchers can use their research to influence the development of health policy. Knowledge translation strategies focused on communicating research to policy-makers require considerable thought and planning.

‘Getting to Zero’: The policy role of social determinants of health as they relate to children and youth living with HIV in sub-Saharan Africa

Major changes in UNAIDS international policy and treatment guidelines from 2010 to 11 still need to be correspondingly translated into policy and practice at national and local in-country levels. This special issue has drawn on social determinants of health (SDH) perspective to investigate how better to provide HIV and health services to affected children and youth. The articles featured here give examples of how a SDH perspective not only supports flexible and coordinated in-country service provision, but also fits well with UNAIDS' broader policy goals for the eradication of HIV and AIDS through the “Getting to Zero” policy campaign. We call for the widespread adoption of a SDH-based framework for policy, programming, and funding at all levels, to advance the UNAIDS policy goals of increased HIV service usage and decreased HIV rates in children and youth, as well as in all populations globally.

Building a framework for evaluation of Fetal Alcohol Spectrum Disorder prevention and support programs: A collaborative Canadian project

Rutman, D., Poole, N., Hume, S., Hubberstey, C., & Van Bibber, M. (2014). Building a framework for evaluation of Fetal Alcohol Spectrum Disorder prevention and support programs: A collaborative Canadian project. The International Journal Of Alcohol And Drug Research, 3(1), 81-89. doi:10.7895/ijadr.v3i1.122Aims: This article discusses a Canadian project that is designed to identify promising evaluation methods and create common evaluation frameworks for FASD prevention programs serving pregnant women and mothers, and FASD supportive intervention programs serving youth and adults living with FASD. A social determinants of health perspective guided the project.Design: The project has employed a mixed-methods approach including a literature search, documentary review, and an iterative set of consultations with program providers, program managers, government managers and funders, researchers, and evaluators in the context of their work across Canada and internationally.Results: The project’s processes led to the development of three visual “maps” comprised of concentric rings that depict theoretical foundations; activities and approaches; formative outcomes; and participant, community and systemic outcomes. The three visual frameworks depict evaluation of 1) FASD prevention programs; 2) FASD support programs; and 3) FASD programs in Aboriginal communities.Conclusions: The development of visual maps to depict common evaluation frameworks promotes individual and collective action towards applying the frameworks on the part of community-based services and governments across Canada, on the service and systemic levels. Program providers, researchers, and system planners have indicated that the maps have wide-ranging applications.

Applying Public Health Frameworks to Advance the Promotion of Mental Health Among Asian American Children.

Asian American (ASA) children experience high rates of mental health problems. Although there is a pressing need to utilize population approaches, emerging frameworks from the fields of public and population health have not been applied to ASA children. This paper addresses this gap by first discussing applications of the National Prevention Strategy (NPS), a population strategy developed from the Social Determinants of Health perspective, to guide ASA prevention work. Next, we provide a practical example to illustrate how the NPS can be applied to prevention program design (using ParentCorps as an example) and dissemination and implementation processes to broadly address ASA children's mental health needs. Finally, we present preliminary data on the feasibility of applying this population strategy to ASA families and a framework for researchers who are considering disseminating and implementing evidence-based programs to ASA or ethnic minority pediatric populations.

Post-secondary students’ views on health: Support for individual and social health determinants

This paper examines how post-secondary students understand health, and whether opinions about health are correlated with area of study. We present results from an online survey administered in 2011 to 287 students at one post-secondary institution in Western Canada. Overall, the survey students are more likely to adopt an individualistic, rather than a social, view of health determinants. Several demographic variables, including sex and political affiliation are associated with adopting a more individualistic view of health. However, students in the Health Sciences are significantly more likely to support the social determinants of health perspective. These results suggest that medical and health science educators at this post-secondary institution may be heeding the century-old call to address social structural causes of health inequalities in their curricula.

Health Inequalities at the Heart of the Social Work Curriculum

Efforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives.

Social Determinants of Breast Cancer Screening in Urban Primary Care Practices: A Community-Engaged Formative Study

BackgroundThe recent decline in the breast cancer mortality rate can be attributed to intensive screening and early detection efforts. However, studies have documented a decline in self-reported recent mammography use and interventions to enhance mammography utilization have yielded modest improvements. To address the root causes of breast cancer disparities and improve mammography use, interventions need to address multiple layers of patient, provider, and health system factors. ObjectiveUsing community-based participatory research principles, we sought to learn from women receiving care through urban primary care practices about issues surrounding mammography screening and strategies to increase screening. MethodsWe conducted five focus groups among 41 eligible women who were predominantly African American, recruited using nonprobability purposive sampling methods from urban community health centers in Baltimore, Maryland. Data are reported from three focus groups (n = 28) that provided usable data. We used the social determinants of health perspective to conduct a qualitative content analysis and interpretation of the data. ResultsMajor obstacles to obtaining a screening mammogram were individual-level (i.e., pain from the procedure) and structural-level factors (i.e., cost, geography, convenience). Strategies to overcome obstacles could include the creation of structural mechanisms whereby women can receive a host of services during one visit to a healthcare professional’s office. Important promoters of screening behavior included social-level factors such as social support, hope, and positive treatment outcomes. ConclusionThe social determinants of health perspective provided a unique perspective to frame barriers and promoters of mammography utilization and insights to develop interventions aimed at improving cancer control among women receiving care at urban primary care health centers.

Reframing Diabetes in American Indian Communities: A Social Determinants of Health Perspective

American Indians and Alaska Natives (AI/ANs) experience some of the greatest health inequities of any group within the United States. AI/ANs are diagnosed with diabetes more than twice as often as non-Hispanic white Americans. Diabetes is a chronic preventable disease often associated with individual risk factors and behaviors that indicate what interventions are needed to prevent or manage the disease. Individual ameliorative strategies in diabetes prevention and management do not fully address the fundamental causes and complexity of diabetes in American Indian communities. Through the application of a social determinants of health paradigm, social work has the opportunity to reframe diabetes and begin to understand it as a product of and a response to unjust conditions and environments, rather than as a disease rooted solely in individual pathology and responsibility.