SOC313H1 Lecture Notes - Lecture 2: Health Care, Whitehall Study, Ottawa Charter For Health Promotion
SOC 316 – Sociology of Health Care
Lecture 2 - September 20, 2017
Defining Health -
• Health is a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity (WHO 1948)
o Not a negative look at health
• Health is a resource of everyday life, not the objective of living (Ottawa Charter for Health 1986)
o Health isn't just a status, but a resource that allows you to fulfill daily activities, meet goals,
etc.
• Don 't think about how much we rely on our health until it matters and then we realize it
What Determines our Health?
• Income, education, stress level, state of mind, work environment, physical environment (pollution,
etc.) and social environment, geographical location, access to health care, social and political
conditions, gender, race, etc.
The Social Determinants of Health Model -
• The individual lifestyle factors
• Social and community networks
o people around you
o What kind of support they offer you
• General socioeconomic, cultural and environmental conditions
o macro level
• Does recognize that individual behaviours and biological factors influence health
o But emphasizes that:
• Individuals do not exist in a social vacuum
• Meso- and macro-level factors shape individual health behaviours and may interact
with biological factors
• Social conditions and contests are uniquely amenable to policy interventions
Do Some Factors have a Greater Impact on Health than Others?
• At the individual level, it is hard to trace exactly what the cause is, complex indirect effects, one
factor can effect many other factors and all become factors
• It is possible to figure out how much specific factors have an influence on health, rather than
others
o 50% is your life
• Income, disability, education, race, gender, community belonging, social safety,
employment/working conditions, safe and nutritious food, housing/homelessness
o 25% Is your healthcare
• Access to healthcare, the structure of the health care systems and the wait times
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o 15% is your biology
o 10% is your environment
Impact of Social Factors -
• Our health is primarily determined by social and contextual factors (rather than biology or
behaviour)
• Social inequities translate to health inequities
• People of higher social status usually have better health care
• The Black Report:
o If we provide everyone with Health care services everyone should have the same health
outcomes
o While health in the UK improved overall, the NHS had not eliminated inequalities in health
o The "health gap" between rich and poor was widening
o Stemmed from economic factors
• Whitehall Study:
o Found step wise social gradient in health
o Health improved in line with increases in seniority/occupational status
o Sociology-economic differences in health occur at all levels of society
o Was using a database based on civil service (government workers) and can see that the
levels in health are quite different in opposed to gaps and over time these gaps will increase
o Not just differences between high and low social strata but differences sister between every
level of occupational status
• HIV AIDS among women in lower social class have a much higher rate of death from this than men
or from higher social class women
• Odds of experiencing health outcomes by race in Canada, compared to white people:
o Black people much more likely to have hypertension (60% more)
o Aboriginal people much more likely to have heart disease (40%), arthritis and cancer (45%)
• Even within the same high income groups, white babies are 3 times less likely than black babies to
die within the first year of life, in low income groups, it is twice as likely
o Higher gap in the higher income group between races
• 88% of the resources we spend on health are dedicated to medical services
o Play a very small role but that is where most of the money is being spent
• Countries that do better spend more on social care than on medical care
o Sweden and France do well on this scale
What Creates Health Inequalities -
• Disparities are not just about lack of access or poor individual choices
• Result of policy designs systematically
• Health care delivery system:
o The totality of resources that a population or society distributes in organizing and delivering
that health care, includes personal and public service performed by individuals for the
purpose of maintaining or restoring the system
Levels of Intervention -
• Primordial:
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o Broader social determinants of health, broad social, economic, cultural, political
determinants that are affecting health and reduce this from ever happening
• Primary:
o When a certain group is more at risk you put forward programs and interventions to reduce
the chance of the negative impact
• Secondary:
o Reduce the prevalence or the consequences
• Tertiary:
o Reduce the complications of disabilities when problems are already present
• Death (if fatal)
• Most health investments are for primary, secondary and tertiary care
• But this may amount to a "Band-Aid" solutions
o Individuals may not be able to do too much about it
o Not addressing the underlying social factor, you will never actually get rid of the problem
itself
o Mopping up the water without turning odd the tap
• More effective on primordial prevention: prevention of risk factors themselves, beginning with
change in social and environmental conditions in which these factors are occurring
Intervening to Reduce Inequalities -
• To reduce health inequalities, the WHO recommends:
o Alter social stratification
o Decreasing people's exposure to health risks
o Decrease the vulnerability, and increase the resiliency of disadvantaged groups
o Intervene through the health care delivery system to reduce the differential consequences
of health
• Not necessarily saying that one of these recommendations is more important than another, but
should be addressed in tandem
• Governance, macroeconomic policies, social policies, public policies, culture and societal values
Guiding Principles of Health Policy -
• Whitehead & Dalhgen (2006) identify ten guidelines:
o Health equality principles should strive to level up, not down
• Rather than lowering those at higher status, we should bring the lower status up
higher
o The main approaches to reducing health inequities are interdependent and should build one
another
o Population health policies should have the dual purpose of promoting health gain and
reducing health inequalities
o Actions should be concerned with tackling SDH
• Not just looking at medical service level or biological
o Just adopting a policy is not enough, track how it is implemented and must be monitored
and assessed
o Appropriate tools are needed to measure the extent of inequities and the progress towards
goals
o Concerted efforts must be made to give voice to the voiceless
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Document Summary
Income, education, stress level, state of mind, work environment, physical environment (pollution, etc. ) and social environment, geographical location, access to health care, social and political conditions, gender, race, etc. The social determinants of health model : the individual lifestyle factors. Social and community networks: people around you, what kind of support they offer you, general socioeconomic, cultural and environmental conditions, macro level, does recognize that individual behaviours and biological factors influence health, but emphasizes that: Individuals do not exist in a social vacuum: meso- and macro-level factors shape individual health behaviours and may interact with biological factors. Social conditions and contests are uniquely amenable to policy interventions. It is possible to figure out how much specific factors have an influence on health, rather than others: 50% is your life. Impact of social factors : our health is primarily determined by social and contextual factors (rather than biology or behaviour)
