1.01.02 Structural & Social Determinants of Health
Recent Submissions
Perspectives on health equity and social determinants of health
(National Academy Of Medicine, 2017)
Social factors, signals, and biases shape the health of our nation. Racism and poverty manifest in unequal social, environmental, and economic conditions, resulting in deep-rooted health disparities that carry over from generation to generation. In Perspectives on Health Equity and Social Determinants of Health, authors call for collective action across sectors to reverse the debilitating and often lethal consequences of health inequity. This edited volume of discussion papers provides recommendations to advance the agenda to promote health eq...
Income Inequality and Outcomes in Heart Failure
(2019)
OBJECTIVES This study examined the relationship between income inequality and heart failure outcomes. BACKGROUND The income inequality hypothesis postulates that population health is influenced by income distribution within a society, with greater inequality associated with worse outcomes. METHODS This study analyzed heart failure outcomes in 2 large trials conducted in 54 countries. Countries were divided by tertiles of Gini coefficients (where 0% represented absolute income equality and 100% represented absolute income inequality), and heart fa...
Income inequality and schizophrenia: Increased schizophrenia incidence in countries with high levels of income inequality
(2014-03)
Background—Income inequality is associated with numerous negative health outcomes. There is evidence that ecological level socio-environmental factors may increase risk for schizophrenia. Aims—The aim was to investigate whether measures of income inequality are associated with incidence of schizophrenia at the country level. Method—We conducted a systematic review of incidence rates for schizophrenia, reported between 1975 and 2011. For each country, national measures of income inequality (Gini coefficient) along with covariate risk factors for...
Global warming has increased global economic inequality
(2019-05-14)
Significance We find that global warming has very likely exacerbated global economic inequality, including ∼25% increase in population-weighted between-country inequality over the past half century. This increase results from the impact of warming on annual economic growth, which over the course of decades has accumulated robust and substantial declines in economic output in hotter, poorer countries—and increases in many cooler, wealthier countries—relative to a world without anthropogenic warming. Thus, the global warming caused by...
Economists: Your Parents Are More Important Than Ever
(the Atlantic)
Global warming has increased global economic inequality
(The Journalist's Resource, Shorenstein center on media, politics and public policy, Harvard Kennedy School, 2019-05-14)
Significance We find that global warming has very likely exacerbated global economic inequality, including ∼25% increase in population-weighted between-country inequality over the past half century. This increase results from the impact of warming on annual economic growth, which over the course of decades has accumulated robust and substantial declines in economic output in hotter, poorer countries—and increases in many cooler, wealthier countries—relative to a world without anthropogenic warming. Thus, the global warming caused by...
Regional strategy on health system strengthening and primary health care
(WHO Regional Office for the Western Pacific, 2010)
Social determinants of health inequalities: towards a theoretical perspective using systems science
(2015)
A systems approach offers a novel conceptualization to natural and social systems. In recent years, this has led to perceiving population health outcomes as an emergent property of a dynamic and open, complex adaptive system. The current paper explores these themes further and applies the principles of systems approach and complexity science (i.e. systems science) to conceptualize social determinants of health inequalities. The conceptualization can be done in two steps: viewing health inequalities from a systems approach and extending it to in...
Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere?
Medical schools are increasingly called
to include social responsibility in their
mandates. As such, they are focusing
their attention on the social determinants
of health (SDOH) as key drivers in the
health of the patients and communities
they serve. However, underlying this
emphasis on SDOH is the assumption that
teaching medical students
about
SDOH
will lead future physicians to take
action
to help achieve health equity. There is
little evidence to support this belief. In
many ways, the current approach to
SDOH within medical...
Health inequalities and social group differences: what should we measure?
(Bulletin of the World Health Organization, 1999)
Both health inequalities and social group health differences are important aspects of measuring population health.
Despite widespread recognition of their magnitude in many high- and low-income countries, there is considerable
debate about the meaning and measurement of health inequalities, social group health differences and inequities. The
lack of standard definitions, measurement strategies and indicators has and will continue to limit comparisons Ð
between and within countries, and over time Ð of health inequalities, and perhaps more im...
Socioeconomic Status and Health: Mediating and Moderating Factors
(Annual Review of Clinical Psychology, 2013-03-28)
Health disparities (differences in health by socioeconomic groups) are a pressing issue in our society. This article provides an overview of a multilevel approach that seeks to understand the mechanisms underlying health disparities by considering factors at the individual, family, and neighborhood levels. In addition, we describe an approach to connecting these factors to various levels of biological processes (systemic inflammation, cellular processes, and genomic pathways) that drive disease pathophysiology. In the second half of the article,...
The wider determinants of inequalities in health: a decomposition analysis
(International Journal for Equity in Health, 2011)
Background: The common starting point of many studies scrutinizing the factors underlying health inequalities is that material, cultural-behavioural, and psycho-social factors affect the distribution of health systematically through income, education, occupation, wealth or similar indicators of socioeconomic structure. However, little is known regarding if and to what extent these factors can assert systematic influence on the distribution of health of a population independent of the effects channelled through income, education, or wealth. Meth...
RESOURCE ALLOCATION FOR HEALTH EQUITY: ISSUES AND METHODS
In this paper, we discuss methods to allocate national health care funds to purchasers or insurers of health care. For administrative reasons, resources are usually allocated as they always have been—which relates more closely to the existing structure and demand than to need. Resource allocation through capitation is needed to achieve equity in access to health care or health outcome. Capitation should be based on epidemiological or sociodemographic need factors. The author discusses how to select and weight need factors and provides examples ...
The Social Determinants of Health: Coming of Age
(Annual Review of Public Health, 2011-04-21)
In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research...
Social Determinants and Their Unequal Distribution: Clarifying Policy Understandings
(The Milbank Quarterly, 2004-03)
Public health policy in older industrialized societies is being reconfigured to improve population health and to address inequalities in the social distribution of health. The concept of social determinants is central to these policies, with tackling the social influences on health seen as a way to reduce health inequalities. But the social factors promoting and undermining the health of individuals and populations should not be confused with the social processes underlying their unequal distribution. This distinction is important because, desp...
A conceptual framework for action on the social determinants of health
(World Health Organization, 2010)
Complexity defines health. Now, more than ever, in the age of globalization, is this so. The Commission on Social Determinants of Health (CSDH) was set up by the World Health Organization (WHO) to get to the heart of this complexity. They were tasked with summarizing
the evidence on how the structure of societies, through myriad social interactions, norms and institutions, are affecting population health, and what governments and public health can do about it. To guide the Commission in its mammoth task, the WHO Secretariat conducted a review ...
The political origins of health inequity: prospects for change
(The Lancet, 2014-02-11)
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. Although the health sector has a crucial role in addressing health inequalities, its eff orts often come into confl ict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.
This is the starting point of The Lancet–University of Oslo Commission on Global Governance for Health. With globalisation, health inequi...
Social determinants of health inequalities
(The Lancet, 2005)
The gross inequalities in health that we see within and between countries present a challenge to the world. That there should be a spread of life expectancy of 48 years among countries and 20 years or more within countries is not inevitable. A burgeoning volume of research identifies social factors at the root of much of these inequalities in health. Social determinants are relevant to communicable and non-communicable disease alike. Health status, therefore, should be of concern to policy makers in every sector, not solely those involved in he...