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Social and Economic
Determinants of Health 1
March 2016
Timothy Moore
Acknowledgements
David Dunt
Shaun Ewen
Danny Liew
Rob Moodie
Alison Morgan
Jeremy Moss
Krishna Hort
THE NOSSAL INSTITUTE
FOR GLOBAL HEALTH
The Nossal Institute for Global Health is committed to improving global health through research, education, inclusive development practice, and training of future leaders The Nossal Institute works in partnership with other organisations who share its vision of improving health where health is at its poorest
Source: Nossal Institute for Global Health
Global Health Lectures
SOCIAL & ECONOMIC DETERMINANTS OF HEALTH /
GLOBAL BURDEN OF DISEASE
By the end of this series of presentations students will be able to:
• demonstrate a deep and broad understanding of the nature, causes and relationships of diverse socio-economic determinants of health, and their applicability to the health and wellbeing of populations and individuals locally and globally.
• articulate the global distributions, burdens and implications thereof in relation to communicable and non-communicable disease.
• critically analyse complex issues and chains of causation impacting the health of individuals and communities.
• report on effective multisectoral approaches to global health.
This session
• Definitions
• Overview of social and economic determinants
• Income and inequity
What is Health?
Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or
infirmity Constitution of the World Health Organization, 1948
What is Global Health?
‘…an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.
Global health emphasises transnational health issues, determinants and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration, and is a synthesis of population-level clinical care’
What is Global Health?
‘…an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.
Global health emphasises transnational health issues, determinants and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration, and is a synthesis of population-level clinical care.’
Social Determinants of Health
• Michael Marmot
– Social Determinants of Health: the Solid Facts (W.H.O)
• Richard Wilkinson
• Kate Pickett
– The Spirit Level
1. The social gradient
Life expectancy is shorter and disease is more common down the social ladder in each society
Social Determinants of Health
2. Stress
Stressful circumstances, making people feel worried, anxious and unable to cope, are damaging to health and may lead to premature death
3. Early start
The health impact of early development and education lasts a lifetime
Social Determinants of Health
4. Social exclusion
Poverty, relative deprivation and social exclusion have a major impact on health and premature death
5. Work
People who have more control over their work have better health
Social Determinants of Health
6. Unemployment
Job security increases health, well-being and job satisfaction. Higher rates of unemployment cause more illness and premature death
7. Social support
Friendship, good social relations and strong supportive networks improve health at home, at work and in the community
Social Determinants of Health
8. Addiction
Individuals turn to alcohol, drugs and tobacco and suffer from their use, but use is influenced by the wider social setting
9. Food
A good diet and adequate food supply are central for promoting health and well-being
Social Determinants of Health
10.Transport
Healthy transport means less driving and more walking and cycling backed by better public transport
Life Expectancy
Life expectancy races up as men close the gap Tim Colebatch
The Age, March 5, 2012
Time is on
our side…
Life Expectancy
Hans Rosling
200 Years
200 Years
INCOME
LIFE
EX
PEC
TAN
CY
poverty colonisation
conflict – world and civil war
epidemic disease
emerging economy
industrialisation
global and intra-country inequality
aid
trade
new technology
peace
• Living to 100 Life Expectancy Calculator
www.livingto100.com
Life Expectancy
Epidemiological Transition
STAGE
Epidemiological Transition
Male
25
65
Female
STAGE 1 STAGE 2 STAGE 3 STAGE 4
Population Pyramids
Source:
•Omran. The epidemiologic transition. Millbank Mem Fund Q 1971 ;49 :509-38
Olshansky & Ault. The 4th stage of the epidemiological transition. Millbank Mem Fund Q 1986 ;64 :355-91
•University of Ottawa
Income / Equity
Inequity and Health
More unequal countries have:
Inequity and Health
More unequal countries have:
Inequity and Health
More unequal countries have: • Worse child well-being
• Lower levels of trust
• Higher prevalence of mental illness
• More drug use
• Higher infant mortality rates
• Greater adult obesity
• Lower educational scores & more school drop outs
• Higher teenage birth rates
• More homicides per capita
• More conflict amongst children
• Higher rates of imprisonment
• Greater social mobility
• Poorer innovation
• Lower levels of recycling
• Rich developed countries have reached a turning point in human history
• … the quality of social relations and how we can develop harmonious and sustainable societies
‘need for a more just and caring society – both economically and socially’
‘we need not only good material conditions but, from early childhood onwards, we need to feel valued and appreciated. We need friends, we need more sociable societies, we need to feel useful, and we need to exercise a significant degree of control over meaningful work’
‘without this we become more prone to depression, drug use, anxiety, hostility and feelings of hopelessness, all which rebound on physical health’
RICHARD WILKINSON & MICHAEL MARMOT
