Narratives and images used by public communication campaigns addressing social determinants of health and health disparities.

PubMed

Clarke, Christopher E; Niederdeppe, Jeff; Lundell, Helen C

2012-12-01

Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation's Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one's home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother's education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means.

Health as freedom: addressing social determinants of global health inequities through the human right to development.

PubMed

Fox, Ashley M; Meier, Benjamin Mason

2009-02-01

In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health--most prominently, poverty reduction and the building of comprehensive primary health systems--inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity.

Addressing the social determinants of health at the local level: Opportunities and challenges.

PubMed

Fosse, E; Helgesen, M K; Hagen, S; Torp, S

2018-02-01

The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

Narratives and Images Used by Public Communication Campaigns Addressing Social Determinants of Health and Health Disparities

PubMed Central

Clarke, Christopher E.; Niederdeppe, Jeff; Lundell, Helen C.

2012-01-01

Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation’s Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one’s home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother’s education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means. PMID:23330220

Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health.

PubMed

Ward, Paul R; Meyer, Samantha B; Verity, Fiona; Gill, Tiffany K; Luong, Tini C N

2011-08-05

In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH) called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH) (e.g. social capital, empowerment, social inclusion). However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory. Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted. Statistical analysis revealed that people on lower incomes (less than $45000) experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion), higher levels of discrimination and less political action (lower social inclusion) and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion) and engaging in more political action (higher social empowerment). In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion). Applying social quality theory allows researchers and policy makers to measure and respond to the

A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health.

PubMed

Ramos, Athena K

2018-01-01

Migrant and seasonal workers have a right to the highest attainable standard of health. Unfortunately, these farmworkers face a multitude of challenges. They are employed in one of the most dangerous industries and face serious occupational health risks, while positioned at the bottom of the social hierarchy. They often lack formal education and training, English language proficiency, legal status, access to information, and equitable opportunities to health and healthcare. This article will explore the international human rights conventions that support farmworkers' right to health and healthcare in the United States. International human rights may provide a valuable legal framework that could be used to advocate on behalf of farmworkers and address the social determinants of health. Therefore, a Human Rights-Based Approach to Farmworker health will be presented along with recommendations for how to advance health and access to healthcare among this population. Fostering the health and well-being of migrant and seasonal farmworkers is critical to advancing equity, social justice, and maintaining the workforce required to meet production needs and safeguard the economic competitiveness of the industry.

Using structured and unstructured data to identify patients' need for services that address the social determinants of health.

PubMed

Vest, Joshua R; Grannis, Shaun J; Haut, Dawn P; Halverson, Paul K; Menachemi, Nir

2017-11-01

Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. A cross-sectional study described patients in need of SDH services offered by a safety-net hospital's federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data. Copyright © 2017. Published by Elsevier B.V.

Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

PubMed Central

2011-01-01

Background In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH) called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH) (e.g. social capital, empowerment, social inclusion). However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory. Methods Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted. Results Statistical analysis revealed that people on lower incomes (less than $45000) experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion), higher levels of discrimination and less political action (lower social inclusion) and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion) and engaging in more political action (higher social empowerment). In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion). Conclusions Applying social quality theory allows researchers and policy

Interprofessional Medical-Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health.

PubMed

Pettignano, Robert; Bliss, Lisa; McLaren, Susan; Caley, Sylvia

2017-09-01

Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical-legal education is essential to optimizing health care delivery. In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical-legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011-2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH's impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests. Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P < .001). Incorporating interprofessional medical-legal education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum's long-term impact will be administered prior to graduation.

Closing the Gap: A Human Rights Approach towards Social Determinants of Health.

PubMed

Toebes, Brigit; Stronks, Karien

2016-12-01

Social determinants of health are major contributors to population health as well as health inequalities. The public perception that health inequalities that arise from these social determinants are unjust seems to be widespread across societies. Nevertheless, there is also scepticism about the progress in the implementation of actual policies to reduce health inequalities. Scholars, activists and policy makers from various disciplinary backgrounds increasingly stress the value of the human rights approach to support policies addressing health inequalities, and to hold actors in policies to address social determinants accountable for these inequalities. The ‘right to health’, in conjunction with the other health-related human rights, captures most elements of social determinants of health, and makes clear appeals to the governmental authorities at all levels to take action when social injustices occur. Existing judicial and non-judicial cases show us how human rights can be instrumental in addressing inequalities in health.

Analysing implementer narratives on addressing health inequity through convergent action on the social determinants of health in India.

PubMed

Nambiar, Devaki; Muralidharan, Arundati; Garg, Samir; Daruwalla, Nayreen; Ganesan, Prathibha

2015-11-17

Understanding health inequity in India is a challenge, given the complexity that characterise the lives of its residents. Interpreting constructive action to address health inequity in the country is rare, though much exhorted by the global research community. We critically analysed operational understandings of inequity embedded in convergent actions to address health-related inequalities by stakeholders in varying contexts within the country. Two implementer groups were purposively chosen to reflect on their experiences addressing inequalities in health (and its determinants) in the public sector working in rural areas and in the private non-profit sector working in urban areas. A representing co-author from each group developed narratives around how they operationally defined, monitored, and addressed health inequality in their work. These narratives were content analysed by two other co-authors to draw out common and disparate themes characterising each action context, operational definitions, shifts and changes in strategies and definitions, and outcomes (both intended and unintended). Findings were reviewed by all authors to develop case studies. We theorised that action to address health inequality converges around a unifying theme or pivot, and developed a heuristic that describes the features of this convergence. In one case, the convergence was a single decision-making platform for deliberation around myriad village development issues, while in the other, convergence brought together communities, legal, police, and health system action around one salient health issue. One case emphasized demand generation, the other was focussed on improving quality and supply of services. In both cases, the operationalization of equity broke beyond a biomedical or clinical focus. Dearth of data meant that implementers exercised various strategies to gather it, and to develop interventions - always around a core issue or population. This exercise demonstrated the

Learning to account for the social determinants of health affecting homeless persons.

PubMed

McNeil, Ryan; Guirguis-Younger, Manal; Dilley, Laura B; Turnbull, Jeffrey; Hwang, Stephen W

2013-05-01

Intersecting social determinants of health constrain access to care and treatment adherence among homeless populations. Because clinicians seldom receive training in the social determinants of health, they may be unprepared to account for or address these factors when developing treatment strategies for homeless individuals. This study explored: (i) clinicians' preparedness to provide care responsive to the social determinants of health in homeless populations, and (ii) the steps taken by clinicians to overcome shortcomings in their clinical training in regard to the social determinants of health. Qualitative interviews were conducted with doctors (n = 6) and nurses (n = 18) in six Canadian cities. Participants had at least 2 years of experience in providing care to homeless populations. Interview transcripts were analysed using methods of constant comparison. Participants highlighted how, when first providing care to this population, they were unprepared to account for or address social determinants shaping the health of homeless persons. However, participants recognised the necessity of addressing these factors to situate care within the social and structural contexts of homelessness. Participants' accounts illustrated that experiential learning was critical to increasing capacity to provide care responsive to the social determinants of health. Experiential learning was a continuous process that involved: (i) engaging with homeless persons in multiple settings and contexts to inform treatment strategies; (ii) evaluating the efficacy of treatment strategies through continued observation and critical reflection, and (iii) adjusting clinical practice to reflect observations and new knowledge. This study underscores the need for greater emphasis on the social determinants of health in medical education in the context of homelessness. These insights may help to inform the development and design of service-learning initiatives that integrate understandings of the

The Social Determinants of Chronic Disease

PubMed Central

Cockerham, William C.; Hamby, Bryant W.; Oates, Gabriela R.

2017-01-01

This review article addresses the concept of the social determinants of health (SDH), selected theories, and its application in studies of chronic disease. Once ignored or regarded only as distant or secondary influences on health and disease, social determinants have been increasingly acknowledged as fundamental causes of health afflictions. For the purposes of this discussion, SDH refers to SDH variables directly relevant to chronic diseases and, in some circumstances, obesity, in the research agenda of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research. The health effects of SDH are initially discussed with respect to smoking and the social gradient in mortality. Next, four leading SDH theories—life course, fundamental cause, social capital, and health lifestyle theory—are reviewed with supporting studies. The article concludes with an examination of neighborhood disadvantage, social networks, and perceived discrimination in SDH research. PMID:27989293

The NCSS Presidential Addresses, 1936-1969: Perspectives on the Social Studies.

ERIC Educational Resources Information Center

Previte, Mark A., Ed.; Sheehan, James J., Ed.

This collection of the National Council for the Social Studies (NCSS) presidential addresses seeks to provide a valuable window to the history of NCSS and the field of social studies. Following the "Introduction" (James J. Sheehan), addresses appear chronologically: 1936 "Social Sanity through the Social Studies" (R. O.…

Social determinants of health in epilepsy.

PubMed

Szaflarski, Magdalena

2014-12-01

Social factors have been identified as key drivers of epilepsy care, outcomes, and disparities, but there is a limited understanding of what these factors are and how they translate into disparities. This targeted review provides an overview of the social determinants of health framework and applies this perspective to the literature about social and psychosocial factors in epilepsy; a social determinants of health--epilepsy model is proposed. The key social determinants of health in epilepsy include socioeconomic status, race/ethnicity, age, and gender. For example, low socioeconomic status and minority status have been associated with a higher risk of epilepsy, more hospitalizations and emergency room visits (versus neurology services), antiepileptic drug nonadherence, and a lower rate of epilepsy surgery. Such differences in care/treatment and outcomes translate into health disparities, many of which are considered unjust (inequitable) and modifiable through social action. Other social determinants of health include structural and sociocultural contextual conditions (e.g., health economy, policy, and social stigma/discrimination) and mediating mechanisms including material (e.g., housing), behavioral/biological (e.g., adherence), psychosocial (e.g., perceived stigma), and health system (e.g., access) factors. There are complex relationships among social determinants of health in epilepsy, which remain poorly understood and hamper efforts to address and eliminate disparities in epilepsy care and outcomes. Further empirical work grounded in sound theory and robust methodologies is needed to identify points of intervention and design effective and socially acceptable solutions to any pervasive disparities in epilepsy. Copyright © 2014 Elsevier Inc. All rights reserved.

Ideological and organizational components of differing public health strategies for addressing the social determinants of health.

PubMed

Raphael, Dennis; Brassolotto, Julia; Baldeo, Navindra

2015-12-01

Despite a history of conceptual contributions to reducing health inequalities by addressing the social determinants of health (SDH), Canadian governmental authorities have struggled to put these concepts into action. Ontario's-Canada's most populous province-public health scene shows a similar pattern. In statements and reports, governmental ministries, professional associations and local public health units (PHUs) recognize the importance of these issues, yet there has been varying implementation of these concepts into public health activity. The purpose of this study was to gain insight into the key features responsible for differences in SDH-related activities among local PHUs. We interviewed Medical Officers of Health (MOH) and key staff members from nine local PHUs in Ontario varying in SDH activity as to their understandings of the SDH, public health's role in addressing the SDH, and their units' SDH-related activities. We also reviewed their unit's documents and their organizational structures in relation to acting on the SDH. Three clusters of PHUs are identified based on their SDH-related activities: service-delivery-oriented; intersectoral and community-based; and public policy/public education-focused. The two key factors that differentiate PHUs are specific ideological commitments held by MOHs and staff and the organizational structures established to carry out SDH-related activities. The ideological commitments and the organizational structures of the most active PHUs showed congruence with frameworks adopted by national jurisdictions known for addressing health inequalities. These include a structural analysis of the SDH and a centralized organizational structure that coordinates SDH-related activities. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Addressing the Social Determinants of Mental Health: If Not Now, When? If Not Us, Who?

PubMed

Shim, Ruth S; Compton, Michael T

2018-06-01

In public health, recognition of the importance of the social determinants of health has led to significant shifts in practice and research. Psychiatry is making great progress in developing evidence-based, high-fidelity treatments that improve outcomes for patients who have access to high-quality mental health care. But for the less fortunate, acting further upstream, long before these mental health problems occur, is just as important as advancing new treatments. "Treating" the social determinants of mental health involves focusing more on policies than on medication, therapy, and neurobiological innovation. It entails creating public policies that improve these issues and changing social norms to place greater value on giving everyone an equal chance at living a fulfilling and healthy life. Local, state, and federal governments set policies, and the psychiatric field has considerable power in influencing those policies and shaping the social norms that inform them. This new column offers a forum to discuss these issues.

Political activities of social workers: addressing perceived barriers to political participation.

PubMed

Rocha, Cynthia; Poe, Bethanie; Thomas, Veliska

2010-10-01

This article reviews the literature on political participation of social workers and the variables that promote or impede political advocacy. Early research in the 1980s and 1990s most often reported education, feelings of efficacy, having a macro-type job, and being a member of a national association as factors that determine greater political participation. Since the late 1990s, organizational and legal issues have surfaced more prominently as barriers to political participation by social workers. This article addresses barriers to participation, such as not feeling competent to perform policy-related tasks and perceived legal barriers.It then analyzes the actual restrictions that nonprofit 501(c)(3) organizations and publicly employed social workers face in lobbying and partisan politics. The article summarizes the activities that are legally allowed in these areas and concludes that social workers can be more politically active than they often realize.

Addressing the Social Determinants of Health: A Call to Action for School Nurses

ERIC Educational Resources Information Center

Schroeder, Krista; Malone, Susan Kohl; McCabe, Ellen; Lipman, Terri

2018-01-01

Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical…

Understanding Medicaid Managed Care Investments in Members' Social Determinants of Health.

PubMed

Gottlieb, Laura; Ackerman, Sara; Wing, Holly; Manchanda, Rishi

2017-08-01

Despite widespread interest in addressing social determinants of health (SDH) as a means to improve health and to reduce health care spending, little information is available about how to develop, sustain, and scale nonmedical interventions in diverse payer environments, including Medicaid Managed Care. This study aimed to explore how Medicaid Managed Care Organization (MMCO) leaders interpret their roles and responsibilities around SDH, how they garner resources to develop and sustain interventions to address SDH, and how they perceive the influences of external organizations on related activities. Semistructured qualitative key informant interviews were conducted with a purposive sample of 26 Medicaid Managed Care corporate executives. Data were analyzed with an iterative coding, thematic development and interpretation process. MMCO leaders' interests and activities around interventions to address SDH are described, as well as their perceptions of existing and potential incentives and barriers to expanding these interventions. Despite significant experimentation and programmatic diversity of interventions addressing social determinants, MMCO leaders struggle with clinical integration, financing, and evaluation efforts that could promote sustainability. Though their efforts are nascent, MMCO leaders are investing in tackling social determinants to improve health and to decrease health care spending in managed care settings that serve low-income populations. Results highlight both opportunities and concerns about sustaining and scaling clinical interventions addressing SDH.

Conditions for addressing environmental determinants of health behavior in intersectoral policy networks: A fuzzy set Qualitative Comparative Analysis.

PubMed

Peters, D T J M; Verweij, S; Grêaux, K; Stronks, K; Harting, J

2017-12-01

Improving health requires changes in the social, physical, economic and political determinants of health behavior. For the realization of policies that address these environmental determinants, intersectoral policy networks are considered necessary for the pooling of resources to implement different policy instruments. However, such network diversity may increase network complexity and therefore hamper network performance. Network complexity may be reduced by network management and the provision of financial resources. This study examined whether network diversity - amidst the other conditions - is indeed needed to address environmental determinants of health behavior. We included 25 intersectoral policy networks in Dutch municipalities aimed at reducing overweight, smoking, and alcohol/drugs abuse. For our fuzzy set Qualitative Comparative Analysis we used data from three web-based surveys among (a) project leaders regarding network diversity and size (n = 38); (b) project leaders and project partners regarding management (n = 278); and (c) implementation professionals regarding types of environmental determinants addressed (n = 137). Data on budgets were retrieved from project application forms. Contrary to their intentions, most policy networks typically addressed personal determinants. If the environment was addressed too, it was mostly the social environment. To address environmental determinants of health behavior, network diversity (>50% of the actors are non-public health) was necessary in networks that were either small (<16 actors) or had small budgets (<€183,172), when both were intensively managed. Irrespective of network diversity, environmental determinants also were addressed by small networks with large budgets, and by large networks with small budgets, when both provided network management. We conclude that network diversity is important - although not necessary - for resource pooling to address environmental determinants of health behavior

Social Determinants of Racial/Ethnic Health Disparities in Children and Adolescents

ERIC Educational Resources Information Center

Price, James H.; McKinney, Molly A.; Braun, Robert E.

2011-01-01

Too many racial/ethnic minorities do not reach their full potential for a healthy and rewarding life. This paper addresses the social determinants that impact, either directly or indirectly, child and adolescent health disparities. Understanding the role social determinants play in the life course of health status can help guide educational…

2011 AERA Presidential Address: Designing Resilient Ecologies--Social Design Experiments and a New Social Imagination

ERIC Educational Resources Information Center

Gutiérrez, Kris D.

2016-01-01

This article is about designing for educational possibilities--designs that in their inception, social organization, and implementation squarely address issues of cultural diversity, social inequality, and robust learning. I discuss an approach to design-based research, social design experiments, that privileges a social scientific inquiry…

Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

PubMed

McPherson, Charmaine M; McGibbon, Elizabeth A

2010-09-01

Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

Integrating Social Determinants of Health into Dental Curricula: An Interprofessional Approach.

PubMed

Sabato, Emily; Owens, Jessica; Mauro, Ann Marie; Findley, Patricia; Lamba, Sangeeta; Fenesy, Kim

2018-03-01

Approaching patient care from a holistic perspective, incorporating not only the patient's medical and dental history but also psychosocial history, improves patient outcomes. Practitioners should be trained to provide this style of care through inclusive education, including training working on interprofessional teams. A component of this education must incorporate social determinants of health into the treatment plan. Social determinants of health include income, race/ethnicity, education level, work opportunities, living conditions, and access to health care. Education regarding social determinants of health should be woven throughout dental curricula, including hands-on application opportunities. This education must extend to patient care situations rather than be limited to didactic settings. This article explains the need to incorporate social determinants of health into dental education and illustrates how social determinants education is being addressed in two U.S. dental schools' curricula, including how to weave social determinants of health into interprofessional education. These descriptions may serve as a model for curricular innovation and faculty development across the dental education community.

Addressing social resistance in emerging security technologies

PubMed Central

Mitchener-Nissen, Timothy

2013-01-01

In their efforts to enhance the safety and security of citizens, governments and law enforcement agencies look to scientists and engineers to produce modern methods for preventing, detecting, and prosecuting criminal activities. Whole body scanners, lie detection technologies, biometrics, etc., are all being developed for incorporation into the criminal justice apparatus.1 Yet despite their purported security benefits these technologies often evoke social resistance. Concerns over privacy, ethics, and function-creep appear repeatedly in analyses of these technologies. It is argued here that scientists and engineers continue to pay insufficient attention to this resistance; acknowledging the presence of these social concerns yet failing to meaningfully address them. In so doing they place at risk the very technologies and techniques they are seeking to develop, for socially controversial security technologies face restrictions and in some cases outright banning. By identifying sources of potential social resistance early in the research and design process, scientists can both engage with the public in meaningful debate and modify their security technologies before deployment so as to minimize social resistance and enhance uptake. PMID:23970863

Migrant women's perceptions of healthcare during pregnancy and early motherhood: addressing the social determinants of health.

PubMed

Almeida, Lígia Moreira; Casanova, Catarina; Caldas, José; Ayres-de-Campos, Diogo; Dias, Sónia

2014-08-01

Recent guidelines from the World Health Organization emphasize the need to monitor the social determinants of health, with particular focus on the most vulnerable groups. With this in mind, we evaluated the access, use and perceived quality of care received by migrant women during pregnancy and early motherhood, in a large urban area in northern Portugal. We performed semi-structured interviews in 25 recent mothers, contacted through welfare institutions, who had immigrated from Eastern European countries, Brazil, or Portuguese-speaking African countries. Six native-Portuguese women of equal economic status were also interviewed for comparison. Misinformation about legal rights and inadequate clarification during medical appointments frequently interacted with social determinants, such as low social-economic status, unemployment, and poor living conditions, to result in lower perceived quality of healthcare. Special attention needs to be given to the most vulnerable populations in order to improve healthcare. Challenges reside not only in assuring access, but also in promoting equity in the quality of care.

Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus

PubMed Central

Williams, Edith M.; Ortiz, Kasim; Browne, Teri

2014-01-01

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions. PMID:26464854

Helping social workers address the educational needs of foster children.

PubMed

Zetlin, Andrea G; Weinberg, Lois A; Kimm, Christina

2005-07-01

The main aim was to evaluate the effectiveness of the Education Initiative, an intervention program in one of the largest urban counties in the US seeking to increase the responsiveness of social workers to the educational needs of foster children. A pre-post test control group design was used. Data from case files and social workers were examined at the start of the project and 18 months later to determine changes in social workers' (a) knowledge and practices regarding school programs and services and (b) maintenance of educational records for children on their caseloads. Data were analyzed from approximately 300 case files and over 200 questionnaires completed by social workers. Findings indicated that social workers who received training and had access to an education liaison (1) increased their knowledge about the school system and (2) were more likely to gather current educational data and comment on schooling needs in the case files. On questionnaires measuring knowledge and practices, supervisory social workers showed no gains while case workers increased their levels of knowledge and involvement. Evaluative data from both sources support the effectiveness of this collaborative model between the school and child welfare agency for addressing the educational needs of foster youth. Social workers in the pilot offices knew more and focused more on the school experience of youth on their caseloads than workers in the control offices. They reported more educational information in the case files and solicited current progress reports from the schools. Discrepancies between worker and school reported performance data raise questions as to whether social workers by themselves are the most effective advocates for foster children.

Measuring students' attitudes toward college education's role in addressing social issues.

PubMed

Weber, James E; Weber, Paula S; Craven, Barney L

2008-06-01

As service-learning projects have spread throughout academia, efforts to assess the service-learning experience have assumed a greater importance. The BERSI scale (Business Education's Role in addressing Social Issues) was developed as a measure of business students' attitudes toward social issues being addressed as part of a business education. As such, it was intended to be useful in assessing attitudinal outcomes of service learning. In order for the BERSI to be useful for nonbusiness students, the scale would need to be reconceptualized and revalidated. This study modified the BERSI items with a focus on college students in general rather than business students, making the resulting scale, College Education's Role in addressing Social Issues (CERSI), potentially helpful to service-learning researchers in a broader setting. The CERSI scale was then validated using standard techniques and normative data were reported.

Public social monitoring reports and their effect on a policy programme aimed at addressing the social determinants of health to improve health equity in New Zealand.

PubMed

Pega, Frank; Valentine, Nicole B; Matheson, Don; Rasanathan, Kumanan

2014-01-01

The important role that monitoring plays in advancing global health is well established. However, the role of social monitoring as a tool for addressing social determinants of health (SDH) and health equity-focused policies remains under-researched. This paper assesses the extent and ways in which New Zealand's (NZ) Social Reports (SRs) supported a SDH- and health equity-oriented policy programme nationally over the 2000-2008 period by documenting the SRs' history and assessing its impact on policies across sectors in government and civil society. We conducted key-informant interviews with five senior policy-makers and an e-mail survey with 24 government and civil society representatives on SRs' history and policy impact. We identified common themes across these data and classified them accordingly to assess the intensity of the reports' use and their impact on SDH- and health equity-focused policies. Bibliometric analyses of government publications and media items were undertaken to empirically assess SRs' impact on government and civil society. SRs in NZ arose out of the role played by government as the "benevolent social welfare planner" and an understanding of the necessity of economic and social security for "progress". The SRs were linked to establishing a government-wide programme aimed at reducing inequalities. They have been used moderately to highly in central and local government and in civil society, both within and outside the health sector, but have neither entered public treasury and economic development departments nor the commercial sector. The SRs have not reached the more universal status of economic indicators. However, they have had some success at raising awareness of, and have stimulated isolated action on, SDH. The NZ case suggests that national-level social monitoring provides a valuable tool for raising awareness of SDH across government and civil society. A number of strategies could improve social reports' effectiveness in stimulating

Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews.

PubMed

Lund, Crick; Brooke-Sumner, Carrie; Baingana, Florence; Baron, Emily Claire; Breuer, Erica; Chandra, Prabha; Haushofer, Johannes; Herrman, Helen; Jordans, Mark; Kieling, Christian; Medina-Mora, Maria Elena; Morgan, Ellen; Omigbodun, Olayinka; Tol, Wietse; Patel, Vikram; Saxena, Shekhar

2018-04-01

Mental health has been included in the UN Sustainable Development Goals. However, uncertainty exists about the extent to which the major social determinants of mental disorders are addressed by these goals. The aim of this study was to develop a conceptual framework for the social determinants of mental disorders that is aligned with the Sustainable Development Goals, to use this framework to systematically review evidence regarding these social determinants, and to identify potential mechanisms and targets for interventions. We did a systematic review of reviews using a conceptual framework comprising demographic, economic, neighbourhood, environmental events, and social and culture domains. We included 289 articles in the final Review. This study sheds new light on how the Sustainable Development Goals are relevant for addressing the social determinants of mental disorders, and how these goals could be optimised to prevent mental disorders. Copyright © 2018 Elsevier Ltd. All rights reserved.

Policy approaches to address the social and environmental determinants of health inequity in Asia-pacific.

PubMed

Friel, Sharon; Loring, Belinda; Aungkasuvapala, Narongsakdi; Baum, Fran; Blaiklock, Alison; Chiang, Tung-Liang; Cho, Youngtae; Dakulala, Paison; Guo, Yan; Hashimoto, Hideki; Horton, Kellie; Jayasinghe, Saroj; Matheson, Don; Nguyen, Huong Thanh; Otto, Caleb; Rao, Mala; Reid, Paaparangi; Surjadi, Charles

2012-11-01

Asia Pacific is home to over 60% of the world's population and the fastest growing economies. Many of the leadership in the Asia Pacific region is becoming increasingly aware that improving the conditions for health would go a long way to sustaining economic prosperity in the region, as well as improving global and local health equity. There is no biological reason why males born in Cambodia can expect to live 23 years less than males born in Japan, or why females born in Tuvalu live 23 years shorter than females in New Zealand or why non-Indigenous Australian males live 12 years longer than Indigenous men. The nature and drivers of health inequities vary greatly among different social, cultural and geo-political contexts and effective solutions must take this into account. This paper utilizes the CSDH global recommendations as a basis for looking at the actions that are taking place to address the structural drivers and conditions of daily living that affect health inequities in the Asia Pacific context. While there are signs of action and hope, substantial challenges remain for health equity in Asia Pacific. The gains that have been made to date are not equally distributed and may be unsustainable as the world encounters new economic, social and environmental challenges. Tackling health inequities is a political imperative that requires leadership, political courage, social action, a sound evidence base and progressive public policy.

A community health worker intervention to address the social determinants of health through policy change.

PubMed

Ingram, Maia; Schachter, Ken A; Sabo, Samantha J; Reinschmidt, Kerstin M; Gomez, Sofia; De Zapien, Jill Guernsey; Carvajal, Scott C

2014-04-01

Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.

Engagement studios: students and communities working to address the determinants of health.

PubMed

Bainbridge, Lesley; Grossman, Susan; Dharamsi, Shafik; Porter, Jill; Wood, Victoria

2014-01-01

This article presents an innovative model for interprofessional community-oriented learning. The Engagement Studios model involves a partnership between community organizations and students as equal partners in conversations and activities aimed at addressing issues of common concern as they relate to the social determinants of health. Interprofessional teams of students from health and non-health disciplines work with community partners to identify priority community issues and explore potential solutions. The student teams work with a particular community organization, combining their unique disciplinary perspectives to develop a project proposal, which addresses the community issues that have been jointly identified. Approved proposals receive a small budget to implement the project. In this paper we present the Engagement Studios model and share lessons learned from a pilot of this educational initiative.

Social determinants, political contexts and civil society action: a historical perspective on the Commission on Social Determinants of Health.

PubMed

Solar, Orielle; Irwin, Alec

2006-12-01

To evaluate opportunities for action on social determinants of health (SDH) requires a historical perspective. Plans for addressing SDH should be developed with an awareness of past similar efforts and factors that contributed to their success or failure. Review of published historical literature on analysis and action on SDH, in particular from the Latin American social medicine movement. In the period since World War II, global public health has oscillated between a social vision of health and a more individualistic, technological and medicalised model. Action on SDH was central to comprehensive primary health care as promulgated at the 1978 Alma-Ata conference and championed by the movement for 'Health for All by the Year 2000'. Subsequently, commitment to addressing SDH declined under the impact of restrictive interpretations of 'selective primary health care' and the pressure of neo-liberal economic and health policies. Through its critique of politically naive medical and public health approaches and of neo-liberal ideology, the Latin American social medicine tradition offers important lessons for today's efforts to advance action on SDH. Key lessons concern: (1) the model of praxis, consciously uniting reflection and action for political change; and (2) the importance of civil society and community participation in action on SDH.

Moving electronic medical records upstream: incorporating social determinants of health.

PubMed

Gottlieb, Laura M; Tirozzi, Karen J; Manchanda, Rishi; Burns, Abby R; Sandel, Megan T

2015-02-01

Knowledge of the biological pathways and mechanisms connecting social factors with health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social determinants of health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations. To illustrate the feasibility of capturing information and promoting interventions related to social determinants of health in electronic medical records. Three case studies were examined in which electronic medical records have been used to collect data and address social determinants of health in clinical settings. From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social determinants of health into clinical systems, including screening, triaging, referring, tracking, and data sharing. If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social determinants of health into healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on health care outcomes before widespread adoption can be recommended. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Social determinants of cardiovascular disease outcomes in Indians

PubMed Central

Jeemon, Panniyammakal; Reddy, K.S.

2010-01-01

Cardiovascular diseases (CVD) are the leading cause of death and disability in both developed and developing countries. In developed countries socio-economic mortality differentials have been studied extensively showing that the low socio-economic group suffers the highest mortality. As the epidemiological transition is taking place against a background of economic globalization, CVD risk factors among the urban poor and middle class are rapidly increasing in India. Recent evidences from India also suggest reversal of social gradient with excess burden of CVD morbidity in the low socio-economic group. Understanding the social determinants of environmental and behavioural exposures, in determining the risk factors for cardiovascular disease is an important challenge for public health professionals as well as communities. Socio-economic disadvantage is not simply a proxy for poor cardiovascular risk factor status, but also an indication of the likely trajectory that an individual or a community may follow in the course of their life. The paucity of intervention research seeking to address the role of social determinants in shaping lifestyle practices among individuals in culturally and socially diverse population groups within India is definitely a measure of inadequacy in public health research. This review article provides an overview of the role of social determinants of CVD and its possible conceptual pathways with special focus on acute coronary syndrome (ACS) outcomes among Indians. PMID:21150014

Social determinants of cardiovascular disease outcomes in Indians.

PubMed

Jeemon, Panniyammakal; Reddy, K S

2010-11-01

Cardiovascular diseases (CVD) are the leading cause of death and disability in both developed and developing countries. In developed countries socio-economic mortality differentials have been studied extensively showing that the low socio-economic group suffers the highest mortality. As the epidemiological transition is taking place against a background of economic globalization, CVD risk factors among the urban poor and middle class are rapidly increasing in India. Recent evidences from India also suggest reversal of social gradient with excess burden of CVD morbidity in the low socio-economic group. Understanding the social determinants of environmental and behavioural exposures, in determining the risk factors for cardiovascular disease is an important challenge for public health professionals as well as communities. Socio-economic disadvantage is not simply a proxy for poor cardiovascular risk factor status, but also an indication of the likely trajectory that an individual or a community may follow in the course of their life. The paucity of intervention research seeking to address the role of social determinants in shaping lifestyle practices among individuals in culturally and socially diverse population groups within India is definitely a measure of inadequacy in public health research. This review article provides an overview of the role of social determinants of CVD and its possible conceptual pathways with special focus on acute coronary syndrome (ACS) outcomes among Indians.

Social inequalities in blindness and visual impairment: A review of social determinants

PubMed Central

Ulldemolins, Anna Rius; Lansingh, Van C; Valencia, Laura Guisasola; Carter, Marissa J; Eckert, Kristen A

2012-01-01

Health inequities are related to social determinants based on gender, socioeconomic status, ethnicity, race, living in a specific geographic region, or having a specific health condition. Such inequities were reviewed for blindness and visual impairment by searching for studies on the subject in PubMed from 2000 to 2011 in the English and Spanish languages. The goal of this article is to provide a current review in understanding how inequities based specifically on the aforementioned social determinants on health influence the prevalence of visual impairment and blindness. With regards to gender inequality, women have a higher prevalence of visual impairment and blindness, which cannot be only reasoned based on age or access to service. Socioeconomic status measured as higher income, higher educational status, or non-manual occupational social class was inversely associated with prevalence of blindness or visual impairment. Ethnicity and race were associated with visual impairment and blindness, although there is general confusion over this socioeconomic position determinant. Geographic inequalities and visual impairment were related to income (of the region, nation or continent), living in a rural area, and an association with socioeconomic and political context was suggested. While inequalities related to blindness and visual impairment have rarely been specifically addressed in research, there is still evidence of the association of social determinants and prevalence of blindness and visual impairment. Additional research should be done on the associations with intermediary determinants and socioeconomic and political context. PMID:22944744

Addressing social responsibility in medical education: the African way.

PubMed

Kwizera, Enoch N; Iputo, Jehu E

2011-01-01

Indigenous sub-Saharan societies have, over the millennia, lived and socialised within the unwritten 'rules' of the 'Ubuntu' or similar philosophies that emphasises holistic 'humanness', and which is a form of 'social responsibility'. This article looks into some relevant social responsibility aspects of medical education in the South African context, with particular emphasis on how these aspects have been addressed. Apartheid was, by its very nature, incompatible with social responsibility for the majority of South Africans, but one medical school that was a non-complicit product of apartheid succeeded in fulfilling a socially responsible mission. Thus, this article implicitly identifies what South Africa, Africa and the global Health Professions Education community could learn from these trail-blazing experiences.

Cultural and Social Interpretation of Chinese Addressing Strategies

ERIC Educational Resources Information Center

Yin, Yahui

2010-01-01

This paper examines the influence of Chinese cultural factors on the addressing terms, together with the history of their use, the social dynamics involved in their use. Through the examination of exact terms, the author demonstrates to the reader, the deeply rooted cultural factors behind it and different ways that these terms can be used,…

How to Address the Volitional Dimension of the Engineer's Social Responsibility

ERIC Educational Resources Information Center

Heikkero, T.

2008-01-01

In this paper I argue that volitional aspects, i.e. ethos, attitude, pathos, will, underlying emotion, in engineering action need to be addressed when teaching social responsibility within the engineering curriculum. After presenting reasons for this claim, I look at two different, but not mutually exclusive, approaches to address volitional…

An analysis of local government health policy against state priorities and a social determinants framework.

PubMed

Browne, Geoffrey R; Davern, Melanie T; Giles-Corti, Billie

2016-04-01

Victorian local governments are required to develop Municipal Public Health and Wellbeing Plans that incorporate state-level health planning priorities and address the social determinants of health. This paper describes a novel method for evaluating councils' performance against these requirements. Deductive content analysis was used to categorise all actions in 14 local government MPHWPs against Victorian state priorities as well as against social determinants of health policy areas. More than 1,000 actions were identified. However, fewer than half directly addressed a state priority, with many actions addressing policy areas known to be broader determinants of health. In particular, there was a marked focus on leisure and culture, and on building social cohesion through changes to living and working conditions. Councils are working beyond state priorities and there was a clear emphasis on addressing the diverse upstream 'causes of the causes' of health, rather than health promotion behaviour change programs. The approach for data analysis and presentation provides a useful method for rapid appraisal of health and wellbeing actions relative to councils', and the State's, responsibility and efficacy in public health. © 2015 Public Health Association of Australia.

Addressing social skills deficits in adults with Williams syndrome.

PubMed

Fisher, Marisa H; Morin, Lindsay

2017-12-01

Individuals with Williams syndrome (WS) are hypersocial; yet, they experience social difficulties and trouble with relationships. This report summarizes findings from three studies examining the social functioning of adults with WS and the feasibility of a social skills training program for adults with WS (SSTP-WS) through the examination of performance on initial lesson plans. Study 1: 114 parents of adults with WS completed the Social Responsiveness Scale-2. Study 2: 10 adults with WS and 12 of their parents participated in focus groups to further describe the deficits identified in Study 1 and to discuss a SSTP-WS. Study 3: 30 adults with WS were randomly assigned to 2 lessons on either conversations or relationships and pre-post change in social skills knowledge was assessed. Study 1 indicates adults with WS experience severe social impairments in social cognition, and mild-moderate impairments in social awareness and social communication. Qualitative results in Study 2 indicate a SSTP-WS should address conversation skills and relationships. In Study 3, participants showed gains in social skills knowledge following completion of lessons. A SSTP-WS may be beneficial for adults with WS. Future research should describe the social needs of individuals with WS at different ages and should further develop a SSTP-WS. Copyright © 2017 Elsevier Ltd. All rights reserved.

Social Determinants, Suboptimal Health Behavior, and Morbidity in Urban Slum Population: An Indian Perspective

PubMed Central

Mohan, Palipudi VenkataTrinadaKrishna; Bansal, Rajkumar K.

2008-01-01

Improving the health of urban residents, particularly those living in slum areas, requires an integrated approach. Appropriate interventions must be based on a well-grounded understanding of health determinants. Social factors are as important as physical factors in determining health status and suggest alternative interventions. Employment, stress, social exclusion, social support, substance use, nutrition, transport, and conditions during childhood are among the most important social determinants of health status identified by the International Center for Health and Society. This paper uses social determinants of health approach to understand morbidity outcomes for people residing in the slums of Surat City, India. To quantify suboptimal health behavior and identify the determinants of health status for this population survey data on household characteristics, health-seeking behavior, socioeconomic status, food and personal habits, social life, and physical activity has been used. After controlling for socioeconomic and demographic factors, logistic regression analysis reveals that social exclusion, stress, and lack of social support are significantly associated with morbidity. Thus, understanding of social determinants of health by policy makers is important as the health sector has a crucial role in addressing disparities in social determinants. PMID:18404392

Social Determinants of Maternal Health in Afghanistan: A Review

PubMed Central

Najafizada, Said Ahmad Maisam; Bourgeault, Ivy Lynn; Labonté, Ronald

2017-01-01

Introduction: Afghanistan has a high maternal mortality rate of 400 per 100,000 live births. Although direct causes of maternal morbidity and mortality in Afghanistan include hemorrhage, obstructed labor, infection, high blood pressure, and unsafe abortion, the high burden of diseases responsible for maternal mortality arises in large part due to social determinants of health. The focus of this literature review is to examine the impact of various social determinants of health on maternal health in Afghanistan, filling an important gap in the existing literature. Methods: This narrative review was conducted using Arksey and O’Malley’s framework of (1) defining the question, (2) searching the literature, (3) assessing the studies, (4) synthesizing selected evidence in context, and (5) summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications. Results: A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality. Conclusion: Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care) is the long-term solution to the maternal health problems in Afghanistan. National and international organizations’ long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally. PMID:29138735

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health.

PubMed

Thornton, Rachel L J; Glover, Crystal M; Cené, Crystal W; Glik, Deborah C; Henderson, Jeffrey A; Williams, David R

2016-08-01

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels. Project HOPE—The People-to-People Health Foundation, Inc.

Translating Research Evidence Into Practice to Reduce Health Disparities: A Social Determinants Approach

PubMed Central

Koh, Howard K.; Massin-Short, Sarah B.; Emmons, Karen M.; Geller, Alan C.; Viswanath, K.

2010-01-01

Translating research evidence to reduce health disparities has emerged as a global priority. The 2008 World Health Organization Commission on Social Determinants of Health recently urged that gaps in health attributable to political, social, and economic factors should be closed in a generation. Achieving this goal requires a social determinants approach to create public health systems that translate efficacy documented by research into effectiveness in the community. We review the scope, definitions, and framing of health disparities and explore local, national, and global programs that address specific health disparities. Such efforts translate research evidence into real-world settings and harness collaborative social action for broad-scale, sustainable change. PMID:20147686

The Social Determinants of Health Core: Taking a Place-Based Approach.

PubMed

Scribner, Richard A; Simonsen, Neal R; Leonardi, Claudia

2017-01-01

There is growing recognition that health disparities research needs to incorporate social determinants in the local environment into explanatory models. In the transdisciplinary setting of the Mid-South Transdisciplinary Collaborative Center (TCC), the Social Determinants of Health (SDH) Core developed an approach to incorporating SDH across a variety of studies. This place-based approach, which is geographically based, transdisciplinary, and inherently multilevel, is discussed. From 2014 through 2016, the SDH Core consulted on a variety of Mid-South TCC research studies with the goal of incorporating social determinants into their research designs. The approach used geospatial methods (e.g., geocoding) to link individual data files with measures of the physical and social environment in the SDH Core database. Once linked, the method permitted various types of analysis (e.g., multilevel analysis) to determine if racial disparities could be explained in terms of social determinants in the local environment. The SDH Core consulted on five Mid-South TCC research projects. In resulting analyses for all the studies, a significant portion of the variance in one or more outcomes was partially explained by a social determinant from the SDH Core database. The SDH Core approach to addressing health disparities by linking neighborhood social and physical environment measures to an individual-level data file proved to be a successful approach across Mid-South TCC research projects. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Social determinants of disability-based disadvantage in Solomon islands.

PubMed

Gartrell, Alexandra; Jennaway, Megan; Manderson, Lenore; Fangalasuu, Judy; Dolaiano, Simon

2018-04-01

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.

Addressing vaccine hesitancy: The potential value of commercial and social marketing principles and practices.

PubMed

Nowak, Glen J; Gellin, Bruce G; MacDonald, Noni E; Butler, Robb

2015-08-14

Many countries and communities are dealing with groups and growing numbers of individuals who are delaying or refusing recommended vaccinations for themselves or their children. This has created a need for immunization programs to find approaches and strategies to address vaccine hesitancy. An important source of useful approaches and strategies is found in the frameworks, practices, and principles used by commercial and social marketers, many of which have been used by immunization programs. This review examines how social and commercial marketing principles and practices can be used to help address vaccine hesitancy. It provides an introduction to key marketing and social marketing concepts, identifies some of the major challenges to applying commercial and social marketing approaches to immunization programs, illustrates how immunization advocates and programs can use marketing and social marketing approaches to address vaccine hesitancy, and identifies some of the lessons that commercial and non-immunization sectors have learned that may have relevance for immunization. While the use of commercial and social marketing practices and principles does not guarantee success, the evidence, lessons learned, and applications to date indicate that they have considerable value in fostering vaccine acceptance. Copyright © 2015. Published by Elsevier Ltd.

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

PubMed

Fuller, Taleria R; White, Carla P; Chu, Jocelyn; Dean, Deborah; Clemmons, Naomi; Chaparro, Carmen; Thames, Jessica L; Henderson, Anitra Belle; King, Pebbles

2018-01-01

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.

Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya

PubMed Central

Bryant, John H.; Bryant, Nancy H.; Williams, Susanna; Ndambuki, Racheal Nduku; Erwin, Paul Campbell

2012-01-01

A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH. PMID:23202764

Addressing social determinants of health by integrating assessment of caregiver-child attachment into community based primary health care in urban Kenya.

PubMed

Bryant, John H; Bryant, Nancy H; Williams, Susanna; Ndambuki, Racheal Nduku; Erwin, Paul Campbell

2012-10-12

A principle strategic insight of the Final Report for WHO's Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July-December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH.

Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health

PubMed Central

Bircher, Johannes; Kuruvilla, Shyama

2014-01-01

The Millennium Development Goals (MDGs) mobilized global commitments to promote health, socioeconomic, and sustainable development. Trends indicate that the health MDGs may not be achieved by 2015, in part because of insufficient coordination across related health, socioeconomic, and environmental initiatives. Explicitly acknowledging the need for such collaboration, the Meikirch Model of Health posits that: Health is a state of wellbeing emergent from conducive interactions between individuals' potentials, life's demands, and social and environmental determinants. Health results throughout the life course when individuals' potentials – and social and environmental determinants – suffice to respond satisfactorily to the demands of life. Life's demands can be physiological, psychosocial, or environmental, and vary across contexts, but in every case unsatisfactory responses lead to disease. This conceptualization of the integrative nature of health could contribute to ongoing efforts to strengthen cooperation across actors and sectors to improve individual and population health – leading up to 2015 and beyond. PMID:24943659

Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease

PubMed Central

Kaufman, Arthur; Powell, Wayne; Alfero, Charles; Pacheco, Mario; Silverblatt, Helene; Anastasoff, Juliana; Ronquillo, Francisco; Lucero, Ken; Corriveau, Erin; Vanleit, Betsy; Alverson, Dale; Scott, Amy

2010-01-01

The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offices (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Office of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community needs, interventions, and outcomes are monitored by county health report cards. The Health Sciences Center is a large and varied resource, the breadth and accessibility of which are mostly unknown to communities. Community health needs vary, and agents are able to tap into an array of existing health center resources to address those needs. Agents serve a broader purpose beyond immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development. Developing local capacity to address local needs has become an overriding concern. Community-based health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease. PMID:20065282

Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians.

PubMed

Chung, Esther K; Siegel, Benjamin S; Garg, Arvin; Conroy, Kathleen; Gross, Rachel S; Long, Dayna A; Lewis, Gena; Osman, Cynthia J; Jo Messito, Mary; Wade, Roy; Shonna Yin, H; Cox, Joanne; Fierman, Arthur H

2016-05-01

Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources. Copyright © 2016 Mosby, Inc. All rights reserved.

Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canada.

PubMed

Raphael, Dennis

2003-12-01

Despite Canada's reputation as a leader in health promotion and population health concepts, actual public health practice for the most part remains wedded to downstream strategies focussed on behaviour change. In Canada's largest province this has led to the implementation of a heart health promotion approach focussed on diet, activity and tobacco use. This is so despite increasing evidence that these approaches are generally ineffective, particularly for those at greatest risk. In addition, these strategies appear to divert public and governmental attention away from addressing the broader societal determinants of health. Examples of Ontario public health units that have begun to address societal determinants of health provide a counterbalance to the dominant paradigm that frames health as an individual responsibility. These new approaches focus attention upon the health-threatening effects of governments' regressive social and economic policies in a manner consistent with the best principles of health promotion.

Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India

PubMed Central

Schneider, Helen

2014-01-01

The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two ‘blocks’, purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women’s collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the

Social Determinants of Depression: Social Cohesion, Negative Life Events, and Depression Among People Living with HIV/Aids in Nigeria, West Africa.

PubMed

Shittu, Rasaki O; Issa, Baba A; Olanrewaju, Ganiyu T; Mahmoud, Abdulraheem O; Odeigah, Louis O; Sule, Abdullateef G

2014-01-01

People Living with HIV/AIDS (PLWHA) continue to face persistent and deep rooted social barriers. Incidentally, studies in social determinants of depression are very limited, necessitating this study, which examined social determinants of depression and the impact of these determinants on depression. This was a hospital based, cross sectional descriptive study of three hundred adult HIV/AIDS patients, attending the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria. Depressive symptoms were measured by the PHQ-9 rating scale. Three variables of social determinants of depression: socio-economic status (years of school and self-reported economic status of family), social cohesion, and negative life events were examined. The self-reported economic status of the family varied from good 35(11.7%), average 162(54%), and poor among 103(34.3%) of the respondents. Social cohesion was low in 199(66.3%), fair in 65(21.7%) and high among 36(12%) of the respondents. There was significant association between social cohesion, negative life events, and depression. Income was the most significant socio-economic determinant. Majority had very low social cohesion and more negative life events, while those with below average years of schooling were more depressed. These are statistically significant. Social determinants of depression should be given a lot of emphasis, when addressing the issue of depression, if we are to meaningfully tackle this increasing scourge in our society.

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health

PubMed Central

Thornton, Rachel L. J.; Glover, Crystal M.; Cené, Crystal W.; Glik, Deborah C.; Henderson, Jeffrey A.; Williams, David R.

2017-01-01

Research reveals that the opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. This article reviews scientific evidence from promising interventions focused on the social determinants of health, and describes ways in which they can improve population health and reduce health disparities. We show that there is sufficient evidence to support policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. When available, cost-effectiveness evaluations show that these interventions lead to long-term societal savings; however, more routine attention to cost considerations is needed for these interventions. We also discuss challenges to implementation, including the need for long-term financing in order to scale-up effective interventions for implementation at the local, state, or national level. Although we know enough to act, questions remain about how to optimally scale-up these interventions and maximize their benefits for the most vulnerable populations. PMID:27503966

Community health centers and community development financial institutions: joining forces to address determinants of health.

PubMed

Kotelchuck, Ronda; Lowenstein, Daniel; Tobin, Jonathan N

2011-11-01

Community health centers and community development financial institutions share similar origins and missions and are increasingly working together to meet community needs. Addressing the social and economic determinants of health is a common focus. The availability of new federal grants and tax credits has led these financial institutions to invest in the creation and expansion of community health centers. This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation's low-income communities.

When do we know enough to recommend action on the social determinants of health?

PubMed

Braveman, Paula A; Egerter, Susan A; Woolf, Steven H; Marks, James S

2011-01-01

The Robert Wood Johnson Foundation Commission to Build a Healthier America was charged to identify strategies beyond medical care to address health disparities in the U.S. related to social and economic disadvantage. Based on insights gained while providing scientific support for the commission's efforts, this paper presents an overview of major issues that arise when assessing evidence to inform policies and programs to address the social determinants of health. While many of the insights are not new, they have not been widely assimilated within medicine and public health. They have particular relevance now, given growing awareness of the important health influences of social factors. The discussion presented here is intended to highlight key considerations for researchers who study social determinants of health and policymakers whose decisions are shaped by research findings. Policies should be based on the best available knowledge, derived from diverse sources and methods. An array of tools and guidelines is now available to guide the assessment of evidence on the social determinants of health, building on--and going beyond--principles first articulated in the "Evidence-Based Medicine" movement. The central thesis of the current paper is that the standards for evidence to guide social policies must be equally rigorous but also more comprehensive than those traditionally used to inform clinical interventions, because social policies must deal with upstream factors that affect health through complex causal pathways over potentially long time periods. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Why wait? The social determinants underlying tuberculosis diagnostic delay.

PubMed

Bonadonna, Lily Victoria; Saunders, Matthew James; Zegarra, Roberto; Evans, Carlton; Alegria-Flores, Kei; Guio, Heinner

2017-01-01

Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28-126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well-known healthcare option available to them. In high

Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India.

PubMed

Nandi, Sulakshana; Schneider, Helen

2014-09-01

The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two 'blocks', purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women's collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the

Language Socialization and Interculturality: Address Terms in Intergenerational Talk in Chinese Diasporic Families

ERIC Educational Resources Information Center

Hua, Zhu

2010-01-01

This paper aims to contribute to the current debate on "interculturality" (IC) by investigating the process of language socialization whereby different generations of diasporic families negotiate, construct, and renew their sociocultural values and identities through interaction. Focusing on the use of address terms and "talk about social,…

Implementing reverse mentoring to address social isolation among older adults.

PubMed

Breck, Bethany M; Dennis, Cory B; Leedahl, Skye N

2018-07-01

Reverse mentoring is a means to address the social work Grand Challenge of social isolation. Among older adults, reverse mentoring can improve social connection by increasing the digital competence of older adults so they can use technology for social benefit, and by facilitating intergenerational connections with young adult mentors. In this paper, reverse mentoring is examined within an intergenerational program that serves older adults and utilizes the native technological knowledge and skills of young adults who mentor older adult participants. Qualitative data were collected through young adult mentor logs of each session, and through open-ended questions on the post-surveys collected from older adults and young adult mentors. Qualitative analysis revealed three themes related to social connection: (1) an increased sense of self-efficacy for older adults as they build confidence in technological use, and for young adults as they develop leadership skills through mentoring, (2) the breaking down of age-related stereotypes, and (3) intergenerational engagement and connection. The findings demonstrate that reverse mentoring can be used in various settings to decrease the social isolation of older adults by developing intergenerational connections and increasing older adult usage of technology.

Widening the aim of health promotion to include the most disadvantaged: vulnerable adolescents and the social determinants of health.

PubMed

Mohajer, Nicole; Earnest, Jaya

2010-06-01

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health promotion. Drawing on a review of literature on health promotion for marginalized and out-of-school adolescents, this paper highlights some urgent areas of focus for researchers and policy makers addressing adolescent health. Social determinants of health affecting marginalized adolescents identified by the review were education, gender, identity, homelessness, poverty, family structure, culture, religion and perceived racism, yet there is little solid evidence as to how to best address these factors. More systematic research, evaluation and global debate about long-term solutions to chronic poverty, lack of education and social marginalization are needed to break the cycle of ill health among vulnerable adolescents.

Complex families, the social determinants of health and psychosocial interventions: Deconstruction of a day in the life of hospital social workers.

PubMed

Muskat, Barbara; Craig, Shelley L; Mathai, Biju

2017-09-01

The roles of hospital social workers are delineated in the literature; however, their daily interventions have only been described anecdotally. This study analyzes the daily work of social workers in a pediatric hospital through a survey completed which examined factors related to interventions utilized and time spent per case over a 1-day period. Length and types of interventions were associated with the social determinants of health, time since diagnosis, biopsychosocial issues, and perception of complexity. The study offers a snapshot of the personalized expertise, provided by social workers that addresses complex contextual and biopsychosocial concerns of patient and families.

Funding quality pre-kindergarten slots with Philadelphia's new 'sugary drink tax': simulating effects of using an excise tax to address a social determinant of health.

PubMed

Langellier, Brent A; Lê-Scherban, Félice; Purtle, Jonathan

2017-09-01

Philadelphia passed a 1·5-cent-per-ounce sweetened beverage tax (SBT). Revenue will fund 10 000 quality pre-kindergarten slots for poor children. It is imperative to understand how revenue from SBT can be used to fund programmes to address education and other social determinants of health. The objective of the present study was to simulate quality pre-kindergarten attendance, educational achievement and sugar-sweetened beverage (SSB) consumption among Philadelphia children and adolescents under six intervention scenarios: (i) no intervention; (ii) 10 000 additional quality pre-kindergarten slots; (iii) a 1·5-cent-per-ounce SBT; (iv) expanded pre-kindergarten and 1·5-cent-per-ounce SBT; (v) a 3-cent-per-ounce SBT; and (vi) expanded pre-kindergarten and 3-cent-per-ounce SBT. We used an agent-based model to estimate pre-kindergarten enrolment, educational achievement and SSB consumption under the six policy scenarios. We identified key parameters in the model from the published literature and secondary analyses of the Panel Study of Income Dynamics - Child Development Supplement. Philadelphia, Pennsylvania, USA. Philadelphia children and adolescents aged 4-18 years. A 1·5-cents-per-ounce tax would reduce SSB consumption by 1·3 drinks/week among Philadelphia children and adolescents relative to no intervention, with larger effects among children below the poverty level. Quality pre-kindergarten expansion magnifies the effect of the SBT by 8 %, but has the largest effect on moderate-income children just above the poverty level. The SBT and quality pre-kindergarten programme each reduce SSB consumption, but primarily benefit different children and adolescents. Pairing an excise tax with a complementary programme to improve a social determinant of health represents a progressive strategy to combat obesity, a disease regressive in its social patterning.

Early life environment and social determinants of cardiac health in children with congenital heart disease.

PubMed

Wong, Peter; Denburg, Avram; Dave, Malini; Levin, Leo; Morinis, Julia Orkin; Suleman, Shazeen; Wong, Jonathan; Ford-Jones, Elizabeth; Moore, Aideen M

2018-04-01

Congenital heart disease is a significant cause of infant mortality. Epidemiology and social context play a crucial role in conditioning disease burden and modulating outcomes, while diagnosis and treatment remain resource intensive. This review will address the role of social demographics, environmental exposure, epigenetics and nutrition in the aetiology of congenital heart disease. We then discuss the determinant effect of social factors on the provision and outcomes of care for congenital heart disease and implications for practice. It is our hope that enhanced knowledge of the intersection of social determinants of health and congenital heart disease will facilitate effective preventative strategies at the individual and population levels to optimize heart health outcomes across the life course.

What determines the fruit and vegetables intake of primary school children? - An analysis of personal and social determinants.

PubMed

Haß, Julia; Hartmann, Monika

2018-01-01

The high prevalence of childhood obesity is a major concern in developed and developing countries. An increase in fruit and vegetable (F&V) intake is perceived as one of the numerous strategies to prevent and reduce the risk of adiposity. The purpose of this study was to investigate the relevance of personal and social determinants in explaining children's F&V intake. Written questionnaire data were collected from 702 parent-child pairs that included 3rd and 4th graders (aged 7 to 10) and their parents. Children's F&V intake was recorded over three food records. Hierarchical linear regression models were applied to assess the impact of personal and social determinants on children's F&V intake. Regression models focusing on personal and social determinants revealed that the most promising personal determinants pertained to the knowledge of different types of F&V and preferences for F&V. Moreover, an exclusive focus on social determinants indicated that parental modeling and peer influence had significant and positive relationships with children's F&V intake, whereas verbal directives to eat F&V exhibited a significant and negative relationship. In combination, the following four personal and social determinants were demonstrated to be significant: knowledge of different types of F&V, preferences for F&V and parental modeling, all of which had positive relationships, and verbal directives to eat F&V, which had a negative impact. The results identify important associative determinants of children's F&V intake. These are in part personal and in part social and are shown by our analysis to be of equal and perhaps mutual importance. Therefore, we suggest that interventions aimed at improving children's F&V intake should address children's preferences for F&V, impart knowledge concerning the variety of F&V and encourage parents to act as role models. Copyright © 2017 Elsevier Ltd. All rights reserved.

Capturing the Social Location of African American Mothers Living with HIV: An Inquiry into How Social Determinants of Health Are Framed

PubMed Central

Caiola, Courtney; Barroso, Julie; Docherty, Sharron L.

2017-01-01

Background The disparate health outcomes of African-American mothers living with HIV are considerable. Multidimensional approaches are needed to address the complex social and economic conditions of their lives, collectively known as the social determinants of health. Objectives The purpose of this paper is to explore the social determinants of health for African-American mothers living with HIV by examining how mothers describe their social location at the intersection of gender-, race-, and class inequality; HIV-related stigma; and motherhood. How they frame the impact of their social location on their health experiences is explored. Methods This exploratory study included in-depth, semistructured interviews with 18 African-American mothers living with HIV at three time points. We used an intersectional framework and frame analysis to explore the meaning of these constructs for participants. Results Findings from 48 interviews include a description of the intersecting social determinants functioning as systems of inequality and the heterogeneous social locations. Three frames of social location were used to organize and explain the how African-American mothers living with HIV may understand their social determinants of health: (a) an emancipatory frame, marked by attempts to transcend the negative social connotations associated with HIV and socially constructed identities of race, gender, and class; (b) a maternal frame, marked by a desire to maintain a positive maternal identity and maternal-child relations; and (c) an internalized frame, marked by an emphasis on the deleterious and stigmatizing effects of HIV, racial-, gender-, and class inequality. Discussion The findings offer knowledge about the heterogeneity in how demographically similar individuals frame their social location as well as how the intersections of social determinants influence participant’s health experiences. Potential health implications and interventions are suggested for the three

Masculinity and School Violence: Addressing the Role of Male Gender Socialization

ERIC Educational Resources Information Center

Stoltz, Jo-Anne

2005-01-01

The author argues for school-based violence prevention programming that addresses the unique predicament faced by male youth when they are asked to adopt attitudes and behaviours that may contradict traditional socialized notions of masculinity. Studies based on the Gender Role Conflict Scale (GRCS) and the Masculine Gender Role Stress Scale…

Social determinants of health in Canada: Are healthy living initiatives there yet? A policy analysis

PubMed Central

2012-01-01

Introduction Preventative strategies that focus on addressing the social determinants of health to improve healthy eating and physical activity have become an important strategy in British Columbia and Ontario for combating chronic diseases. What has not yet been examined is the extent to which healthy living initiatives implemented under these new policy frameworks successfully engage with and change the social determinants of health. Methods Initiatives active between January 1, 2006 and September 1, 2011 were found using provincial policy documents, web searches, health organization and government websites, and databases of initiatives that attempted to influence to nutrition and physical activity in order to prevent chronic diseases or improve overall health. Initiatives were reviewed, analyzed and grouped using the descriptive codes: lifestyle-based, environment-based or structure-based. Initiatives were also classified according to the mechanism by which they were administered: as direct programs (e.g. directly delivered), blueprints (or frameworks to tailor developed programs), and building blocks (resources to develop programs). Results 60 initiatives were identified in Ontario and 61 were identified in British Columbia. In British Columbia, 11.5% of initiatives were structure-based. In Ontario, of 60 provincial initiatives identified, 15% were structure-based. Ontario had a higher proportion of direct interventions than British Columbia for all intervention types. However, in both provinces, as the intervention became more upstream and attempted to target the social determinants of health more directly, the level of direct support for the intervention lessened. Conclusions The paucity of initiatives in British Columbia and Ontario that address healthy eating and active living through action on the social determinants of health is problematic. In the context of Canada's increasingly neoliberal political and economic policy, the public health sector may face

Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas.

PubMed

Jackson, Suzanne F; Birn, Anne-Emanuelle; Fawcett, Stephen B; Poland, Blake; Schultz, Jerry A

2013-12-01

Health promotion and social determinants of health approaches, when integrated, can better contribute to understanding and addressing health inequities. Yet, they have typically been pursued as two solitudes. This paper presents the key elements, principles, actions, and potential synergies of these complementary frameworks for addressing health equity. The value-added of integrating these two approaches is illustrated by three examples drawn from the authors' experiences in the Americas: at the community level, through a community-based coalition for reducing chronic disease disparities among minorities in an urban center in the United States; at the national level, through healthy-settings interventions in Canada; and at the Regional level, through health cooperation based on social justice values in Latin America. Challenges to integrating health promotion and social determinants of health approaches in the Americas are also discussed.

Why wait? The social determinants underlying tuberculosis diagnostic delay

PubMed Central

Saunders, Matthew James; Zegarra, Roberto; Evans, Carlton; Alegria-Flores, Kei; Guio, Heinner

2017-01-01

Background Early detection and diagnosis of tuberculosis remain major global priorities for tuberculosis control. Few studies have used a qualitative approach to investigate the social determinants contributing to diagnostic delay and none have compared data collected from individual, community, and health-system levels. We aimed to characterize the social determinants that contribute to diagnostic delay among persons diagnosed with tuberculosis living in resource-constrained settings. Methods/Principle findings Data were collected in public health facilities with high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured interviews with persons diagnosed with tuberculosis (n = 105) and their family members (n = 63) explored health-seeking behaviours, community perceptions of tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were conducted with health personnel (n = 35) working in the National Tuberculosis Program. All interview data were transcribed and analysed using a grounded theory approach. The median delay between symptom onset and the public health facility visit that led to the first positive diagnostic sample was 57 days (interquartile range 28–126). The great majority of persons diagnosed with tuberculosis distrusted the public health system and sought care at public health facilities only after exhausting other options. It was universally agreed that persons diagnosed with tuberculosis faced discrimination by public and health personnel. Self-medication with medicines bought at local pharmacies was reported as the most common initial health-seeking behaviour due to the speed and low-cost of treatment in pharmacies. Most persons diagnosed with tuberculosis initially perceived their illness as a simple virus. Conclusions Diagnostic delay was common and prolonged. When individuals reached a threshold of symptom severity, they addressed their health with the least time-consuming, most economically feasible, and well

[Learning about social determinants of health through chronicles, using a virtual learning environment].

PubMed

Restrepo-Palacio, Sonia; Amaya-Guio, Jairo

2016-01-01

To describe the contributions of a pedagogical strategy based on the construction of chronicles, using a Virtual Learning Environment for training medical students from Universidad de La Sabana on social determinants of health. Descriptive study with a qualitative approach. Design and implementation of a Virtual Learning Environment based on the ADDIE instructional model. A Virtual Learning Environment was implemented with an instructional design based on the five phases of the ADDIE model, on the grounds of meaningful learning and social constructivism, and through the narration of chronicles or life stories as a pedagogical strategy. During the course, the structural determinants and intermediaries were addressed, and nine chronicles were produced by working groups made up of four or five students, who demonstrated meaningful learning from real life stories, presented a coherent sequence, and kept a thread; 82% of these students incorporated in their contents most of the social determinants of health, emphasizing on the concepts of equity or inequity, equality or inequality, justice or injustice and social cohesion. A Virtual Learning Environment, based on an appropriate instructional design, allows to facilitate learning of social determinants of health through a constructivist pedagogical approach by analyzing chronicles or life stories created by ninth-semester students of medicine from Universidad de La Sabana.

Disrupting the pathways of social determinants of health: doula support during pregnancy and childbirth

PubMed Central

Kozhimannil, Katy B.; Vogelsang, Carrie A.; Hardeman, Rachel R.; Prasad, Shailendra

2017-01-01

Purpose The goal of this study was to assess perspectives of racially/ethnically diverse, low-income pregnant women on how doula services (nonmedical maternal support) may influence the outcomes of pregnancy and childbirth. Methods We conducted four in-depth focus group discussions with low-income pregnant women. We used a selective coding scheme based on five themes (agency, personal security, connectedness, respect, and knowledge) identified in the Good Birth framework, and analyzed salient themes in the context of the Gelberg-Anderson behavioral model and the social determinants of birth outcomes. Results Participants identified the role doulas played in mitigating the effects of social determinants. The five themes of a Good Birth characterized the means through which nonmedical support from doulas influenced the pathways between social determinants of health and birth outcomes. By addressing health literacy and social support needs, pregnant women noted that doulas affect access to and quality of health care services. Conclusions Access to doula services for pregnant women who are at risk of poor birth outcomes may help disrupt the pervasive influence of social determinants as predisposing factors for health during pregnancy and childbirth. PMID:27170788

Social determinants of health--a question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes.

PubMed

Ahnquist, Johanna; Wamala, Sarah P; Lindstrom, Martin

2012-03-01

Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. Copyright © 2012 Elsevier Ltd. All rights reserved.

Addressing the Academic and Social Needs of Young Male Students through School-Based Mentoring

ERIC Educational Resources Information Center

Alston, Curtis E.

2013-01-01

This study addressed the problem within the U.S. public school system to sustainably meet the academic and social needs of its African American male students. The administrative team of the elementary school in this study desired an evaluation of a school-based male mentoring program that was designed to address these needs. The program, Gentlemen…

[Social determinants of overweight and obesity in Spain in 2006].

PubMed

Ortiz-Moncada, Rocio; Alvarez-Dardet, Carlos; Miralles-Bueno, Juan José; Ruíz-Cantero, María Teresa; Dal Re-Saavedra, María Angeles; Villar-Villalba, Carmen; Pérez-Farinós, Napoleón; Serra-Majem, Lluís

2011-12-10

Obesity in the Spanish adult population has almost doubled from 1987 to 2003. The aim is to update the prevalence of overweight and obesity, and reassess its main social determinants using the National Health Household Survey (ENS) from 2006. Cross sectional study based on the ENS-2006. Sample of 29,478 adults who answered questions on self-reported weight and height. We calculated the body mass index (WHO classification) for the dependent variable. Sociodemographic independent variables used were age, sex, marriage status, educational level, social class (manual, non-manual), and monthly income. A descriptive study was conducted as well as different logistic regression models. In 2006, the prevalence of overweight is higher in men (43.9%) than women (28.9%). Sex differences were not observed in the prevalence of obesity (15.0%). The multinomial logistic regression analysis shows significant associations between obesity and marriage status: married OR=1.69 (1.51-1.89), widower OR=1.77 (1.45-2.16); population without education: OR=2.77 (2.34-3.28) and income below 600 €: OR=1.50 (1.18-1.91). There was a statistically significant interaction (p<0.001) between sex and social class. Women from manual social class have 49% more chances to be overweight and 96% greater risk of obesity compared to non-manual social class women. In addition, men of manual social class have less risk of overweight (18%) and obesity (12%) than non-manual social class men. Gender and socioeconomic status are key social determinants for obesity in Spain and, consequently, this needs to be addressed when developing preventive activities. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Social Justice Approach to Road Safety in Kenya: Addressing the Uneven Distribution of Road Traffic Injuries and Deaths across Population Groups

PubMed Central

Azetsop, Jacquineau

2010-01-01

Road traffic injury and deaths (RTID) are an important public health problem in Kenya, primarily affecting uneducated and disenfranchised people from lower socioeconomic groups. Studies conducted by Kenyan experts from police reports and surveys have shown that pedestrian and driver behaviors are the most important proximal causes of crashes, signifying that the occurrence of crashes results directly from human action. However, behaviors and risk factors do not fully explain the magnitude of RTID neither does it account for socioeconomic gradient in RTID. Instead, a social justice approach to RTID highlights the need for emphasizing distal causal factors. They allow us to understand how social inequities determine risk for RTID. Hence, designing policies that focus on behaviors will simply mask the underlying systemic causes of this growing phenomenon. To eradicate the RTID and address the gradient, a broader policy framework that includes the social dimension of injury, a strong political will to address the underlying causes of RTID and an effective partnership with stakeholders needs to be developed. PMID:20664752

Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

PubMed Central

Gibson, M; Sowden, A; Wright, K; Whitehead, M; Petticrew, M

2010-01-01

Background There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development. Methods Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport. Results Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment. Conclusion Intervention studies that address inequalities in health are a priority area for future public health research. PMID:19692738

Addressing the social and environmental determinants of urban health equity: evidence for action and a research agenda.

PubMed

Friel, Sharon; Akerman, Marco; Hancock, Trevor; Kumaresan, Jacob; Marmot, Michael; Melin, Thomas; Vlahov, David

2011-10-01

Urban living is the new reality for the majority of the world's population. Urban change is taking place in a context of other global challenges--economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban-rural divide) and within cities (the rich-poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central

Teaching social determinants of child health in a pediatric advocacy rotation: small intervention, big impact.

PubMed

Klein, Melissa; Vaughn, Lisa M

2010-01-01

Traditionally, medical education does not specifically address the social determinants of health or how to advocate for families' cultural, social or economic needs in spite of our increasingly diverse society. This article describes a new social-legal curriculum added to a Pediatric Resident's Advocacy course. Pediatric interns completed 'Memos To Myself' after the Advocacy rotation. The curriculum impacted residents' (1) realization regarding family circumstances; (2) reflections regarding self and personal practice; and (3) knowledge about advocacy issues and community partnerships for solutions. This curriculum raised awareness about topics that are traditionally not covered in medical education.

Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016.

PubMed

Singh, Gopal K; Daus, Gem P; Allender, Michelle; Ramey, Christine T; Martin, Elijah K; Perry, Chrisp; Reyes, Andrew A De Los; Vedamuthu, Ivy P

2017-01-01

This study describes key population health concepts and examines major empirical trends in US health and healthcare inequalities from 1935 to 2016 according to important social determinants such as race/ethnicity, education, income, poverty, area deprivation, unemployment, housing, rural-urban residence, and geographic location. Long-term trend data from the National Vital Statistics System, National Health Interview Survey, National Survey of Children's Health, American Community Survey, and Behavioral Risk Factor Surveillance System were used to examine racial/ethnic, socioeconomic, rural-urban, and geographic inequalities in health and health care. Life tables, age-adjusted rates, prevalence, and risk ratios were used to examine health differentials, which were tested for statistical significance at the 0.05 level. Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. In 2015, life expectancy was highest for Asian/Pacific Islanders (87.7 years) and lowest for African-Americans (75.7 years). Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas, with rural-urban disparities increasing during the 1990-2014 time period. Infant mortality rates declined dramatically during the past eight decades. However, racial disparities widened over time; in 2015, black infants had 2.3 times higher mortality than white infants (11.4 vs. 4.9 per 1,000 live births). Infant and child mortality was markedly higher in rural areas and poor communities. Black infants and children in poor, rural communities had nearly three times higher mortality rate compared to those in affluent, rural areas. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, homicide

Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016

PubMed Central

Singh, Gopal K.; Daus, Gem P.; Allender, Michelle; Ramey, Christine T.; Martin, Elijah K.; Perry, Chrisp; Reyes, Andrew A. De Los; Vedamuthu, Ivy P.

2017-01-01

Objectives: This study describes key population health concepts and examines major empirical trends in US health and healthcare inequalities from 1935 to 2016 according to important social determinants such as race/ethnicity, education, income, poverty, area deprivation, unemployment, housing, rural-urban residence, and geographic location. Methods: Long-term trend data from the National Vital Statistics System, National Health Interview Survey, National Survey of Children’s Health, American Community Survey, and Behavioral Risk Factor Surveillance System were used to examine racial/ethnic, socioeconomic, rural-urban, and geographic inequalities in health and health care. Life tables, age-adjusted rates, prevalence, and risk ratios were used to examine health differentials, which were tested for statistical significance at the 0.05 level. Results: Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. In 2015, life expectancy was highest for Asian/Pacific Islanders (87.7 years) and lowest for African-Americans (75.7 years). Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas, with rural-urban disparities increasing during the 1990-2014 time period. Infant mortality rates declined dramatically during the past eight decades. However, racial disparities widened over time; in 2015, black infants had 2.3 times higher mortality than white infants (11.4 vs. 4.9 per 1,000 live births). Infant and child mortality was markedly higher in rural areas and poor communities. Black infants and children in poor, rural communities had nearly three times higher mortality rate compared to those in affluent, rural areas. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer

Globalization and social determinants of health: Promoting health equity in global governance (part 3 of 3).

PubMed

Labonté, Ronald; Schrecker, Ted

2007-06-19

This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy. Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.

[HPV vaccine implementation in Chile: an appraisal from the social determinants of health model].

PubMed

Fernández González, Loreto

2017-12-01

Cervical cancer is the fourth most common neoplasm in women worldwide and its incidence is associated with profound social inequities. In Chile, it is the second cause of death in women of reproductive age. The Chilean clinical guideline identifies the vaccine against Human Papillomavirus (HPV) as the main preventive measure. Since 2014, the Ministry of Health has implemented free immunization against HPV for girls and female adolescents. This article critically analyzes this public policy from the viewpoint of health equity, using as framework the Social Determinants of Health Model. Specifically, we address the structural determinants of income and gender, which act as material and social barriers for achieving immunization, affecting protection against cervical cancer. These barriers correspond to the high cost of the vaccine, and social attitudes/cultural beliefs towards sexual behavior in Latin America and Chile that affect the acceptability of vaccination. The Social Determinants of Health Model constitutes a useful tool for identifying health inequities and understanding public policy from an equity viewpoint that complements the biomedical and epidemiological understanding of disease. In this topic, the initiative aims to strengthen the idea of health as a human right and health promotion as an essential function of public health policy.

Training medical students in the social determinants of health: the Health Scholars Program at Puentes de Salud.

PubMed

O'Brien, Matthew J; Garland, Joseph M; Murphy, Katie M; Shuman, Sarah J; Whitaker, Robert C; Larson, Steven C

2014-01-01

Given the large influence of social conditions on health, physicians may be more effective if they are trained to identify and address social factors that impact health. Despite increasing interest in teaching the social determinants of health in undergraduate medical education, few models exist. We present a 9-month pilot course on the social determinants of health for medical and other health professional students, which is based at Puentes de Salud, Philadelphia, PA, USA, a community health center serving a Latino immigrant population. This service-learning course, called the Health Scholars Program (HSP), was developed and implemented by volunteer medical and public health faculty in partnership with the community-based clinic. The HSP curriculum combines didactic instruction with service experiences at Puentes de Salud and opportunities for critical reflection. The HSP curriculum also includes a longitudinal project where students develop, implement, and evaluate an intervention to address a community-defined need. In our quantitative evaluation, students reported high levels of agreement with the HSP meeting stated course goals, including developing an understanding of the social determinants of health and working effectively with peers to implement community-based projects. Qualitative assessments revealed students' perception of learning more about this topic in the HSP than in their formal medical training and of developing a long-term desire to serve vulnerable communities as a result. Our experience with the HSP suggests that partnerships between academic medical centers and community-based organizations can create a feasible, effective, and sustainable platform for teaching medical students about the social determinants of health. Similar medical education programs in the future should seek to achieve a larger scale and to evaluate both students' educational experiences and community-defined outcomes.

Social determinants in an Australian urban region: a 'complexity' lens.

PubMed

Fisher, Matthew; Milos, Danijela; Baum, Frances; Friel, Sharon

2016-03-01

Area-based strategies have been widely employed in efforts to improve population health and take action on social determinants of health (SDH) and health inequities, including in urban areas where many of the social, economic and environmental factors converge to influence health. Increasingly, these factors are recognized as being part of a complex system, where population health outcomes are shaped by multiple, interacting factors operating at different levels of social organization. This article reports on research to assess the extent to which an alliance of health and human service networks is able to promote action on SDH within an Australian urban region, using a complex systems frame. We found that such an alliance was able to promote some effective action which takes into account complex interactions between social factors affecting health, but also identified significant potential barriers to other forms of desired action identified by alliance members. We found that a complex systems lens was useful in assessing a collaborative intervention to address SDH within an urban region. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Developmental and Social Determinants of Religious Social Categorization

ERIC Educational Resources Information Center

van der Straten Waillet, Nastasya; Roskam, Isabelle

2012-01-01

The purpose of this study was to assess developmental and social determinants of the age at which children become aware that the social environment can be marked by categorization into religious groups and that those groups are associated with different religious beliefs. The results show that middle childhood is a critical period for this…

Widening the Aim of Health Promotion to Include the Most Disadvantaged: Vulnerable Adolescents and the Social Determinants of Health

ERIC Educational Resources Information Center

Mohajer, Nicole; Earnest, Jaya

2010-01-01

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health…

Social support and social network as intermediary social determinants of dental caries in adolescents.

PubMed

Fontanini, Humberto; Marshman, Zoe; Vettore, Mario

2015-04-01

The aim of this study was to investigate the association between intermediary social determinants, namely social support and social network with dental caries in adolescents. An adapted version of the WHO social determinants of health conceptual framework was used to organize structural and intermediary social determinants of dental caries into six blocks including perceived social support and number of social networks. A cross-sectional study was conducted with a representative sample of 542 students between 12 and 14 years of age in public schools located in the city of Dourados, Brazil in 2012. The outcome variables were caries experience (DMFT ≥ 1) and current dental caries (component D of DMFT ≥ 1) recorded by a calibrated dentist. Individual interviews were performed to collect data on perceived social support and numbers of social networks from family and friends and covariates. Multivariate Poisson regressions using hierarchical models were conducted. The prevalence of adolescents with caries experience and current dental caries was 55.2% and 32.1%, respectively. Adolescents with low numbers of social networks and low levels of social support from family (PR 1.47; 95% CI = 1.01-2.14) were more likely to have DMFT ≥ 1. Current dental caries was associated with low numbers of social networks and low levels of social support from family (PR 2.26; 95% CI = 1.15-4.44). Social support and social network were influential psychosocial factors to dental caries in adolescents. This finding requires confirmation in other countries but potentially has implications for programmes to promote oral health. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Addressing Environmental Health Inequalities.

PubMed

Gouveia, Nelson

2016-08-27

Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), "Addressing Environmental Health Inequalities-Proceedings from the ISEE Conference 2015", we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics.

Addressing Consent Issues in Donation After Circulatory Determination of Death.

PubMed

Overby, Kim J; Weinstein, Michael S; Fiester, Autumn

2015-01-01

Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria (i.e., brain death), there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death. First we discuss several general concerns regarding consent related to this form of organ donation, and then we address additional issues that are unique to three different patient categories: adult patients with medical decision-making capacity or potential capacity, adult patients who lack capacity, and pediatric patients.

An exploration of social determinants of health amongst internally displaced persons in northern Uganda

PubMed Central

2009-01-01

Social determinants of health describe the conditions in which people are born, grow, live, work and age and their influence on health. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. Armed conflict and forced displacement are important influences on the social determinants of health. There is limited evidence on the social determinants of health of internally displaced persons (IDPs) who have been forced from their homes due to armed conflict but remain within the borders of their country. The aim of this study was to explore the social determinants of overall physical and mental health of IDPs, including the response strategies used by IDPs to support their health needs. Northern Uganda was chosen as a case-study, and 21 face-to-face semi-structured interviews with IDPs were conducted in fifteen IDP camps between November and December 2006. The findings indicated a number of key social determinants. Experiencing traumatic events could cause "over thinking" which in turn could lead to "madness" and physical ailments. Respondents also attributed "over thinking" to the spirit (cen) of a killed person returning to disturb its killer. Other social determinants included overcrowding which affected physical health and contributed to an emotional sense of loss of freedom; and poverty and loss of land which affected physical health from lack of food and income, and mental health because of worry and uncertainty. Respondents also commented on how the conflict and displacement and led to changes in social and cultural norms such as increased "adultery", "defilement", and "thieving". Response strategies included a combination of biopsychosocial health services, traditional practices, religion, family and friends, and isolating. This study supports work exploring the political, environmental, economic, and socio-cultural determinants of health of IDPs

Corporate Social Responsibility Initiatives Addressing Social Exclusion in Bangladesh

PubMed Central

2009-01-01

The private sector is often seen as a driver of exclusionary processes rather than a partner in improving the health and welfare of socially-excluded populations. However, private-sector initiatives and partnerships—collectively labelled corporate social responsibility (CSR) initiatives—may be able to positively impact social status, earning potential, and access to services and resources for socially-excluded populations. This paper presents case studies of CSR projects in Bangladesh that are designed to reduce social exclusion among marginalized populations and explores whether CSR initiatives can increase economic and social capabilities to reduce exclusion. The examples provide snapshots of projects that (a) increase job-skills and employment opportunities for women, disabled women, and rehabilitated drug-users and (b) provide healthcare services to female workers and their communities. The CSR case studies cover a limited number of people but characteristics and practices replicable and scaleable across different industries, countries, and populations are identified. Common success factors from the case studies form the basis for recommendations to design and implement more CSR initiatives targeting socially-excluded groups. The analysis found that CSR has potential for positive and lasting impact on developing countries, especifically on socially-excluded populations. However, there is a need for additional monitoring and critical evaluation. PMID:19761088

Corporate social responsibility initiatives addressing social exclusion in Bangladesh.

PubMed

Werner, Wendy J

2009-08-01

The private sector is often seen as a driver of exclusionary processes rather than a partner in improving the health and welfare of socially-excluded populations. However, private-sector initiatives and partnerships- collectively labelled corporate social responsibility (CSR) initiatives-may be able to positively impact social status, earning potential, and access to services and resources for socially-excluded populations. This paper presents case studies of CSR projects in Bangladesh that are designed to reduce social exclusion among marginalized populations and explores whether CSR initiatives can increase economic and social capabilities to reduce exclusion. The examples provide snapshots of projects that (a) increase job-skills and employment opportunities for women, disabled women, and rehabilitated drug-users and (b) provide healthcare services to female workers and their communities. The CSR case studies cover a limited number of people but characteristics and practices replicable and scaleable across different industries, countries, and populations are identified. Common success factors from the case studies form the basis for recommendations to design and implement more CSR initiatives targeting socially-excluded groups. The analysis found that CSR has potential for positive and lasting impact on developing countries, especifically on socially-excluded populations. However, there is a need for additional monitoring and critical evaluation.

Immigration as a social determinant of health.

PubMed

Castañeda, Heide; Holmes, Seth M; Madrigal, Daniel S; Young, Maria-Elena DeTrinidad; Beyeler, Naomi; Quesada, James

2015-03-18

Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of morbidity and mortality follow inequities rooted in societal, political, and economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena-social determinants of health and immigration-has resulted in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.

A social-ecological framework: A model for addressing ethical practice in nursing.

PubMed

Davidson, Patricia; Rushton, Cynda Hylton; Kurtz, Melissa; Wise, Brian; Jackson, Debra; Beaman, Adam; Broome, Marion

2018-03-01

To develop a framework to enable discussion, debate and the formulation of interventions to address ethical issues in nursing practice. Social, cultural, political and economic drivers are rapidly changing the landscape of health care in our local environments but also in a global context. Increasingly, nurses are faced with a range of ethical dilemmas in their work. This requires investigation into the culture of healthcare systems and organisations to identify the root causes and address the barriers and enablers of ethical practice. The increased medicalisation of health care; pressures for systemisation; efficiency and cost reduction; and an ageing population contribute to this complexity. Often, ethical issues in nursing are considered within the abstract and philosophical realm until a dilemma is encountered. Such an approach limits the capacity to tangibly embrace ethical values and frameworks as pathways to equitable, accessible, safe and quality health care and as a foundation for strengthening a supportive and enabling workplace for nurses and other healthcare workers. Conceptual framework development. A comprehensive literature review was undertaken using the social-ecological framework as an organising construct. This framework views ethical practice as the outcome of interaction among a range of factors at eight levels: individual factors (patients and families); individual factors (nurses); relationships between healthcare professionals; relationships between patients and nurses; organisational healthcare context; professional and education regulation and standards; community; and social, political and economic. Considering these elements as discrete, yet interactive and intertwined forces can be useful in developing interventions to promote ethical practice. We consider this framework to have utility in policy, practice, education and research. Nurses face ethical challenges on a daily basis, considering these within a social-ecological framework can

The Untold Story: Examining Ontario's Community Health Centres' Initiatives to Address Upstream Determinants of Health

PubMed Central

Collins, Patricia A.; Resendes, Sarah J.; Dunn, James R.

2014-01-01

Background: Unlike traditional primary care centres, part of the Community Health Centre (CHC) mandate is to address upstream health determinants. In Ontario, CHCs refer to these activities as Community Initiatives (CIs); yet, little is known about how CIs operate. The objective of this study was to examine the scope, resource requirements, partnerships, successes and challenges among selected Ontario CIs. Methods: We conducted qualitative interviews with 10 CHC staff members representing 11 CIs across Ontario. CIs were identified through an online inventory, recruited by e-mail and interviewed between March and June 2011. Results: Most CIs aim to increase community participation, while addressing social isolation and poverty. They draw minimal financial resources from their CHC, and employ highly skilled staff to support implementation. Most enlist support from various partners, and use numerous methods for community engagement. Successes include improved community relations, increased opportunities for education and employment and rewarding partnerships, while insufficient funding was a commonly identified challenge. Conclusions: Despite minimal attention from researchers and funders, our findings suggest that CIs play key capacity-building roles in vulnerable communities across Ontario, and warrant further investigation. PMID:25410693

Social determinants of breast cancer in the Caribbean: a systematic review.

PubMed

Brown, Catherine R; Hambleton, Ian R; Hercules, Shawn M; Alvarado, Miriam; Unwin, Nigel; Murphy, Madhuvanti M; Harris, E Nigel; Wilks, Rainford; MacLeish, Marlene; Sullivan, Louis; Sobers-Grannum, Natasha

2017-04-05

Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women. MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways ('relationship groups') to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible. Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in

The Benefits of Interactive Read-Alouds to Address Social-Emotional Learning in Classrooms for Young Children

ERIC Educational Resources Information Center

Britt, Shelby; Wilkins, Julia; Davis, Jessica; Bowlin, Amy

2016-01-01

In this article, we describe how books addressing social-emotional topics can be used by teachers of young children during class read-alouds to enhance students' social-emotional development. Teachers of young children typically choose books for class read-alouds based on curriculum topics and student interest; however, they may not be aware of…

[Monitoring social determinants of health].

PubMed

Espelt, Albert; Continente, Xavier; Domingo-Salvany, Antonia; Domínguez-Berjón, M Felicitas; Fernández-Villa, Tania; Monge, Susana; Ruiz-Cantero, M Teresa; Perez, Glòria; Borrell, Carme

2016-11-01

Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

A Community Health Worker-Led Rotation to Train Medical Students in the Social Determinants of Health.

PubMed

Kangovi, Shreya; Carter, Tamala; Smith, Robyn A; DeLisser, Horace M

2018-01-01

Medical students often lack training in understanding and addressing the social determinants that shape the health of high-risk populations. We describe a novel clinical elective rotation in which fourth-year medical students served as apprentices to community health workers in order to develop community engagement skills and cultural humility.

Globalization and social determinants of health: Promoting health equity in global governance (part 3 of 3)

PubMed Central

Labonté, Ronald; Schrecker, Ted

2007-01-01

This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy. Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values. PMID:17578570

Association of the Social Determinants of Health With Quality of Primary Care.

PubMed

Katz, Alan; Chateau, Dan; Enns, Jennifer E; Valdivia, Jeff; Taylor, Carole; Walld, Randy; McCulloch, Scott

2018-05-01

In primary care, there is increasing recognition of the difficulty of treating patients' immediate health concerns when their overall well-being is shaped by underlying social determinants of health. We assessed the association of social complexity factors with the quality of care patients received in primary care settings. Eleven social complexity factors were defined using administrative data on poverty, mental health, newcomer status, and justice system involvement from the Manitoba Population Research Data Repository. We measured the distribution of these factors among primary care patients who made at least 3 visits during 2010-2013 to clinicians in Manitoba, Canada. Using generalized linear mixed modeling, we measured 26 primary care indicators to compare the quality of care received by patients with 0 to 5 or more social complexity factors. Among 626,264 primary care patients, 54% were living with at least 1 social complexity factor, and 4% were living with 5 or more. Social complexity factors were strongly associated with poorer outcomes with respect to primary care indicators for prevention (eg, breast cancer screening; odds ratio [OR] = 0.77; 99% CI, 0.73-0.81), chronic disease management (eg, diabetes management; OR = 0.86; 99% CI, 0.79-0.92), geriatric care (eg, benzodiazepine prescriptions; OR = 1.63; 99% CI, 1.48-1.80), and use of health services (eg, ambulatory visits; OR = 1.09; 99% CI, 1.08-1.09). Linking health and social data demonstrates how social determinants are associated with primary care service provision. Our findings provide insight into the social needs of primary care populations, and may support the development of focused interventions to address social complexity in primary care. © 2018 Annals of Family Medicine, Inc.

The social and behavioural determinants of health in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

PubMed

Huijts, Tim; Stornes, Per; Eikemo, Terje A; Bambra, Clare

2017-02-01

Previous studies comparing the social and behavioural determinants of health in Europe have largely focused on individual countries or combined data from various national surveys. In this article, we present the findings from the new rotating module on social determinants of health in the European Social Survey (ESS) (2014) to obtain the first comprehensive comparison of estimates on the prevalence of the following social and behavioural determinants of health: working conditions, access to healthcare, housing quality, unpaid care, childhood conditions and health behaviours. We used the 7th round of the ESS. We present separate results for men and women. All estimates were age-standardized in each separate country using a consistent metric. We show country-specific results as well as pooled estimates for the combined cross-national sample. We found that social and behavioural factors that have a clear impact on physical and mental health, such as lack of healthcare access, risk behaviour and poor working conditions, are reported by substantial numbers of people in most European countries. Furthermore, our results highlight considerable cross-national variation in social and behavioural determinants of health across European countries. Substantial numbers of Europeans are exposed to social and behavioural determinants of health problems. Moreover, the extent to which people experience these social and behavioural factors varies cross-nationally. Future research should examine in more detail how these factors are associated with physical and mental health outcomes, and how these associations vary across countries. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The Influence of Deferred Action for Childhood Arrivals on Undocumented Asian and Pacific Islander Young Adults: Through a Social Determinants of Health Lens.

PubMed

Sudhinaraset, May; To, Tu My; Ling, Irving; Melo, Jason; Chavarin, Josue

2017-06-01

There is an urgent need to provide evidence-based policies to address the health of the 11.7 million undocumented immigrants in the United States. Deferred Action for Childhood Arrivals (DACA) offers temporary relief to qualified undocumented immigrants. Asians and Pacific Islanders (APIs), in particular, are the fastest growing immigrant population; yet, little is known about their health challenges. This article examines the influence of DACA on the health of API undocumented young adults. In total, 32 unique participants participated in 24 in-depth interviews and four focus group discussions. Participants were aged 18-31 years and identified as undocumented API. DACA potentially improves health outcomes through four potential social determinants: economic stability, educational opportunities, social and community contexts, and access to health care. These determinants improve the mental health and sense of well-being among undocumented young adults. Targeted outreach and education in communities should be informed by these research findings with an eye toward promoting the economic, education, and health benefits of enrolling in DACA. Social policies that address the social determinants of health have significant potential to address health inequities. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Priorities of low-income urban residents for interventions to address the socio-economic determinants of health.

PubMed

Danis, Marion; Kotwani, Namrata; Garrett, Joanne; Rivera, Ivonne; Davies-Cole, John; Carter-Nolan, Pamela

2010-11-01

To determine the priorities of low-income urban residents for interventions that address the socio-economic determinants of health. We selected and estimated the cost of 16 interventions related to education, housing, nutrition, employment, health care, healthy behavior, neighborhood improvement, and transportation. Low-income residents of Washington, D.C. (N=431) participated in decision exercises to prioritize these interventions. Given a budget valued at approximately twice an estimated cost of medical and dental care ($885), the interventions ultimately prioritized by the greatest percentage of individuals were: health insurance (95%), housing vouchers (82%) dental care (82%), job training (72%), adult education (63%), counseling (68%), healthy behavior incentives (68%), and job placement (67%). The percentages of respondents who received support for housing, adult education, and job training and placement were far less than the percentage who prioritized these interventions. Poor and low-income residents' priorities may usefully inform allocation of social services that affect health.

78 FR 9987 - Social Security Ruling, SSR 13-1p; Titles II and XVI: Agency Processes for Addressing Allegations...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2012-0071] Social Security Ruling, SSR 13-1p; Titles II and XVI: Agency Processes for Addressing Allegations of Unfairness, Prejudice, Partiality, Bias, Misconduct, or Discrimination by Administrative Law Judges (ALJs); Correction AGENCY: Social Security...

Social determinants of depression and suicidal behaviour in the Caribbean: a systematic review.

PubMed

Brown, Catherine R; Hambleton, Ian R; Sobers-Grannum, Natasha; Hercules, Shawn M; Unwin, Nigel; Nigel Harris, E; Wilks, Rainford; MacLeish, Marlene; Sullivan, Louis; Murphy, Madhuvanti M

2017-06-15

Depressive disorder is the largest contributor to years lived with disability in the Caribbean, adding 948 per 100,000 in 2013. Depression is also a major risk factor for suicidal behaviour. Social inequalities influence the occurrence of depression, yet little is known about the social inequalities of this condition in the Caribbean. In support of the 2011 Rio Political Declaration on addressing health inequities, this article presents a systematic review of the role of social determinants on depression and its suicidal behaviours in the Caribbean. Eight databases were searched for observational studies reporting associations between social determinants and depression frequency, severity, or outcomes. Based on the PROGRESS-plus checklist, we considered 9 social determinant groups (of 15 endpoints) for 6 depression endpoints, totalling 90 possible ways ('relationship groups') to explore the role of social determinants on depression. Studies with ≥50 participants conducted in Caribbean territories between 2004 and 2014 were eligible. The review was conducted according to STROBE and PRISMA guidelines. Results were planned as a narrative synthesis, with meta-analysis if possible. From 3951 citations, 55 articles from 45 studies were included. Most were classified as serious risk of bias. Fifty-seven relationship groups were reported by the 55 included articles, leaving 33 relationship groups (37%) without an evidence base. Most associations were reported for gender, age, residence, marital status, and education. Depression, its severity, and its outcomes were more common among females (except suicide which was more common among males), early and middle adolescents (among youth), and those with lower levels of education. Marriage emerged as both a risk and protective factor for depression score and prevalence, while several inequality relationships in Haiti were in contrast to typical trends. The risk of bias and few numbers of studies within relationship groups

Addressing Breastfeeding Disparities in Social Work

ERIC Educational Resources Information Center

Hurst, Carol Grace

2007-01-01

This article examines social justice issues affecting breastfeeding in the United States. Public health goals for breastfeeding initiation and duration and barriers to breastfeeding among low-income groups are discussed. Suggestions are made about ways social workers may more assertively support breastfeeding in the context of social work practice.

The relationship between social determinants of health, and rehabilitation of neurological conditions: a systematic literature review.

PubMed

Frier, Amanda; Barnett, Fiona; Devine, Sue

2017-05-01

This systematic literature review aims to explore the relationship between social determinants of health (SDH), and the rehabilitation of neurological conditions. In particular, the review will consider relationships between social determinants and peoples' attendance and sustained adherence to rehabilitation programs, and motivation regarding neurological rehabilitation. A systematic search of peer-reviewed literature from electronic databases; MEDLINE, Scopus, CINAHL and Informit health, was conducted. Papers published between 2004 and 2014 were considered. Eleven quantitative studies met the inclusion criteria. There was a lack of research addressing SDH and neurological rehabilitation simultaneously. Cardiac and cancer rehabilitation studies reported employment and income, social support, transport, housing and food security as the most frequent SDH factors influencing attendance, sustained adherence and motivation. Given this association, a similar relationship between neurological rehabilitation and SDH is plausible. Rehabilitation of neurological conditions can be a long and difficult process. To pursue optimal outcomes, an individual's social circumstances should be considered. Understanding how SDH interact with neurological rehabilitation may enhance service delivery, thus maximizing the possible rehabilitation outcomes for individuals. Future research that considers SDH and rehabilitation of neurological conditions jointly may benefit service providers and those requiring neurological rehabilitation. Implications for Rehabilitation Social determinants of health are important to consider in the rehabilitation of neurological conditions. Understanding the interplay between the social determinants of health and neurological rehabilitation may enhance the possible outcomes for those requiring rehabilitation. Increased awareness and capacity of health care professionals involved in neurological rehabilitation may hasten momentum towards decreased health

The impact of social determinants on cardiovascular disease

PubMed Central

Kreatsoulas, Catherine; Anand, Sonia S

2010-01-01

Cardiovascular disease is the leading cause of death among high-income countries and is projected to be the leading cause of death worldwide by 2030. Much of the current research efforts have been aimed toward the identification, modification and treatment of individual-level risk factors. Despite significant advancements, gross inequalities continue to persist over space and time. Although increasing at different rates worldwide, the magnitude of increase in the prevalence of various cardiovascular risk factors has shifted research efforts to study the causes of the risk factors (ie, the ‘causes of the causes’), which include the social determinants of health. The social determinants of health reflect the impact of the social environment on health among people sharing a particular community. Imbalances in the social determinants of health have been attributed to the inequities in health observed between and within countries. The present article reviews the role of the social determinants of health on a global level, describing the epidemiological transition and the persistent trend known as the ‘inverse social gradient’. The impact of social determinants in Canada will also be examined, including data from ethnic and Aboriginal communities. Possible solutions and future directions to reduce the impact of social factors on cardiovascular health are proposed. PMID:20847985

The impact of social determinants on cardiovascular disease.

PubMed

Kreatsoulas, Catherine; Anand, Sonia S

2010-01-01

Cardiovascular disease is the leading cause of death among high-income countries and is projected to be the leading cause of death worldwide by 2030. Much of the current research efforts have been aimed toward the identification, modification and treatment of individual-level risk factors. Despite significant advancements, gross inequalities continue to persist over space and time. Although increasing at different rates worldwide, the magnitude of increase in the prevalence of various cardiovascular risk factors has shifted research efforts to study the causes of the risk factors (ie, the 'causes of the causes'), which include the social determinants of health. The social determinants of health reflect the impact of the social environment on health among people sharing a particular community. Imbalances in the social determinants of health have been attributed to the inequities in health observed between and within countries. The present article reviews the role of the social determinants of health on a global level, describing the epidemiological transition and the persistent trend known as the 'inverse social gradient'. The impact of social determinants in Canada will also be examined, including data from ethnic and Aboriginal communities. Possible solutions and future directions to reduce the impact of social factors on cardiovascular health are proposed.

Using Confidence Interval-Based Estimation of Relevance to Select Social-Cognitive Determinants for Behavior Change Interventions.

PubMed

Crutzen, Rik; Peters, Gjalt-Jorn Ygram; Noijen, Judith

2017-01-01

When developing an intervention aimed at behavior change, one of the crucial steps in the development process is to select the most relevant social-cognitive determinants. These determinants can be seen as the buttons one needs to push to establish behavior change. Insight into these determinants is needed to select behavior change methods (i.e., general behavior change techniques that are applied in an intervention) in the development process. Therefore, a study on determinants is often conducted as formative research in the intervention development process. Ideally, all relevant determinants identified in such a study are addressed by an intervention. However, when developing a behavior change intervention, there are limits in terms of, for example, resources available for intervention development and the amount of content that participants of an intervention can be exposed to. Hence, it is important to select those determinants that are most relevant to the target behavior as these determinants should be addressed in an intervention. The aim of the current paper is to introduce a novel approach to select the most relevant social-cognitive determinants and use them in intervention development. This approach is based on visualization of confidence intervals for the means and correlation coefficients for all determinants simultaneously. This visualization facilitates comparison, which is necessary when making selections. By means of a case study on the determinants of using a high dose of 3,4-methylenedioxymethamphetamine (commonly known as ecstasy), we illustrate this approach. We provide a freely available tool to facilitate the analyses needed in this approach.

Resurrecting social infrastructure as a determinant of urban tuberculosis control in Delhi, India

PubMed Central

2014-01-01

Background The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. Social infrastructure development generates social capital and addresses the crucial social determinants of TB, thereby improving program performance. Recently, there has been renewed interest in the concept of social infrastructure development for TB control in developing countries. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. Further, it explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings. Methods A wide range of published Government records pertaining to social development parameters and TB program surveillance, between 2001 and 2011 in Delhi, were studied. Social infrastructure development parameters like human development index along with other indicators reflecting patient profile and habitation in urban settings were selected as social determinants of TB. These include adult literacy rates, per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units. The impact of the Revised National Tuberculosis Control Program on TB incidence was assessed as an annual decline in new TB cases notified under the program. Univariate linear regression was employed to examine the interrelationship between social development parameters and TB program outcomes. Results The decade saw a significant growth in most of the social development parameters in the State. TB program performance showed 46% increment in lives saved among all types of TB cases per 100,000 population. The 7% reduction in new TB case notifications from the year 2001 to 2011, translates to a logarithmic decline of 5.4 new TB cases per 100,000 population. Except per capita

Resurrecting social infrastructure as a determinant of urban tuberculosis control in Delhi, India.

PubMed

Chandra, Shivani; Sharma, Nandini; Joshi, Kulanand; Aggarwal, Nishi; Kannan, Anjur Tupil

2014-01-17

The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. Social infrastructure development generates social capital and addresses the crucial social determinants of TB, thereby improving program performance. Recently, there has been renewed interest in the concept of social infrastructure development for TB control in developing countries. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. Further, it explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings. A wide range of published Government records pertaining to social development parameters and TB program surveillance, between 2001 and 2011 in Delhi, were studied. Social infrastructure development parameters like human development index along with other indicators reflecting patient profile and habitation in urban settings were selected as social determinants of TB. These include adult literacy rates, per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units. The impact of the Revised National Tuberculosis Control Program on TB incidence was assessed as an annual decline in new TB cases notified under the program. Univariate linear regression was employed to examine the interrelationship between social development parameters and TB program outcomes. The decade saw a significant growth in most of the social development parameters in the State. TB program performance showed 46% increment in lives saved among all types of TB cases per 100,000 population. The 7% reduction in new TB case notifications from the year 2001 to 2011, translates to a logarithmic decline of 5.4 new TB cases per 100,000 population. Except per capita income, literacy, and net

Social determinants in the sexual health of adolescent Aboriginal Australians: a systematic review.

PubMed

MacPhail, Catherine; McKay, Kathy

2018-03-01

While research indicates that Aboriginal and Torres Strait Islander adolescents may be at increased risk of some sexually transmitted infections, there is limited information about factors that may place these young people at more risk of adverse sexual health than their non-Indigenous counterparts. Current research has tended to focus on surveillance-type data, but there is an increasing need to understand social determinants of sexual health risk. This systematic review assessed the evidence of social determinants impacting on Aboriginal and Torres Strait Islander adolescents' sexual health in Australia. Published, English-language literature was searched across key databases from 2003 to 2015. Fourteen studies were included in the qualitative synthesis. Findings suggest that social determinants such as access to healthcare, poverty, substance use, educational disadvantage, sociocultural context, gender inequalities, status and identity, and social disadvantage impacted on Indigenous adolescents' sexual behaviours and sexual health risk. Evidence from the literature included in the review suggests that peer education may be an acceptable and appropriate approach for addressing such issues. There remains a need for programmes and services to be community-developed and community-led, thus ensuring cultural appropriateness and relevance. However, there is also a significant need for such programmes to be effectively and rigorously evaluated with data that goes beyond surveillance, and seeks to unpack how sexual norms are experienced by Indigenous adolescents, particularly outside of remote Australia - and how these experiences act as either risk or protective factors to good sexual health and positive social and emotional well-being. © 2016 John Wiley & Sons Ltd.

Report Summary--Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015.

PubMed

Stankiewicz, A; Herel, M; DesMeules, M

2015-09-01

In 2012, Canada and other United Nations (UN) Member States endorsed the "Rio Political Declaration on Social Determinants of Health" (Rio Declaration), a non-binding pledge which calls on World Health Organization (WHO) Member States to improve/influence the working and living conditions that affect health and well-being. The Rio Declaration sets out actions to address health inequities in five themes: to adopt better governance for health and development; to promote participation in policy making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor and increase accountability. In 2013, following the endorsement of the Rio Declaration, the Government of Canada released a report to begin to document Canadian actions related to its five themes. Building on this first report, and in anticipation of WHO reporting on Member State implementation of the Rio Declaration at the May 2015 World Health Assembly, the Government of Canada developed the report, Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015, which showcases Canada's recent actions since 2013 contributing to the advancement of the five Rio Declaration themes. The report provides a current picture of the diverse spectrum of activities undertaken across levels of government and sectors to advance health equity and address social determinants of health in Canada, and intends to stimulate global and domestic exchange and uptake of promising practices to advance health equity.

Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

PubMed

Kramer, Betty J

2013-01-01

This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life.

Ethics and Social Justice within the New DEEL: Addressing the Paradox of Control/Democracy

ERIC Educational Resources Information Center

Shapiro, Joan Poliner

2006-01-01

This paper addresses the ethical and social justice implications of an educational movement called, The New DEEL (Democratic Ethical Educational Leadership). In particular, this paper emphasizes the ethical underpinnings of this movement by focusing on the paradox in the form of the dyad of control/democracy. This important paradox is developed…

Automatic address validation and health record review to identify homeless Social Security disability applicants.

PubMed

Erickson, Jennifer; Abbott, Kenneth; Susienka, Lucinda

2018-06-01

Homeless patients face a variety of obstacles in pursuit of basic social services. Acknowledging this, the Social Security Administration directs employees to prioritize homeless patients and handle their disability claims with special care. However, under existing manual processes for identification of homelessness, many homeless patients never receive the special service to which they are entitled. In this paper, we explore address validation and automatic annotation of electronic health records to improve identification of homeless patients. We developed a sample of claims containing medical records at the moment of arrival in a single office. Using address validation software, we reconciled patient addresses with public directories of homeless shelters, veterans' hospitals and clinics, and correctional facilities. Other tools annotated electronic health records. We trained random forests to identify homeless patients and validated each model with 10-fold cross validation. For our finished model, the area under the receiver operating characteristic curve was 0.942. The random forest improved sensitivity from 0.067 to 0.879 but decreased positive predictive value to 0.382. Presumed false positive classifications bore many characteristics of homelessness. Organizations could use these methods to prompt early collection of information necessary to avoid labor-intensive attempts to reestablish contact with homeless individuals. Annually, such methods could benefit tens of thousands of patients who are homeless, destitute, and in urgent need of assistance. We were able to identify many more homeless patients through a combination of automatic address validation and natural language processing of unstructured electronic health records. Copyright © 2018. Published by Elsevier Inc.

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.

PubMed

de Andrade, Luiz Odorico Monteiro; Pellegrini Filho, Alberto; Solar, Orielle; Rígoli, Félix; de Salazar, Lígia Malagon; Serrate, Pastor Castell-Florit; Ribeiro, Kelen Gomes; Koller, Theadora Swift; Cruz, Fernanda Natasha Bravo; Atun, Rifat

2015-04-04

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Interrogating Single-Sex Classes as a Strategy for Addressing Boys' Educational and Social Needs

ERIC Educational Resources Information Center

Martino, Wayne; Mills, Martin; Lingard, Bob

2005-01-01

This paper explores the policy of single-sex classes that is currently being adopted in some schools as a strategy for addressing boys educational and social needs. It draws on research in one Australian government, coeducational primary school to examine teachers' and students' experiences of this strategy. Interviews with the principal, male and…

Community health center provider ability to identify, treat and account for the social determinants of health: a card study.

PubMed

Lewis, Joy H; Whelihan, Kate; Navarro, Isaac; Boyle, Kimberly R

2016-08-27

The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.

The Social Determinants of Infant Mortality and Birth Outcomes in Western Developed Nations: A Cross-Country Systematic Review

PubMed Central

Kim, Daniel; Saada, Adrianna

2013-01-01

Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world. PMID:23739649

Korean Early Childhood Educators' Perceptions of Importance and Implementation of Strategies to Address Young Children's Social-Emotional Competence

ERIC Educational Resources Information Center

Heo, Kay H.; Cheatham, Gregory A.; Hemmeter, Mary Louise; Noh, Jina

2014-01-01

In South Korea, there has been a rapid increase in challenging behaviors and other social-emotional difficulties at the early childhood level. Korean early childhood educators' perspectives and strategies to address young children's social-emotional competencies and challenging behaviors were investigated. Overall, results suggest that many Korean…

Do Social Work Students Assess and Address Economic Barriers to Clients Implementing Agreed Tasks?

ERIC Educational Resources Information Center

Eamon, Mary Keegan; Zhang, Sai-jun

2006-01-01

Identical vignettes except for a sentence describing a client's economic resources were randomly assigned to 129 MSW students. The vignettes described a social worker who agreed with a client's decision to relocate her residence as a partial solution to a presenting problem but did not assess or address economic barriers to the client's…

Social Determinants of LGBT Cancer Health Inequities.

PubMed

Matthews, Alicia K; Breen, Elizabeth; Kittiteerasack, Priyoth

2018-02-01

To describe the extant literature on social determinants of health as they relate to the cancer disparities and to highlight the research findings relating to lesbian, gay, bisexual, and transgender (LGBT) populations. Published scientific literature and clinical literature, and published reports from the World Health Organization and US Department of Health and Human Services. The larger literature on health inequities is moving beyond individual-level predictors of risk to evaluate the influence of social determinants of health on the persistent health inequalities in a population. As it has for other groups, additional research into social determinants of health for LGBT persons of color may play an important role in identifying and reducing cancer inequities for this group. Increased awareness of the factors that contribute to health inequities for the LGBT population may provide insight into improving patient-provider relationships with LGBT patients. A large body of experiential and clinical knowledge positions nurses to conduct meaningful research to expand the current understanding of the social determinants of LGBT cancer health inequities. Copyright © 2017 Elsevier Inc. All rights reserved.

[Social determinants of health and disability: updating the model for determination].

PubMed

Tamayo, Mauro; Besoaín, Álvaro; Rebolledo, Jaime

Social determinants of health (SDH) are conditions in which people live. These conditions impact their lives, health status and social inclusion level. In line with the conceptual and comprehensive progression of disability, it is important to update SDH due to their broad implications in implementing health interventions in society. This proposal supports incorporating disability in the model as a structural determinant, as it would lead to the same social inclusion/exclusion of people described in other structural SDH. This proposal encourages giving importance to designing and implementing public policies to improve societal conditions and contribute to social equity. This will be an act of reparation, justice and fulfilment with the Convention on the Rights of Persons with Disabilities. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The Social Determinants of Mental Health.

PubMed

Sederer, Lloyd I

2016-02-01

Ninety percent of the determinants of our health derive from our lifetime social and physical environment-not from the provision of health care. The author describes behaviors, such as poor eating, excessive drinking and abuse of drugs, smoking, and physical inactivity, and social factors, such as adverse childhood experiences, poor education, food insecurity, poor housing quality, unemployment, and discrimination, that contribute to ill health and early demise. Better health and mental health can be achieved by understanding and responding to these determinants of health.

Social networks, social support and psychiatric symptoms: social determinants and associations within a multicultural community population.

PubMed

Smyth, Natasha; Siriwardhana, Chesmal; Hotopf, Matthew; Hatch, Stephani L

2015-07-01

Little is known about how social networks and social support are distributed within diverse communities and how different types of each are associated with a range of psychiatric symptoms. This study aims to address such shortcomings by: (1) describing the demographic and socioeconomic characteristics of social networks and social support in a multicultural population and (2) examining how each is associated with multiple mental health outcomes. Data is drawn from the South East London Community Health Study; a cross-sectional study of 1,698 adults conducted between 2008 and 2010. The findings demonstrate variation in social networks and social support by socio-demographic factors. Ethnic minority groups reported larger family networks but less perceived instrumental support. Older individuals and migrant groups reported lower levels of particular network and support types. Individuals from lower socioeconomic groups tended to report less social networks and support across the indicators measured. Perceived emotional and instrumental support, family and friend network size emerged as protective factors for common mental disorder, personality dysfunction and psychotic experiences. In contrast, both social networks and social support appear less relevant for hazardous alcohol use. The findings both confirm established knowledge that social networks and social support exert differential effects on mental health and furthermore suggest that the particular type of social support may be important. In contrast, different types of social network appear to impact upon poor mental health in a more uniform way. Future psychosocial strategies promoting mental health should consider which social groups are vulnerable to reduced social networks and poor social support and which diagnostic groups may benefit most.

What determines social capital in a social-ecological system? Insights from a network perspective.

PubMed

Barnes-Mauthe, Michele; Gray, Steven Allen; Arita, Shawn; Lynham, John; Leung, PingSun

2015-02-01

Social capital is an important resource that can be mobilized for purposive action or competitive gain. The distribution of social capital in social-ecological systems can determine who is more productive at extracting ecological resources and who emerges as influential in guiding their management, thereby empowering some while disempowering others. Despite its importance, the factors that contribute to variation in social capital among individuals have not been widely studied. We adopt a network perspective to examine what determines social capital among individuals in social-ecological systems. We begin by identifying network measures of social capital relevant for individuals in this context, and review existing evidence concerning their determinants. Using a complete social network dataset from Hawaii's longline fishery, we employ social network analysis and other statistical methods to empirically estimate these measures and determine the extent to which individual stakeholder attributes explain variation within them. We find that ethnicity is the strongest predictor of social capital. Measures of human capital (i.e., education, experience), years living in the community, and information-sharing attitudes are also important. Surprisingly, we find that when controlling for other factors, industry leaders and formal fishery representatives are generally not well connected. Our results offer new quantitative insights on the relationship between stakeholder diversity, social networks, and social capital in a coupled social-ecological system, which can aid in identifying barriers and opportunities for action to overcome resource management problems. Our results also have implications for achieving resource governance that is not only ecologically and economically sustainable, but also equitable.

What Determines Social Capital in a Social-Ecological System? Insights from a Network Perspective

NASA Astrophysics Data System (ADS)

Barnes-Mauthe, Michele; Gray, Steven Allen; Arita, Shawn; Lynham, John; Leung, PingSun

2015-02-01

Social capital is an important resource that can be mobilized for purposive action or competitive gain. The distribution of social capital in social-ecological systems can determine who is more productive at extracting ecological resources and who emerges as influential in guiding their management, thereby empowering some while disempowering others. Despite its importance, the factors that contribute to variation in social capital among individuals have not been widely studied. We adopt a network perspective to examine what determines social capital among individuals in social-ecological systems. We begin by identifying network measures of social capital relevant for individuals in this context, and review existing evidence concerning their determinants. Using a complete social network dataset from Hawaii's longline fishery, we employ social network analysis and other statistical methods to empirically estimate these measures and determine the extent to which individual stakeholder attributes explain variation within them. We find that ethnicity is the strongest predictor of social capital. Measures of human capital (i.e., education, experience), years living in the community, and information-sharing attitudes are also important. Surprisingly, we find that when controlling for other factors, industry leaders and formal fishery representatives are generally not well connected. Our results offer new quantitative insights on the relationship between stakeholder diversity, social networks, and social capital in a coupled social-ecological system, which can aid in identifying barriers and opportunities for action to overcome resource management problems. Our results also have implications for achieving resource governance that is not only ecologically and economically sustainable, but also equitable.

Collaborative capacity, problem framing, and mutual trust in addressing the wildland fire social problem: An annotated reading list

Treesearch

Jeffrey J. Brooks; Alexander N. Bujak; Joseph G. Champ; Daniel R. Williams

2006-01-01

We reviewed, annotated, and organized recent social science research and developed a framework for addressing the wildland fire social problem. We annotated articles related to three topic areas or factors, which are critical for understanding collective action, particularly in the wildland-urban interface. These factors are collaborative capacity, problem framing, and...

Using a Health in All Policies Approach to Address Social Determinants of Sexually Transmitted Disease Inequities in the Context of Community Change and Redevelopment

PubMed Central

Fuller, Elizabeth; Branscomb, Jane; Cheung, Karen; Reed, Phillip Jackson; Wong, Naima; Henderson, Michael; Williams, Samantha

2013-01-01

Objectives We used a Health in All Policies (HiAP) framework to determine what data, policy, and community efficacy opportunities exist for improving sexual health and reducing sexually transmitted diseases (STDs) in an area surrounding an Army base undergoing redevelopment in Atlanta, Georgia. Methods We conducted a literature review, consulted with experts, mapped social determinants in the community, conducted key informant interviews with community leaders to explore policy solutions, used Photovoice with community members to identify neighborhood assets, and shared data with all stakeholder groups to solicit engagement for next steps. Results We identified the following HiAP-relevant determinants of STD inequities in the literature: education, employment, male incarceration, drug and alcohol marketing, and social capital. Quantitative data confirmed challenges in education, employment, and male incarceration in the area. Interviews identified policy opportunities such as educational funding ratios, Community Hire Agreements, code and law enforcement, addiction and mental health resources, lighting for safety, and a nonemergency public safety number. Photovoice participants identified community assets to protect including family-owned businesses, green spaces, gathering places, public transportation resources, historical sites, and architectural elements. Stakeholder feedback provided numerous opportunities for next steps. Conclusions This study contributes to the HiAP literature by providing an innovative mixed-methods design that locates social determinants of STDs within a geographic context, identifies policy solutions from local leaders, highlights community assets through the lens of place attachment, and engages stakeholders in identifying next steps. Findings from this study could inform other redevelopments, community-based studies of STDs, and HiAP efforts. PMID:24179283

[Ethics, equity and social determinants of health].

PubMed

Puyol, Ángel

2012-01-01

The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine. The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine, and between a normative and a descriptive approach. Studies on the social determinants of health have also modified the traditional concept of equity, necessary health policies and the future of bioethics. More specifically: 1) the boundary between medicine and ethics has become much fuzzier, especially in the field of epidemiology, whose objectives are now inseparable from ethical considerations; 2) the concept of health equity traditionally defined as access to healthcare should be corrected or expanded to incorporate unfair health inequalities that occur before patients reach the healthcare system; and 3) the traditional autonomy bias of bioethics should be replaced by a primary concern for social justice and its relationship with health. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

[An examination of the determinants of social withdrawal and affinity for social withdrawal].

PubMed

Watanabe, Asami; Matsui, Yutaka; Takatsuka, Yusuke

2010-12-01

This study examined the determinants of social withdrawal using data from a survey by the Tokyo Metropolitan Government Office for Youth Affairs and Public Safety (2008). In addition, this study identified young people who showed an affinity for social withdrawal although they were not in a state of withdrawal, and examined the determinants of an affinity for social withdrawal. The results of stepwise discriminant analysis showed that factors such as social phobia, depression, violence, and emotional bonds with family differentiated between the general youth group and the social withdrawal group and the "affinity group". Social phobia, violence, and refusal to be interfered in self-decision making differentiated between the social withdrawal group and the "affinity group". This study shows that an "affinity group" should be cared as well as an actual withdrawal group.

Seeds of HOPE: a model for addressing social and economic determinants of health in a women's obesity prevention project in two rural communities.

PubMed

Benedict, Salli; Campbell, Marci; Doolen, Anne; Rivera, Imana; Negussie, Tezita; Turner-McGrievy, Gabrielle

2007-10-01

Socioeconomic status (SES) and income disparity are strong predictors of health, and health promotion interventions that address them are more likely to be meaningful to participants and to sustain positive effects. Seeds of HOPE is an innovative project that is the result of a long-standing collaboration between the University of North Carolina (UNC) Center for Health Promotion and Disease Prevention, a Centers for Disease Control and Prevention (CDC) Prevention Research Center, and communities in rural North Carolina. Initial formative work, including key informant interviews, community surveys, and focus groups, strengthened our understanding of the link between hope and health and the importance of addressing social and economic issues as part of our health promotion interventions. A Seeds of HOPE strategic plan was developed using a community-based participatory process and led to the idea to start Threads of HOPE, an enterprise that will serve as a business laboratory where women will produce and market a unique product and also learn business skills. Threads of HOPE will be a health-enhancing business and will serve as a training program for a new cadre of women entrepreneurs in two rural communities.

FACETS: using open data to measure community social determinants of health.

PubMed

Cantor, Michael N; Chandras, Rajan; Pulgarin, Claudia

2018-04-01

To develop a dataset based on open data sources reflective of community-level social determinants of health (SDH). We created FACETS (Factors Affecting Communities and Enabling Targeted Services), an architecture that incorporates open data related to SDH into a single dataset mapped at the census-tract level for New York City. FACETS (https://github.com/mcantor2/FACETS) can be easily used to map individual addresses to their census-tract-level SDH. This dataset facilitates analysis across different determinants that are often not easily accessible. Wider access to open data from government agencies at the local, state, and national level would facilitate the aggregation and analysis of community-level determinants. Timeliness of updates to federal non-census data sources may limit their usefulness. FACETS is an important first step in standardizing and compiling SDH-related data in an open architecture that can give context to a patient's condition and enable better decision-making when developing a plan of care.

Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health.

PubMed

Jackson, Chazeman S; Gracia, J Nadine

2014-01-01

Despite major advances in medicine and public health during the past few decades, disparities in health and health care persist. Racial/ethnic minority groups in the United States are at disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes from preventable and treatable conditions. As reducing these disparities has become a national priority, insight into the social determinants of health has become increasingly important. This article offers a rationale for increasing the diversity and cultural competency of the health and health-care workforce, and describes key strategies led by the U.S. Department of Health and Human Services' Office of Minority Health to promote cultural competency in the health-care system and strengthen community-level approaches to improving health and health care for all.

Social Influences on Interest. Presidential Address

ERIC Educational Resources Information Center

Bergin, David A.

2016-01-01

Where does enduring individual interest come from? One answer is, through social experience that derives from a need for belongingness. Because of this need, students seek social links that influence the development of individual interest. This may occur through experiences with parents, friends, passionate affinity groups, competition, public…

[Determinants of social participation and social inclusion of people with severe mental illness].

PubMed

Schützwohl, Matthias

2017-03-01

Individuals with mental disorders are known to be socially excluded so that improving social inclusion has become a major goal of healthcare provision. However, empirical research on specific determinants of social inclusion is rather scarce. A cross-sectional survey of adults with a severe mental illness (n =70) was conducted using a measure of participation and social inclusion for individuals with a chronic mental disorder (F-INK). Univariate and multivariate regression analyses were conducted to identify determinants of social participation and social inclusion. Social participation increased with the number of friends and was, independently thereof, higher in adults living independently than in adults living in supported housing arrangements. The level of social inclusion was higher in those cohabitating and increased with duration of illness. Findings on social participation indicate the need for a re-organization of community-based supported housing arrangements, and, with respect to existing settings, an amendment of present conditions. To promote social inclusion, measures to prime a feeling of ongoing social affiliation should be taken during the first years of psychiatric illness.

Training Social Workers and Human Service Professionals to Address the Complex Financial Needs of Clients

ERIC Educational Resources Information Center

Frey, Jodi Jacobson; Hopkins, Karen; Osteen, Philip; Callahan, Christine; Hageman, Sally; Ko, Jungyai

2017-01-01

In social work and other community-based human services settings, clients often present with complex financial problems. As a need for more formal training is beginning to be addressed, evaluation of existing training is important, and this study evaluates outcomes from the Financial Stability Pathway (FSP) project. Designed to prepare…

Social Determinants of Racial Disparities in CKD

PubMed Central

Norton, Jenna M.; Moxey-Mims, Marva M.; Eggers, Paul W.; Narva, Andrew S.; Star, Robert A.; Rodgers, Griffin P.

2016-01-01

Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups. PMID:27178804

A Research Agenda for Helminth Diseases of Humans: Social Ecology, Environmental Determinants, and Health Systems

PubMed Central

Gazzinelli, Andrea; Correa-Oliveira, Rodrigo; Yang, Guo-Jing; Boatin, Boakye A.; Kloos, Helmut

2012-01-01

In this paper, the Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), with the mandate to review helminthiases research and identify research priorities and gaps, focuses on the environmental, social, behavioural, and political determinants of human helminth infections and outlines a research and development agenda for the socioeconomic and health systems research required for the development of sustainable control programmes. Using Stockols' social-ecological approach, we describe the role of various social (poverty, policy, stigma, culture, and migration) and environmental determinants (the home environment, water resources development, and climate change) in the perpetuation of helminthic diseases, as well as their impact as contextual factors on health promotion interventions through both the regular and community-based health systems. We examine these interactions in regard to community participation, intersectoral collaboration, gender, and possibilities for upscaling helminthic disease control and elimination programmes within the context of integrated and interdisciplinary approaches. The research agenda summarises major gaps that need to be addressed. PMID:22545168

[Role of the UNASUR national institutes of health in generating evidence on the social determinants of health].

PubMed

Rosenberg, Félix; Tobar, Sebastián; Buss, Paulo

2015-08-01

The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network's websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.

A Social-Ecological Approach to Promote Self-Determination

ERIC Educational Resources Information Center

Walker, Hill M.; Calkins, Carl; Wehmeyer, Michael L.; Walker, Laura; Bacon, Ansley; Palmer, Susan B.; Jesien, George S.; Nygren, Margaret A.; Heller, Tamar; Gotto, George S.; Abery, Brian H.; Johnson, David R.

2011-01-01

This article describes a social-ecological approach for promoting and enhancing self-determination among individuals with developmental disabilities. A five-level model is presented, based on the interaction of person and environmental factors, that identifies a series of social mediator variables (i.e., social effectiveness, social capital,…

The Social Determinants of Tuberculosis: From Evidence to Action

PubMed Central

Boccia, Delia; Evans, Carlton A.; Adato, Michelle; Petticrew, Mark; Porter, John D. H.

2011-01-01

Growing consensus indicates that progress in tuberculosis control in the low- and middle-income world will require not only investment in strengthening tuberculosis control programs, diagnostics, and treatment but also action on the social determinants of tuberculosis. However, practical ideas for action are scarcer than is notional support for this idea. We developed a framework based on the recent World Health Organization Commission on Social Determinants of Health and on current understanding of the social determinants of tuberculosis. Interventions from outside the health sector—specifically, in social protection and urban planning—have the potential to strengthen tuberculosis control. PMID:21330583

Determining sociability, social space, and social presence in (a)synchronous collaborative groups.

PubMed

Kreijns, Karel; Kirschner, Paul A; Jochems, Wim; Van Buuren, Hans

2004-04-01

The effectiveness of group learning in asynchronous distributed learning groups depends on the social interaction that takes place. This social interaction affects both cognitive and socioemotional processes that take place during learning, group forming, establishment of group structures, and group dynamics. Though now known to be important, this aspect is often ignored, denied or forgotten by educators and researchers who tend to concentrate on cognitive processes and on-task contexts. This "one-sided" educational focus largely determines the set of requirements in the design of computer-supported collaborative learning (CSCL) environments resulting in functional CSCL environments. In contrast, our research is aimed at the design and implementation of sociable CSCL environments which may increase the likelihood that a sound social space will emerge. We use a theoretical framework that is based upon an ecological approach to social interaction, centering on the concept of social affordances, the concept of the sociability of CSCL environments, and social presence theory. The hypothesis is that the higher the sociability, the more likely that social interaction will take place or will increase, and the more likely that this will result in an emerging sound social space. In the present research, the variables of interest are sociability, social space, and social presence. This study deals with the construction and validation of three instruments to determine sociability, social space, and social presence in (a)synchronous collaborating groups. The findings suggest that the instruments have potential to be useful as measures for the respective variables. However, it must be realized that these measures are "first steps."

Happiness and social determinants across age cohorts in Taiwan.

PubMed

Hsu, Hui-Chuan; Chang, Wen-Chiung; Chong, Young-Sook; An, Jeong Shin

2016-09-01

The purpose of this study was to examine happiness and social determinants across age cohorts in Taiwan. The data were obtained from the 2011 Taiwan Social Change Survey (aged 18 +, n = 2,199). The social determinants of happiness included socioeconomic status and social connection. Happiness was not different across the age groups. Receiving less family support, less formal support, more social trust and more control over life were significant for the younger group. Being married and having more social participation were significant for the middle-aged. Receiving less family support and having a higher economic status were significant for the older group. © The Author(s) 2015.

Health in global context; beyond the social determinants of health?

PubMed Central

Krumeich, Anja; Meershoek, Agnes

2014-01-01

The rise of the social determinants of health (SDH) discourse on the basis of statistical evidence that correlates ill health to SDH and pictures causal pathways in comprehensive theoretical frameworks led to widespread awareness that health and health disparities are the outcome of complex pathways of interconnecting SDH. In this paper we explore whether and how SDH frameworks can be translated to effectively inform particular national health policies. To this end we identified major challenges for this translation followed by reflections on ways to overcome them. Most important challenges affecting adequate translation of these frameworks into concrete policy and intervention are 1) overcoming the inclination to conceptualize SDH as mere barriers to health behavior to be modified by lifestyle interventions by addressing them as structural factors instead; 2) obtaining sufficient in-depth insight in and evidence for the exact nature of the relationship between SDs and health; 3) to adequately translate the general determinants and pathways into explanations for ill health and limited access to health care in local settings; 4) to develop and implement policies and other interventions that are adjusted to those local circumstances. We conclude that to transform generic SDH models into useful policy tools and to prevent them to transform in SDH themselves, in depth understanding of the unique interplay between local, national and global SDH in a local setting, gathered by ethnographic research, is needed to be able to address structural SD in the local setting and decrease health inequity.

A qualitative study on the intersectional social determinants for indigenous people who become infected with HIV in their youth.

PubMed

Woodgate, Roberta L; Zurba, Melanie; Tennent, Pauline; Cochrane, Carla; Payne, Mike; Mignone, Javier

2017-07-21

Indigenous young people are currently highly overrepresented in the HIV epidemic in Canada, especially in the Prairie Provinces, such as Manitoba. Understanding HIV-vulnerability in Indigenous peoples must begin with understanding that social determinants are intersectional and linked to the historical legacy of European colonization. In this paper findings that detail the influence of the intersectional social determinants on Indigenous people who become infected with HIV in their youth are presented. The qualitative research design of phenomenology was used as it afforded the opportunity to understand Indigenous young people from their frames of reference and experiences of reality, resulting in a phenomenological understanding of their perspectives and experiences of the early years of living with HIV. A total of 21 Indigenous young people took part open-ended interviews. The stories that the Indigenous young people shared revealed their deeply interconnected social worlds, and how social determinants including abuse, trauma, being part of the child welfare system, and housing and food security were connected throughout various stages of their lives. Such stages included childhood, adolescence and young adulthood (the time of HIV infection), and later adulthood for older participants with the social determinants having multiple influences on their health trajectories. The findings highlight the need for policies and programs that are broadly focused, addressing multiple social determinants together. Overall, there needs to be more emphasis on the multiple social determinants in the life situations of all Indigenous youth. Reducing the health and social disparities in Indigenous youth is key to reducing the number of young Indigenous people diagnosed with HIV. The findings also shed light on the importance of listening to young Indigenous people who have experienced HIV diagnosis and life following diagnosis.

[Social capital as a determinant of public health].

PubMed

Bravo Vallejos, N D

The concept of Social Capital (SC), originally described by Durkheim (1893), is composed of dimensions related to cohesion and trust between members of a social group, and considered by the Word Health Organization (WHO) as part of the social determinants of public health for the decrease of inequities and inequalities in health provision. To contribute to the dissemination of the concept of SC related to the social determinants of Public Health, in order to offer the reader in-depth content to observe the potential applications and practices in this field. Literature search (Google Academics™, PubMed, Science direct™, Ebsco Host™). A total of 294 full-text publications were obtained, and those selected were the most influential sources on the evolution and application of the concept of Social Capital, socioeconomic development and health in the last decade. Although the current evidence shows that Social Capital is a determinant related to health, standards are still needed for its measurement. This could allow the concept to be measured, and facilitate its integration into the form of actions that exert positive influence and contribute to the implementation of institutional interventions planned for development and public health. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Effects of workplace, family and cultural influences on low back pain: what opportunities exist to address social factors in general consultations?

PubMed

Shaw, William S; Campbell, Paul; Nelson, Candace C; Main, Chris J; Linton, Steven J

2013-10-01

Social factors are widely acknowledged in behavioural models of pain and pain management, but incorporating these factors into general medical consultations for low back pain (LBP) can be challenging. While there is no compelling evidence that social factors contribute to LBP onset, these factors have been shown to influence functional limitation and disability, especially the effects of organisational support in the workplace, spousal support, family conflict and social disadvantage. A number of barriers exist to address such social factors in routine medical encounters for LBP, but there is emerging evidence that improving social and organisational support may be an effective strategy to reduce the negative lifestyle consequences of LBP. For clinicians to address these factors in LBP treatment requires a clearer psychosocial framework in assessment and screening, more individualised problem-solving efforts, more patient-centred interventions involving family, peers and workplace supports and a less biomechanical and diagnostic approach. Copyright © 2013 Elsevier Ltd. All rights reserved.

Advocacy through Social Media: Exploring Student Engagement in Addressing Social Issues

ERIC Educational Resources Information Center

Bowen, Glenn A.; Gordon, Nickesia S.; Chojnacki, Margaret K.

2017-01-01

Social media have become ubiquitous and are seen as beneficial to society. Although the use of social media for educational purposes has been the subject of recent research, not much is known about their role in higher education civic engagement. Employing critical discourse analysis, this study explored the function of social media as a tool to…

Social Determinants of HIV-Related Stigma in Faith-Based Organizations.

PubMed

Coleman, Jason D; Tate, Allan D; Gaddist, Bambi; White, Jacob

2016-03-01

To examine the association between social factors in faith-based settings (including religiosity and proximity to people living with HIV/AIDS) and HIV stigma. A total of 1747 congregants from primarily African American faith-based organizations of Project FAITH (Fostering AIDS Initiatives That Heal), a South Carolina statewide initiative to address HIV-related stigma, completed a survey. Female gender (P = .001), higher education (P < .001), knowing someone with HIV/AIDS (P = .01), and knowing someone who is gay (P < .001), but not religiosity, were associated with lower levels of stigma and with lower odds of stigmatizing attitudes (P < .05). Opportunities for connection with people living with HIV/AIDS tailored to the social characteristics of faith-based organizations may address HIV stigma in African American communities.

Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity

PubMed Central

Pierre, Geraldine

2014-01-01

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. PMID:24385659

Integrating the 3Ds--social determinants, health disparities, and health-care workforce diversity.

PubMed

LaVeist, Thomas A; Pierre, Geraldine

2014-01-01

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce.

Challenges Addressing Unmet Need for Contraception: Voices of Family Planning Service Providers in Rural Tanzania.

PubMed

Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin

2015-12-01

Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.

Addressing Social Aggression in State Anti-Bullying Policies

ERIC Educational Resources Information Center

Temkin, Deborah

2008-01-01

Social aggression, or victimization using social exclusion, rumors, and body language, has been overlooked in state anti-bullying policies since the policy surge following the 1999 Columbine Massacres. Social aggression has been associated with social anxiety disorder, depression and suicide, and lowered academic achievement and involvement. An…

Social determinants of adolescent depression: an examination of racial differences.

PubMed

Respress, Brandon N; Morris, Diana L; Gary, Faye A; Lewin, Linda C; Francis, Shelley A

2013-07-01

Conventional behavior theories that assert adolescent risk behaviors are determined by peer and parental relationships are being challenged as research begins to consider broader socioenvironmental factors. This study, using data from the Longitudinal Study for Adolescent Health (Add Health), Wave II, Public Use Data, and the Social Determinants of Adolescent Risk Behaviors (SDOARB) framework, examines relationships among socioeconomic status (SES), academic performance, perceived peer prejudice, and perceived teacher discrimination as predictors of depressive symptoms among high school adolescents. Overall, the study found that GPA was a significant predictor of depressive symptoms across all three racial groups (Black, White, and Other Minority). Teacher discrimination predicted depressive symptoms among White and Other minority adolescents, but not Black adolescents. These findings suggest the need for interventions within schools for both students and teachers around racial differences in perceptions of prejudice and discrimination. Failure to address overt and covert subtleties of discrimination and prejudice within schools and policies which affect these interpersonal dynamics may have a significant impact on the overall mental wellbeing of adolescents.

Political Activities of Social Workers: Addressing Perceived Barriers to Political Participation

ERIC Educational Resources Information Center

Rocha, Cynthia; Poe, Bethanie; Thomas, Veliska

2010-01-01

This article reviews the literature on political participation of social workers and the variables that promote or impede political advocacy. Early research in the 1980s and 1990s most often reported education, feelings of efficacy, having a macro-type job, and being a member of a national association as factors that determine greater political…

Modelling the social and structural determinants of tuberculosis: opportunities and challenges

PubMed Central

Boccia, D.; Dodd, P. J.; Lönnroth, K.; Dowdy, D. W.; Siroka, A.; Kimerling, M. E.; White, R. G.; Houben, R. M. G. J.

2017-01-01

INTRODUCTION: Despite the close link between tuberculosis (TB) and poverty, most mathematical models of TB have not addressed underlying social and structural determinants. OBJECTIVE: To review studies employing mathematical modelling to evaluate the epidemiological impact of the structural determinants of TB. METHODS: We systematically searched PubMed and personal libraries to identify eligible articles. We extracted data on the modelling techniques employed, research question, types of structural determinants modelled and setting. RESULTS: From 232 records identified, we included eight articles published between 2008 and 2015; six employed population-based dynamic TB transmission models and two non-dynamic analytic models. Seven studies focused on proximal TB determinants (four on nutritional status, one on wealth, one on indoor air pollution, and one examined overcrowding, socioeconomic and nutritional status), and one focused on macro-economic influences. CONCLUSIONS: Few modelling studies have attempted to evaluate structural determinants of TB, resulting in key knowledge gaps. Despite the challenges of modelling such a complex system, models must broaden their scope to remain useful for policy making. Given the intersectoral nature of the interrelations between structural determinants and TB outcomes, this work will require multidisciplinary collaborations. A useful starting point would be to focus on developing relatively simple models that can strengthen our knowledge regarding the potential effect of the structural determinants on TB outcomes. PMID:28826444

Right back like we left something: examining the commodification of Blackness in social services to address racial disparities - the case of Hartford.

PubMed

Searcy, Yan

2018-05-14

Market-based approaches to addressing racial disparities have essentially re-commodified Blackness. Utilizing Hartford, which contains the largest percentage of Blacks per capita in Connecticut, this article examines market-based approaches to address racial disparities while discussing Blackness as an enduring commodity that is tied to private sector profit. The study argues that market based approaches incentivize punitive approaches to social problems associated with Blackness. The study concludes by suggesting that addressing disparities utilizing markets requires reimagining policy incentives to focus on prevention and treatment of social problems associated with Blackness. Failure to reimagine policy incentives serves to commodify Blackness whereby industries benefit from the continuity of disparities rather than the elimination of disparities.

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health

PubMed Central

Prochaska, John D.; Nolen, Alexandra B.; Kelley, Hilton; Sexton, Ken; Linder, Stephen H.; Sullivan, John

2014-01-01

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society. PMID:24771993

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health.

PubMed

Prochaska, John D; Nolen, Alexandra B; Kelley, Hilton; Sexton, Ken; Linder, Stephen H; Sullivan, John

2014-01-01

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society.

Social determinants and osteoarthritis outcomes

PubMed Central

Luong, My-Linh N; Cleveland, Rebecca J; Nyrop, Kirsten A; Callahan, Leigh F

2012-01-01

Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual’s socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one’s neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA. PMID:23243459

The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review.

PubMed

Hynie, Michaela

2018-05-01

With the global increase in the number of refugees and asylum seekers, mental health professionals have become more aware of the need to understand and respond to the mental health needs of forced migrants. This critical review summarizes the findings of recent systematic reviews and primary research on the impact of post-migration conditions on mental disorders and PTSD among refugees and asylum seekers. Historically, the focus of mental health research and interventions with these populations has been on the impact of pre-migration trauma. Pre-migration trauma does predict mental disorders and PTSD, but the post-migration context can be an equally powerful determinant of mental health. Moreover, post-migration factors may moderate the ability of refugees to recover from pre-migration trauma. The importance of post-migration stressors to refugee mental health suggests the need for therapeutic interventions with psychosocial elements that address the broader conditions of refugee and asylum seekers' lives. However, there are few studies of multimodal interventions with refugees, and even fewer with control conditions that allow for conclusions about their effectiveness. These findings are interpreted using a social determinants of health framework that connects the risk and protective factors in the material and social conditions of refugees' post-migration lives to broader social, economic and political factors.

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

PubMed Central

2013-01-01

Background The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Methods Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. Results While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services’ responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse “dilemmatic space” in their work. Conclusions The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health’s recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints.

PubMed

Baum, Frances E; Legge, David G; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Jolley, Gwyneth M

2013-05-10

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services' responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse "dilemmatic space" in their work. The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health's recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value

Social determinants of self-reported health for Canada's indigenous peoples: a public health approach.

PubMed

Bethune, R; Absher, N; Obiagwu, M; Qarmout, T; Steeves, M; Yaghoubi, M; Tikoo, R; Szafron, M; Dell, C; Farag, M

2018-04-14

In Canada, indigenous peoples suffer from a multitude of health disparities. To better understand these disparities, this study aims to examine the social determinants of self-reported health for indigenous peoples in Canada. This study uses data from Statistics Canada's Aboriginal Peoples Survey 2012. Multinomial logistic regression models were used to examine how selected social determinants of health are associated with self-reported health among off-reserve First Nations and Métis peoples in Canada. Our analysis shows that being older, female, and living in urban settings were significantly associated with negative ratings of self-reported health status among the indigenous respondents. Additionally, we found that higher income and levels of education were strongly and significantly associated with positive ratings of self-reported health status. Compared with indigenous peoples with an education level of grade 8 or lower, respondents with higher education were 10 times (5.35-22.48) more likely to report 'excellent' and 'very good' health. Respondents who earned more than $40,000 annually were three times (2.17-4.72) more likely to report 'excellent' and 'very good' health compared with those who earned less than $20,000 annually. When interacted with income, we also found that volunteering in the community is associated with better self-reported health. There are known protective determinants (income and education) and risk determinants (location of residence, gender, and age) which are associated with self-reported health status among off-reserve First Nations and Métis peoples. For indigenous-specific determinants, volunteering in the community appears to be associated with self-perceived health status. Thus, addressing these determinants will be necessary to achieve better health outcomes for indigenous peoples in Canada. Next steps include developing indigenous-specific social determinants of health indicators that adequately measure culture, connection

Essentialism goes social: belief in social determinism as a component of psychological essentialism.

PubMed

Rangel, Ulrike; Keller, Johannes

2011-06-01

Individuals tend to explain the characteristics of others with reference to an underlying essence, a tendency that has been termed psychological essentialism. Drawing on current conceptualizations of essentialism as a fundamental mode of social thinking, and on prior studies investigating belief in genetic determinism (BGD) as a component of essentialism, we argue that BGD cannot constitute the sole basis of individuals' essentialist reasoning. Accordingly, we propose belief in social determinism (BSD) as a complementary component of essentialism, which relies on the belief that a person's essential character is shaped by social factors (e.g., upbringing, social background). We developed a scale to measure this social component of essentialism. Results of five correlational studies indicate that (a) BGD and BSD are largely independent, (b) BGD and BSD are related to important correlates of essentialist thinking (e.g., dispositionism, perceived group homogeneity), (c) BGD and BSD are associated with indicators of fundamental epistemic and ideological motives, and (d) the endorsement of each lay theory is associated with vital social-cognitive consequences (particularly stereotyping and prejudice). Two experimental studies examined the idea that the relationship between BSD and prejudice is bidirectional in nature. Study 6 reveals that rendering social-deterministic explanations salient results in increased levels of ingroup favoritism in individuals who chronically endorse BSD. Results of Study 7 show that priming of prejudice enhances endorsement of social-deterministic explanations particularly in persons habitually endorsing prejudiced attitudes. 2011 APA, all rights reserved

Criticisms of chlorination: social determinants of drinking water beliefs and practices among the Tz'utujil Maya.

PubMed

Nagata, Jason M; Valeggia, Claudia R; Smith, Nathaniel W; Barg, Frances K; Guidera, Mamie; Bream, Kent D W

2011-01-01

To explore social determinants of drinking water beliefs and practices among the Tz'utujil Maya of Santiago Atitlán, Guatemala, through analysis of demographics, socioeconomic status, memory of historical events, sensory experience, and water attitudes. Parallel mixed (qualitative and quantitative) methods, including participant observation, in-depth interviews based on a purposive sample, and 201 semi-structured interviews based on a regional quota sample, were used to collect data from March 2007 to August 2008. Data analysis included the use of grounded theory methodology and Pearson's chi-square test for independence. Qualitative results based on grounded theory highlighted how memory of the Guatemalan Civil War and Hurricane Stan, attitudes about Lake Atitlán water, and the taste and smell of chlorine influenced Tz'utujil Maya drinking water beliefs. Quantitative survey results revealed that differences in ethnicity, literacy, years of schooling, distrust of the water supply during the Civil War and Hurricane Stan, and current beliefs about Lake Atitlán and tap water quality were associated with significantly different water self-treatment practices. In accordance with social determinants of health paradigms, demographic, socioeconomic, social, cultural, political, and historical factors continue to be significant determinants of water-related health. Public health water interventions must address inequalities related to these underlying factors in order to achieve maximum effectiveness.

The corporate impact of addressing social issues: a financial case study of a project in Peru.

PubMed

Dabbs, Alan; Bateson, Matthew

2002-05-01

Large, multinational resource development projects can affect many aspects, including social, economic and ecological realities, in the regions where they operate. Social and environmental issues that are usually ignored in such projects are increasingly affecting the financial future of multinational corporations in negative ways. In this article, we advance the argument that corporations can successfully manage these issues and that if they choose to view these management efforts as an investment rather than an expense, they may well acquire a competitive advantage over companies that do not. We describe as a case study the Camisea natural gas and condensates development project in Peru, operated by Shell Prospecting and Development Peru (SPDP). Camisea is one of the first projects anywhere in the world to conduct a detailed analysis of key industry-related social issues and the processes, required investment and financial impact of managing them. The Camisea example supports the argument that addressing social and environmental concerns makes financial sense. In present value terms, the benefit of managing these concerns was expected to surpass the cost investment by approximately US$50 million.

Creating change in government to address the social determinants of health: how can efforts be improved?

PubMed

Carey, Gemma; Crammond, Brad; Keast, Robyn

2014-10-20

The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the 'Fairness Agenda'), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards 'joined up government', where greater integration is sought between government departments, agencies and actors outside of government. In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives.We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise 'change instruments' that have been found to be ineffective. Moreover, we find that - like many joined up initiatives - there is room for improvement in the alignment between the goals of the interventions and their design. Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be 'fit-for-purpose', and cannot be easily replicated from one context to the next.

Addressing social aspects associated with wastewater treatment facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Padilla-Rivera, Alejandro; Morgan-Sagastume, Juan Manuel; Noyola, Adalberto

In wastewater treatment facilities (WWTF), technical and financial aspects have been considered a priority, while other issues, such as social aspects, have not been evaluated seriously and there is not an accepted methodology for assessing it. In this work, a methodology focused on social concerns related to WWTF is presented. The methodology proposes the use of 25 indicators as a framework for measuring social performance to evaluate the progress in moving towards sustainability. The methodology was applied to test its applicability and effectiveness in two WWTF in Mexico (urban and rural). This evaluation helped define the key elements, stakeholders andmore » barriers in the facilities. In this context, the urban facility showed a better overall performance, a result that may be explained mainly by the better socioeconomic context of the urban municipality. Finally, the evaluation of social aspects using the semi-qualitative approach proposed in this work allows for a comparison between different facilities and for the identification of strengths and weakness, and it provides an alternative tool for achieving and improving wastewater management. - Highlights: • The methodology proposes 25 indicators as a framework for measuring social performance in wastewater treatment facilities. • The evaluation helped to define the key elements, stakeholders and barriers in the wastewater treatment facilities. • The evaluation of social aspects allows the identification of strengths and weakness for improving wastewater management. • It provides a social profile of the facility that highlights the best and worst performances.« less

Intersectoriality in Danish municipalities: corrupting the social determinants of health?

PubMed

Holt, Ditte H; Frohlich, Katherine L; Tjørnhøj-Thomsen, Tine; Clavier, Carole

2017-10-01

Action on the social determinants of health (SDH) through intersectoral policymaking is often suggested to promote health and health equity. This paper argues that the process of intersectoral policymaking influences how the SDH are construed and acted upon in municipal policymaking. We discuss how the intersectoral policy process legitimates certain practices in the setting of Danish municipal health promotion and the potential impact this can have for long-term, sustainable healthy public policy. Based on ethnographic fieldwork, we show how the intention of intersectoriality produces a strong concern for integrating health into non-health sectors to ensure productive collaboration. To encourage this integration, health is often framed as a means to achieve the objectives of non-health sectors. In doing so, the intersectoral policy process tends to favor smaller-scale interventions that aim to introduce healthier practices into various settings, e.g. creating healthy school environments for increased physical activity and healthy eating. While other more overarching interventions on the health impacts of broader welfare policies (e.g. education policy) tend to be neglected. The interventions hereby neglect to address more fundamental SDH. Based on these findings, we argue that intersectoral policymaking to address the SDH may translate into a limited approach to action on so-called 'intermediary determinants' of health, and as such may end up corrupting the broader SDH. Further, we discuss how this corruption affects the intended role of non-health sectors in tackling the SDH, as it may impede the overall success and long-term sustainability of intersectoral efforts. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Commentary: what role should physician organizations play in addressing social justice issues?

PubMed

Bright, Cedric M

2012-06-01

A study by Peek and colleagues in this issue reveals that although racial and ethnic health disparities are recognized as a major national challenge, few physician organizations with both the influence and ability to change practice standards and address disparities appear to be effectively directing their resources to mitigate health disparities. In this commentary, the author examines the history of U.S. health disparities through the lens of social justice. He argues that today, physician organizations have the opportunity to change the paradigm of medicine from being a reactive industry to becoming a proactive industry through collaborations such as the Commission to End Health Disparities, which brings together more than 60 organizations, and the National Medical Association's "We Stand With You" program to improve health and combat disparities. Physician organizations can also address health disparities through advocacy for fair reimbursement policies, funding for pipeline programs to increase the diversity of the workforce, diversity in clinical trials, and other issues. Health disparities present to us in organized medicine a challenge that is cleverly disguised as an immovable object but that is truly a great opportunity for innovation, improvement, and growth. Physician organizations have a unique opportunity to provide avenues of innovation and accomplishment.

Determinism versus Creativity: Which Way for Social Work?

ERIC Educational Resources Information Center

Peile, Colin

1993-01-01

Contends that dominant cosmology within social work is determinism. Argues for creative cosmology that can synthesize deterministic and random processes. Sees this development made possible by reconceptualization of relative nature of time. Discussion is grounded in relation to small example of social work practice, and implications of creative…

Social determinants of health--a comparative study of Bosnian adolescents in different cultural contexts.

PubMed

Sujoldzić, Anita; Peternel, Lana; Kulenović, Tarik; Terzić, Rifet

2006-12-01

This study investigated the effects of sociocultural contexts on health and the psychological well-being of immigrant adolescents, aged 15 to 18 years, originally from Bosnia and Herzegovina and now living as displaced persons either in Bosnia, or immigrants in Croatia and Austria. The study addresses the social determinants of health with a specific focus on five factors in the social environment that might have an influence on health status: gender, socio-economic status (SES), perceived discrimination and exposure to violence, social support and religious commitment. Dependent variables included self-rated health, a count of self-reported objective health problems and a range of indices of psychological well-being (somatic stress, anxiety, depression and self-esteem). The purpose of the study was to examine whether social risk factors have an effect on health, which factors mediate these effects on self-rated health and to assess whether these effects differ by gender Results indicate that perceived discrimination and violence are related to poor health through psychological stress as a major mechanism with stronger effects for girls in the study. Differences across the three socio-cultural contexts reveal the complexity and specificity of the relationships between analyzed factors as the association between discrimination and health was attenuated for some groups due to the protective resources of immigrants.

Gender/Sex as a Social Determinant of Cardiovascular Risk.

PubMed

O'Neil, Adrienne; Scovelle, Anna J; Milner, Allison J; Kavanagh, Anne

2018-02-20

The social gradient for cardiovascular disease (CVD) onset and outcomes is well established. The American Heart Association's Social Determinants of Risk and Outcomes of Cardiovascular Disease Scientific Statement advocates looking beyond breakthroughs in biological science toward a social determinants approach that focuses on socioeconomic position, race and ethnicity, social support, culture and access to medical care, and residential environments to curb the burden of CVD going forward. Indeed, the benefits of this approach are likely to be far reaching, enhancing the positive effects of advances in CVD related to prevention and treatment while reducing health inequities that contribute to CVD onset and outcomes. It is disappointing that the role of gender has been largely neglected despite being a critical determinant of cardiovascular health. It is clear that trajectories and outcomes of CVD differ by biological sex, yet the tendency for sex and gender to be conflated has contributed to the idea that both are constant or fixed with little room for intervention. Rather, as distinct from biological sex, gender is socially produced. Overlaid on biological sex, gender is a broad term that shapes and interacts with one's cognition to guide norms, roles, behaviors, and social relations. It is a fluid construct that varies across time, place, and life stage. Gender can interact with biological sex and, indeed, other social determinants, such as ethnicity and socioeconomic position, to shape cardiovascular health from conception, through early life when health behaviors and risk factors are shaped, into adolescence and adulthood. This article will illustrate how gender shapes the early adoption of health behaviors in childhood, adolescence, and young adulthood by focusing on physical activity, drinking, and smoking behaviors (including the influence of role modeling). We will also discuss the role of gender in psychosocial stress with a focus on trauma from life

Terms of Address in Libyan Arabic Compared to Other Arabic Varieties

ERIC Educational Resources Information Center

Abugharsa, ?Azza B.

2014-01-01

This paper presents a discussion about the terms of address used mainly in Libyan Arabic, and how they are similar and/or different from the terms used in other Arabic societies. In addition, the current paper describes how the use of such terms is determined by various social factors and perceptions, and how it is emphasized that these titles…

Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.

PubMed

Dasgupta, Nabarun; Beletsky, Leo; Ciccarone, Daniel

2018-02-01

The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Overreliance on opioid medications is emblematic of a health care system that incentivizes quick, simplistic answers to complex physical and mental health needs. In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge. We trace the crisis' trajectory through the intertwined use of opioid analgesics, heroin, and fentanyl analogs, and we urge engaging the structural determinants lens to address this formidable public health emergency. A broad focus on suffering should guide both patient- and community-level interventions.

Inclusion of the equity focus and social determinants of health in health care education programmes in Colombia: a qualitative approach.

PubMed

Hernández-Rincón, Erwin H; Pimentel-González, Juan P; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción

2016-06-01

The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Social determinants of health, inequality and social inclusion among people with disabilities.

PubMed

Fiorati, Regina Celia; Elui, Valeria Meirelles Carril

2015-01-01

to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

Experimental Evidence that Social Relationships Determine Individual Foraging Behavior.

PubMed

Firth, Josh A; Voelkl, Bernhard; Farine, Damien R; Sheldon, Ben C

2015-12-07

Social relationships are fundamental to animals living in complex societies. The extent to which individuals base their decisions around their key social relationships, and the consequences this has on their behavior and broader population level processes, remains unknown. Using a novel experiment that controlled where individual wild birds (great tits, Parus major) could access food, we restricted mated pairs from being allowed to forage at the same locations. This introduced a conflict for pair members between maintaining social relationships and accessing resources. We show that individuals reduce their own access to food in order to sustain their relationships and that individual foraging activity was strongly influenced by their key social counterparts. By affecting where individuals go, social relationships determined which conspecifics they encountered and consequently shaped their other social associations. Hence, while resource distribution can determine individuals' spatial and social environment, we illustrate how key social relationships themselves can govern broader social structure. Finally, social relationships also influenced the development of social foraging strategies. In response to forgoing access to resources, maintaining pair bonds led individuals to develop a flexible "scrounging" strategy, particularly by scrounging from their pair mate. This suggests that behavioral plasticity can develop to ameliorate conflicts between social relationships and other demands. Together, these results illustrate the importance of considering social relationships for explaining behavioral variation due to their significant impact on individual behavior and demonstrate the consequences of key relationships for wider processes. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Addressing Social Issues in the Classroom and Beyond: The Pedagogical Efforts of Pioneers in the Field. Research in Curriculum and Instruction

ERIC Educational Resources Information Center

Totten, Samuel, Ed.; Pedersen, Jon, Ed.

2007-01-01

Addressing Social Issues in the Classroom and Beyond: The Pedagogical Efforts of Pioneers in the Field is comprised of essays that delineate the genesis and evolution of the thought and work of pioneers in the field of social issues and education. The authors (many of whom, themselves, are noted professors of education and who have done…

[Latin-American public policy regarding social determinants of health].

PubMed

García-Ramírez, Jorge A; Vélez-Álvarez, Consuelo

2013-01-01

The study was aimed at identifying Latin-American countries' public policy which has been related to the social determinants of health. A topic review was thus made of papers kept in the 22 Latin-American countries' databases and official documents issued by their multilateral organisations and ministries of health. The World Health Organization's concept of the social determinants of health has been summarised and a history given of the pertinent work developed worldwide in regions such as Europe and Latin-America. Public policy regarding the field of study in Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, México and Venezuela has been described. It was concluded that Latin-America provides a panorama of inequality regarding the application of policy concerning the social determinants of health and that there was segmented intervention, mainly regarding intermediate determinants of health, without taking an integrated approach from different entrance points into account, according to the stated conceptual framework.

Variation in Swedish Address Practices

ERIC Educational Resources Information Center

Norrby, Catrin

2006-01-01

This article explores variation in address in contemporary Swedish in Sweden-Swedish and Finland-Swedish. The research is part of a large-scale Australian project on changes in the address systems of French, German and Swedish. The present article focuses on results from 72 social network interviews conducted in Sweden (Gothenburg) and Finland…

Addressing therapeutic boundaries in social networking.

PubMed

Ginory, Almari; Sabatier, Laura Mayol; Eth, Spencer

2012-01-01

Facebook is the leading social networking website, with over 500 million users. Prior studies have shown an increasing number of housestaff accessing the site. While Facebook can be used to foster camaraderie, it can also create difficulties in the doctor-patient relationship, especially when boundaries are crossed. This study explored the prevalence of such boundary crossings and offers recommendations for training. An anonymous voluntary survey regarding Facebook use was distributed to current psychiatry residents through the American Psychiatric Association (APA) listserv. Of the 182 respondents, 95.7% had current Facebook profiles, and 9.7% had received friend requests from patients. In addition, 18.7% admitted to viewing patient profiles on Facebook. There is a substantial utilization of Facebook among psychiatric residents as compared with prior studies. Specific guidance regarding social media websites and the potential for ethical difficulties should be offered to trainees. © 2012 Guilford Publications, Inc.

Addressing the social determinants of health through the Alameda County, California, place matters policy initiative.

PubMed

Schaff, Katherine; Desautels, Alexandra; Flournoy, Rebecca; Carson, Keith; Drenick, Teresa; Fujii, Darlene; Lee, Anna; Luginbuhl, Jessica; Mena, Mona; Shrago, Amy; Siegel, Anita; Stahl, Robert; Watkins-Tartt, Kimi; Willow, Pam; Witt, Sandra; Woloshin, Diane; Yamashita, Brenda

2013-11-01

In Alameda County, California, significant health inequities by race/ethnicity, income, and place persist. Many of the county's low-income residents and residents of color live in communities that have faced historical and current disinvestment through public policies. This disinvestment affects community conditions such as access to economic opportunities, well-maintained and affordable housing, high-quality schools, healthy food, safe parks, and clean water and air. These community conditions greatly affect health. At the invitation of the Joint Center for Political and Economic Studies' national Place Matters initiative, Alameda County Supervisor Keith Carson's Office and the Alameda County Public Health Department launched Alameda County Place Matters, an initiative that addresses community conditions through local policy change. We describe the initiative's creation, activities, policy successes, and best practices.

Interventions Addressing the Social Determinants of Teenage Pregnancy

ERIC Educational Resources Information Center

Fletcher, Adam; Harden, Angela; Brunton, Ginny; Oakley, Ann; Bonell, Chris

2008-01-01

Purpose: The limited evidence of effectiveness of existing teenage pregnancy strategies which focus on sex education, together with growing evidence that factors such as poor school ethos, disaffection, truancy, poor employment prospects and low expectations are associated with teenage pregnancy, has increased interest in interventions which…

Integrating the social determinants of health into two interprofessional courses: Findings from a pilot study.

PubMed

Lane, Sandra D; Keefe, Robert H; Rubinstein, Robert A; Hall, Meghan; Kelly, Kathleen A; Satterly, Lynn Beth; Shaw, Andrea; Fisher, Julian

2018-02-07

Five colleges and universities in Upstate New York, United States, created the 'Route-90 Collaborative' to support faculty implementing the Institute of Medicine's (IOM) Framework for Educating Health Professionals to Address the Social Determinants of Health. The two courses described herein used a flipped classroom approach in which students from 14 different nations were responsible for facilitating individual classes. This descriptive study used an educational intervention in two interprofessional courses - reproductive health and global health - based on the IOM Framework into two courses. The evaluation used quantitative and open-ended text response data from students. Course evaluations indicated the students found the courses helped them to learn more about health issues and service delivery in various countries, expand their knowledge base on sociocultural and ecological influences on health care, and broaden their perspectives on various health topics so they will be able to provide higher quality healthcare. Although this is the first effort of our Collaborative to implement the Framework, given the student feedback, we believe implementing the Framework in various courses has the potential to enhance healthcare service delivery and reduce the negative impact of social determinants of health.

Addressing the Social Determinants of Health through the Alameda County, California, Place Matters Policy Initiative

PubMed Central

Schaff, Katherine; Flournoy, Rebecca; Carson, Keith; Drenick, Teresa; Fujii, Darlene; Lee, Anna; Luginbuhl, Jessica; Mena, Mona; Shrago, Amy; Siegel, Anita; Stahl, Robert; Watkins-Tartt, Kimi; Willow, Pam; Witt, Sandra; Woloshin, Diane; Yamashita, Brenda

2013-01-01

In Alameda County, California, significant health inequities by race/ethnicity, income, and place persist. Many of the county's low-income residents and residents of color live in communities that have faced historical and current disinvestment through public policies. This disinvestment affects community conditions such as access to economic opportunities, well-maintained and affordable housing, high-quality schools, healthy food, safe parks, and clean water and air. These community conditions greatly affect health. At the invitation of the Joint Center for Political and Economic Studies' national Place Matters initiative, Alameda County Supervisor Keith Carson's Office and the Alameda County Public Health Department launched Alameda County Place Matters, an initiative that addresses community conditions through local policy change. We describe the initiative's creation, activities, policy successes, and best practices. PMID:24179279

An interdisciplinary perspective on social and physical determinants of seismic risk

NASA Astrophysics Data System (ADS)

Lin, K.-H.; Chang, Y.-C.; Liu, G.-Y.; Chan, C.-H.; Lin, T.-H.; Yeh, C.-H.

2015-01-01

While disaster studies researchers usually view risk as a function of hazard, exposure, and vulnerability, few studies have systematically examined the relationships among the various physical and socioeconomic determinants underlying disasters, and fewer have done so through seismic risk analysis. In the context of the 1999 Chi-Chi earthquake in Taiwan, this study constructs five hypothetical models to test different determinants that affect disaster fatality at the village level, namely seismic hazard intensity, population, building fragility, demographics and socioeconomics. The Poisson Regression Model is used to estimate the impact of natural hazards and social factors on fatality. Results indicate that although all of the determinants have an impact on the specific dimension of seismic fatality, some indicators of social inequality, such as gender ratio, dependency ratio, income and its SD, are the driving determinants deteriorating vulnerability to seismic risk. These findings have strong social implications for policy interventions to mitigate such disasters. This study presents an interdisciplinary investigation into social and physical determinants in seismic risk.

Opioid Crisis: No Easy Fix to Its Social and Economic Determinants

PubMed Central

Beletsky, Leo; Ciccarone, Daniel

2018-01-01

The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Overreliance on opioid medications is emblematic of a health care system that incentivizes quick, simplistic answers to complex physical and mental health needs. In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge. We trace the crisis’ trajectory through the intertwined use of opioid analgesics, heroin, and fentanyl analogs, and we urge engaging the structural determinants lens to address this formidable public health emergency. A broad focus on suffering should guide both patient- and community-level interventions. PMID:29267060

Social determinants of workers' health in Central America.

PubMed

Aragón, Aurora; Partanen, Timo; Felknor, Sarah; Corriols, Marianela

2011-01-01

This communication summarizes the available data on work-related determinants of health in Central America. The Central American working population is young and moving from agriculture toward industry and services. Ethnicity, gender, migration, subemployment and precarious work, informality, rural conditions, low-level educational, poverty, ubiquitous worksite health hazards, insufficient occupational health services, low labor inspection density, and weak unions define the constellation of social determinants of workers' health in Central America. Data are, however, scanty both for hazards and work-related illnesses and injuries. Governments and industries have the responsibility of opening decent work opportunities, especially for those facing multiple inequalities in social determinants of health. A first step would be the ratification and implementation of the ILO Convention (187) on occupational safety and health by the seven national governments of the region.

Health workers who ask about social determinants of health are more likely to report helping patients: Mixed-methods study.

PubMed

Naz, Anila; Rosenberg, Ellen; Andersson, Neil; Labonté, Ronald; Andermann, Anne

2016-11-01

To assess the feasibility of implementing a clinical decision aid called the CLEAR Toolkit that helps front-line health workers ask their patients about social determinants of health, refer to local support resources, and advocate for wider social change. A mixed-methods study using quantitative (online self-completed questionnaires) and qualitative (in-depth interviews, focus groups, and key informant interviews) methods. A large, university-affiliated family medicine teaching centre in Montreal, Que, serving one of the most ethnically diverse populations in Canada. Fifty family doctors and allied health workers responded to the online survey (response rate of 50.0%), 15 completed in-depth interviews, 14 joined 1 of 2 focus groups, and 3 senior administrators participated in key informant interviews. Our multimethod approach included an online survey of front-line health workers to assess current practices and collect feedback on the tool kit; in-depth interviews to understand why they consider certain patients to be more vulnerable and how to help such patients; focus groups to explore barriers to asking about social determinants of health; and key informant interviews with high-level administrators to identify organizational levers for changing practice. Senior administrators consider asking about social determinants to be part of the mandate of health workers. However, barriers perceived by front-line clinicians include insufficient training in social history taking, uncertainty about how to address these issues in clinical practice, and a lack of knowledge of local referral resources. Health workers with specific ways of asking patients about their social challenges were more likely to report having helped their patients as compared with those who did not know how to ask (93.8% vs 52.9%; P = .003). While health workers recognize the importance of social determinants, many are unsure how to ask about these often sensitive issues or where to refer patients. The

Social determinants of self-reported health in women and men: understanding the role of gender in population health.

PubMed

Hosseinpoor, Ahmad Reza; Stewart Williams, Jennifer; Amin, Avni; Araujo de Carvalho, Islene; Beard, John; Boerma, Ties; Kowal, Paul; Naidoo, Nirmala; Chatterji, Somnath

2012-01-01

Women and men share similar health challenges yet women report poorer health. The study investigates the social determinants of self-reported health in women and men, and male-female differences in health. Data on 103154 men and 125728 women were analysed from 57 countries in the World Health Survey 2002-2004. Item Response Theory was used to construct a composite measure of health. Associations between health and determinants were assessed using multivariate linear regression. Blinder-Oaxaca decomposition partitioned the inequality in health between women and men into an "explained" component that arises because men and women differ in social and economic characteristics, and an "unexplained" component due to the differential effects of these characteristics. Decomposition was repeated for 18 countries in the World Health Organization (WHO) African region and 19 countries in the WHO European region. Women's health was significantly lower than men's. Health was associated with education, household economic status, employment, and marital status after controlling for age. In the pooled analysis decomposition showed that 30% of the inequality was "explained", of which almost 75% came from employment, education, marital status. The differential effects of being in paid employment increased the inequality. When countries in Africa and Europe were compared, the "explained" component (31% and 39% respectively) was largely attributed to the social determinants in the African countries and to women's longevity in the European countries. Being in paid employment had a greater positive effect on the health of males in both regions. Ways in which age and the social determinants contribute to the poorer health status of women compared with men varies between groups of countries. This study highlights the need for action to address social structures, institutional discrimination and harmful gender norms and roles that differently influence health with ageing.

Social Determinants of Self-Reported Health in Women and Men: Understanding the Role of Gender in Population Health

PubMed Central

Hosseinpoor, Ahmad Reza; Stewart Williams, Jennifer; Amin, Avni; Araujo de Carvalho, Islene; Beard, John; Boerma, Ties; Kowal, Paul; Naidoo, Nirmala; Chatterji, Somnath

2012-01-01

Background Women and men share similar health challenges yet women report poorer health. The study investigates the social determinants of self-reported health in women and men, and male-female differences in health. Methods Data on 103154 men and 125728 women were analysed from 57 countries in the World Health Survey 2002–2004. Item Response Theory was used to construct a composite measure of health. Associations between health and determinants were assessed using multivariate linear regression. Blinder-Oaxaca decomposition partitioned the inequality in health between women and men into an “explained" component that arises because men and women differ in social and economic characteristics, and an “unexplained" component due to the differential effects of these characteristics. Decomposition was repeated for 18 countries in the World Health Organization (WHO) African region and 19 countries in the WHO European region. Results Women's health was significantly lower than men's. Health was associated with education, household economic status, employment, and marital status after controlling for age. In the pooled analysis decomposition showed that 30% of the inequality was “explained", of which almost 75% came from employment, education, marital status. The differential effects of being in paid employment increased the inequality. When countries in Africa and Europe were compared, the “explained" component (31% and 39% respectively) was largely attributed to the social determinants in the African countries and to women's longevity in the European countries. Being in paid employment had a greater positive effect on the health of males in both regions. Conclusions Ways in which age and the social determinants contribute to the poorer health status of women compared with men varies between groups of countries. This study highlights the need for action to address social structures, institutional discrimination and harmful gender norms and roles that differently

Using social marketing to address barriers and motivators to agricultural safety and health best practices.

PubMed

Yoder, Aaron M; Murphy, Dennis J

2012-01-01

Social marketing is an intervention development strategy that pays considerable attention to barriers to and motivators for behavioral change or adoption of recommended behaviors. Barriers are obstacles that prevent individuals from changing or adopting behaviors and are often referred to as the "cons" or "costs" of doing something. Motivators, on the other hand, are factors that encourage individuals to change or adopt behaviors and are often referred to as the "pros," "benefits," or "influencing factors" of doing something. Importantly, social marketing does not target education or knowledge change as an end point; rather, it targets behavior change. Studies across several types of desired behaviors (e.g., smoking cessation, weight control, more exercise, sunscreen use, radon testing) using the Stages of Change model have found systematic relationships between stages of change and pros and cons of changing behavior. A review of literature identifies numerous research and intervention studies that directly reference social marketing in agricultural safety and health, studies that identify reasons why parents allow their children to be exposed to hazardous situations on the farm, and reasons why youth engage in risky behaviors, but only two studies were found that show evidence of systematically researching specific behavioral change motivating factors. The authors offer several suggestions to help address issues relating to social marketing and agricultural safety and health.

Privacy Breach Analysis in Social Networks

NASA Astrophysics Data System (ADS)

Nagle, Frank

This chapter addresses various aspects of analyzing privacy breaches in social networks. We first review literature that defines three types of privacy breaches in social networks: interactive, active, and passive. We then survey the various network anonymization schemes that have been constructed to address these privacy breaches. After exploring these breaches and anonymization schemes, we evaluate a measure for determining the level of anonymity inherent in a network graph based on its topological structure. Finally, we close by emphasizing the difficulty of anonymizing social network data while maintaining usability for research purposes and offering areas for future work.

The Social Determinants of Health in Military Forces of Iran: A Qualitative Study

PubMed Central

Sanaeinasab, Hormoz; Ghanei, Mostafa; Mehrabi Tavana, Ali; Ravangard, Ramin; Karamali, Mazyar

2015-01-01

Providing effective health interventions and achieving equity in health need to apply the community-based approaches such as social determinants of health. In the military organizations, these determinants have received less attention from the military health researchers and policymakers. Therefore, this study aimed to identify and explain the social determinants affecting the health of military forces in Iran. This was a qualitative study which was conducted in 2014. The required data were collected through semistructured interviews and analyzed through Conventional Content Analysis. The studied sample consisted of 22 military health experts, policymakers, and senior managers selected using purposeful sampling method with maximum variation sampling. MAXQDA.2007 was used to analyze the collected data. After analyzing the collected data, two main contents, that is, “general social determinants of health” and “military social determinants of health,” with 22 themes and 90 subthemes were identified as the social determinants of military forces' health. Main themes were religious rule, spirituality promotion policies, international military factors, military command, and so forth. Given the role and importance of social factors determining the military forces' health, it can be recommended that the military organizations should pay more attention to these determinants in making policies and creating social, economic, and cultural structures for their forces. PMID:26379716

The Influence of Social Determinants on Late Stage Breast Cancer for Women in Mississippi.

PubMed

Fortune, Melody L

2017-02-01

Breast cancer is the most common diagnosed cancer in women exacting an emotional and economic hardship for them and their families. There are no known causes of breast cancer, but there are certain genetic, social, and environment risk factors that pre-dispose women to this disease. Also, diagnosis at later stages of disease has been shown to have adverse outcomes for many as compared to early stages. The social determinants researched to examine their influence on breast cancer outcomes were race, health insurance, and income. The results of this study confirmed that race and health insurance were the two major factors that negatively impacted stages of breast cancer diagnoses. The purpose of this study was to investigate the influence that social determinants have on stage of breast cancer diagnoses. This research focused on three social determinants that research demonstrated had an influence on stages of breast cancer diagnoses (race, income, and lack of health insurance). Bivariate analyses were conducted to examine the relationships between race and income, race and health insurance, and race and stage of diagnosis. The findings confirmed what was suspected for Mississippians; more African Americans had lower incomes, had less health insurance coverage, and were diagnosed at later stages of breast cancer disease. Only race and health insurance directly affected late stage diagnosis in analyses for this study. The influence of income on stage of breast cancer diagnosis was not statistically significant. The results of these analyses demonstrated that African American women in Mississippi were disproportionately diagnosed at late stage breast cancer as opposed to early stage. An individual cannot alter the genetic factor of race, but some of the disparate health outcomes that appear to be associated with race may be behavioral or socio-economically based and can be addressed, which could impact health outcomes. Adequate health insurance could positively impact

Creating Art Environments That Address Social Justice Issues

ERIC Educational Resources Information Center

Tremblay, Gail

2013-01-01

In this article, I examine strategies for teaching students to make socially conscious art using a variety of media that emphasizes installation work. I present issues of social justice in the contemporary art world and include concerns of censorship that artists sometimes confront. I offer examples of team taught coordinated studies programs…

Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration.

PubMed

Scott, A J; Wilson, R F

2011-01-01

in the community) representing another. At the environmental level, the community built environment was an area of concern as it lacked opportunities for physical activity and access to healthy foods. The local job environment was identified as a potential social determinant of health, given the strong ties between income and health. At the structural level, participants complained of cronyism and nepotism favoring Whites in access to jobs, including those where local policies and funding allocations were made (eg funding for the local health department). In education, school system tracking policies were perceived to discourage African Americans from university education. At the superstructural level, high rates of poverty and racism emerged as potential social determinants. Poverty directly limited many African Americans' access to quality health care, and subtle racism was perceived in some delivery of care. Persistent stress from poverty and racism was reported, which creates health risks through physiologic pathways. This study identified potential social determinants of health, at multiple ecological levels, among African Americans in a rural community in the Deep South. The social determinants identified had the ability to impact a variety of health behaviors and health outcomes. The results demonstrate the value of this approach to conducting rural, community-based research. This descriptive and exploratory study highlights the need for quantitative exploration of these issues, as well as the development of context-appropriate, community-based health interventions that address multiple ecological levels.

Social determinants of health, inequality and social inclusion among people with disabilities1

PubMed Central

Fiorati, Regina Celia; Elui, Valeria Meirelles Carril

2015-01-01

OBJECTIVE: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. METHOD: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. RESULTS: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. CONCLUSION: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion. PMID:26039305

Understanding and Effectively Addressing Breast Cancer in African American Women: Unpacking the Social Context

PubMed Central

Williams, David R.; Mohammed, Selina A.; Shields, Alexandra E.

2017-01-01

Black women have higher incidence of breast cancer before the age of 40, more severe disease at all ages, and elevated mortality risk compared to white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse, and the complex ways that socioeconomic status and racism shape exposure to psychosocial, physical, chemical and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which Black women live is also needed to maximize the opportunities to prevent breast cancer among this underserved group. PMID:26930024

Forms of Address in Chilean Spanish

ERIC Educational Resources Information Center

Bishop, Kelley; Michnowicz, Jim

2010-01-01

The present investigation examines possible social and linguistic factors that influence forms of address used in Chilean Spanish with various interlocutors. A characteristic of the Spanish of Chile is the use of a variety of forms of address for the second person singular, "tu", "vos", and "usted", with corresponding…

Recognizing, Determining, and Addressing Entrepreneurial Innovations by Superintendents of Emerging or Established Educational Service Agencies

ERIC Educational Resources Information Center

Arfstrom, Kari M.

2009-01-01

This dissertation describes how entrepreneurial superintendents of educational service agencies (ESAs) recognize, determine and address common and distinct innovative characteristics within emerging or established regional educational environments. Because internal and external factors assist in recognizing innovative practices, this study…

75 FR 11610 - Notice Announcing Addresses for Service of Process

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-11

... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2009-0076] Notice Announcing Addresses for Service of Process AGENCY: Social Security Administration. ACTION: Notice announcing addresses for summonses and complaints. SUMMARY: The Office of the General Counsel (OGC) is responsible for processing and...

49 CFR 26.67 - What rules determine social and economic disadvantage?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false What rules determine social and economic... Standards § 26.67 What rules determine social and economic disadvantage? (a) Presumption of disadvantage. (1... individual's presumption of economic disadvantage is rebutted. You are not required to have a proceeding...

49 CFR 26.67 - What rules determine social and economic disadvantage?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false What rules determine social and economic... Standards § 26.67 What rules determine social and economic disadvantage? (a) Presumption of disadvantage. (1... individual's presumption of economic disadvantage is rebutted. You are not required to have a proceeding...

49 CFR 26.67 - What rules determine social and economic disadvantage?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false What rules determine social and economic... Standards § 26.67 What rules determine social and economic disadvantage? (a) Presumption of disadvantage. (1... individual's presumption of economic disadvantage is rebutted. You are not required to have a proceeding...

49 CFR 26.67 - What rules determine social and economic disadvantage?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false What rules determine social and economic... Standards § 26.67 What rules determine social and economic disadvantage? (a) Presumption of disadvantage. (1... individual's presumption of economic disadvantage is rebutted. You are not required to have a proceeding...

49 CFR 26.67 - What rules determine social and economic disadvantage?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false What rules determine social and economic... Standards § 26.67 What rules determine social and economic disadvantage? (a) Presumption of disadvantage. (1... individual's presumption of economic disadvantage is rebutted. You are not required to have a proceeding...

How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study

PubMed Central

P. van Dijk, Jitse

2017-01-01

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP’s agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program’s merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP’s everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs’ impact on SDH, their theories and procedures should be adapted according to the programs’ more promising actual practice regarding SDH. PMID:29236067

How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study.

PubMed

Belak, Andrej; Veselska, Zuzana Dankulincova; Geckova, Andrea Madarasova; Dijk, Jitse P van; Reijneveld, Sijmen A

2017-12-13

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP's agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program's merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP's everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs' impact on SDH, their theories and procedures should be adapted according to the programs' more promising actual practice regarding SDH.

Globalization and social determinants of health: The role of the global marketplace (part 2 of 3)

PubMed Central

Labonté, Ronald; Schrecker, Ted

2007-01-01

Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic. In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace. PMID:17578569

Globalization and social determinants of health: The role of the global marketplace (part 2 of 3).

PubMed

Labonté, Ronald; Schrecker, Ted

2007-06-19

Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic. In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace.

Exploring Relationships Among Belief in Genetic Determinism, Genetics Knowledge, and Social Factors

NASA Astrophysics Data System (ADS)

Gericke, Niklas; Carver, Rebecca; Castéra, Jérémy; Evangelista, Neima Alice Menezes; Marre, Claire Coiffard; El-Hani, Charbel N.

2017-12-01

Genetic determinism can be described as the attribution of the formation of traits to genes, where genes are ascribed more causal power than what scientific consensus suggests. Belief in genetic determinism is an educational problem because it contradicts scientific knowledge, and is a societal problem because it has the potential to foster intolerant attitudes such as racism and prejudice against sexual orientation. In this article, we begin by investigating the very nature of belief in genetic determinism. Then, we investigate whether knowledge of genetics and genomics is associated with beliefs in genetic determinism. Finally, we explore the extent to which social factors such as gender, education, and religiosity are associated with genetic determinism. Methodologically, we gathered and analyzed data on beliefs in genetic determinism, knowledge of genetics and genomics, and social variables using the "Public Understanding and Attitudes towards Genetics and Genomics" (PUGGS) instrument. Our analyses of PUGGS responses from a sample of Brazilian university freshmen undergraduates indicated that (1) belief in genetic determinism was best characterized as a construct built up by two dimensions or belief systems: beliefs concerning social traits and beliefs concerning biological traits; (2) levels of belief in genetic determination of social traits were low, which contradicts prior work; (3) associations between knowledge of genetics and genomics and levels of belief in genetic determinism were low; and (4) social factors such as age and religiosity had stronger associations with beliefs in genetic determinism than knowledge. Although our study design precludes causal inferences, our results raise questions about whether enhancing genetic literacy will decrease or prevent beliefs in genetic determinism.

Social manipulation in nonhuman primates: Cognitive and motivational determinants.

PubMed

Völter, C J; Rossano, F; Call, J

2017-11-01

Social interactions are the result of individuals' cooperative and competitive tendencies expressed over an extended period of time. Although social manipulation, i.e., using another individual to achieve one's own goals, is a crucial aspect of social interactions, there has been no comprehensive attempt to differentiate its various types and to map its cognitive and motivational determinants. For this purpose, we survey in this article the experimental literature on social interactions in nonhuman primates. We take social manipulation, illustrated by a case study with orangutans (Pongo abelii), as our starting point and move in two directions. First, we will focus on a flexibility/sociality axis that includes technical problem solving, social tool-use and communication. Second, we will focus on a motivational/prosociality axis that includes exploitation, cooperation, and helping. Combined, the two axes offer a way to capture a broad range of social interactions performed by human and nonhuman primates. Copyright © 2016 Elsevier Ltd. All rights reserved.

20 CFR 410.706 - Effect of the Social Security Administration determination of entitlement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Effect of the Social Security Administration determination of entitlement. 410.706 Section 410.706 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL... the Social Security Administration determination of entitlement. Under section 435 of the BLBRA of...

20 CFR 410.706 - Effect of the Social Security Administration determination of entitlement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Effect of the Social Security Administration determination of entitlement. 410.706 Section 410.706 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL... the Social Security Administration determination of entitlement. Under section 435 of the BLBRA of...

Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program.

PubMed

Spiegel, Jerry M; Breilh, Jaime; Yassi, Annalee

2015-02-27

Focus on "social determinants of health" provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of "risk factors" related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of "social determination of health" has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis. In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as "collective health" and "critical epidemiology" have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the "4 S" elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth). We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory

Addressing research capacity for health equity and the social determinants of health in three African countries: the INTREC programme.

PubMed

Hofman, Karen; Blomstedt, Yulia; Addei, Sheila; Kalage, Rose; Maredza, Mandy; Sankoh, Osman; Bangha, Martin; Kahn, Kathleen; Becher, Heiko; Haafkens, Joke; Kinsman, John

2013-04-03

The importance of tackling economic, social and health-related inequities is increasingly accepted as a core concern for the post-Millennium Development Goal framework. However, there is a global dearth of high-quality, policy-relevant and actionable data on inequities within populations, which means that development solutions seldom focus on the people who need them most. INTREC (INDEPTH Training and Research Centres of Excellence) was established with this concern in mind. It aims to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers. As part of a baseline situation analysis for INTREC, this paper assesses the current status of SDH training in three of the African INTREC countries - Ghana, Tanzania, and South Africa - as well as the gaps, barriers, and opportunities for training. SDH-related courses from the three countries were identified through personal knowledge of the researchers, supplemented by snowballing and online searches. Interviews were also conducted with, among others, academics engaged in SDH and public health training in order to provide context and complementary material. Information regarding access to the Internet, as a possible INTREC teaching medium, was gathered in each country through online searches. SDH-relevant training is available, but 1) the number of places available for students is limited; 2) the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH; and 3) insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. We also identified rapidly expanding Internet connectivity in all three countries, which opens up opportunities for e-learning on SDH, though the current quality of the Internet services

Social determinants and lifestyles: integrating environmental and public health perspectives.

PubMed

Graham, H; White, P C L

2016-12-01

Industrialization and urbanization have been associated with an epidemiological transition, from communicable to non-communicable disease, and a geological transition that is moving the planet beyond the stable Holocene epoch in which human societies have prospered. The lifestyles of high-income countries are major drivers of these twin processes. Our objective is to highlight the common causes of chronic disease and environmental change and, thereby, contribute to shared perspectives across public health and the environment. Integrative reviews focused on social determinants and lifestyles as two 'bridging' concepts between the fields of public health and environmental sustainability. We drew on established frameworks to consider the position of the natural environment within social determinants of health (SDH) frameworks and the position of social determinants within environmental frameworks. We drew on evidence on lifestyle factors central to both public health and environmental change (mobility- and diet-related factors). We investigated how public health's focus on individual behaviour can be enriched by environmental perspectives that give attention to household consumption practices. While SDH frameworks can incorporate the biophysical environment, their causal structure positions it as a determinant and one largely separate from the social factors that shape it. Environmental frameworks are more likely to represent the environment and its ecosystems as socially determined. A few frameworks also include human health as an outcome, providing the basis for a combined public health/environmental sustainability framework. Environmental analyses of household impacts broaden public health's concern with individual risk behaviours, pointing to the more damaging lifestyles of high-income households. The conditions for health are being undermined by rapid environmental change. There is scope for frameworks reaching across public health and environmental

Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health.

PubMed

Lévesque, Martine C; Levine, Alissa; Bedos, Christophe

2015-04-30

Front line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients' health. Developing and evaluating approaches to raising health professional awareness and capacity to respond to social determinants is a crucial step in addressing this issue. McGill University, in partnership with Université de Montréal, Québec dental regulatory authorities, and the Québec anti-poverty coalition, co-developed a continuing education (CE) intervention that aims to transfer knowledge and improve the practices of oral health professionals with people living on welfare. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching. A qualitative case study was conducted, in Montreal Canada, among members of a dental team who participated in this innovative CE course over a period of four months. Data collection consisted in a series of semi-structured individual interviews conducted with 15 members of the dental team throughout the training, digitally recorded group discussions linked to the CE activities, clinic administrative documents and researcher-trainer field notes and journal. In line with adult transformative learning theory, interpretive analysis aimed to reveal learning processes, perceived outcomes and collective perspectives that constrain individual and organizational change. The findings presented in this article consist in four interactive themes, reflective of clinic culture and context, that act as barriers to humanizing patient care: 1) belief in the "ineluctable" commoditization of dentistry; 2) "equal treatment", a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into

Health Sector Reform and Social Determinants of Health: building up theoretical and methodological interconnections to approach complex global challenges.

PubMed

Junior, Garibaldi Dantas Gurgel

2014-01-01

Health Sector Reform and Social Determinants of Health are central issues for the current international policy debate, considering the turbulent scenario and the threat of economic recession in a global scale. Although these themes have been discussed for a long time, three major issues still calls the attention of the scientific community and health policymakers. The first one is the matter of how to approach scientifically the intricate connections between them in order to understand the consequences of policies for healthcare services, once this debate will become much more tensioned in the coming years. The second one is the lack of explanatory frameworks to investigate the policies of reform strategies, simultaneously observed in a variety of countries within distinct health services, which aim to achieve multiple and contradictory goals vis-à-vis the so-called social determinants of health. The third one is the challenge that governments face in developing and sustaining equitable health services, bearing in mind the intense political dispute behind the health sector reform processes. This article discusses an all-embracing theoretical and methodological scheme to address these questions. The aim is to connect macro- and middle-range theories to examine Social Determinants and Health Sector Reform interdependent issues, with view to developing new knowledge and attaining scientific understanding upon the role of universal and equitable healthcare systems, in order to avoid deepening economic crises.

A Multi-Systemic School-Based Approach for Addressing Childhood Aggression

ERIC Educational Resources Information Center

Runions, Kevin

2008-01-01

School-based approaches to addressing aggression in the early grades have focused on explicit curriculum addressing social and emotional processes. The current study reviews research on the distinct modes of aggression, the status of current research on social and emotional processing relevant to problems of aggression amongst young children, as…

Social work and end-of-life decisions: self-determination and the common good.

PubMed

Wesley, C A

1996-05-01

Client self-determination is the key element of NASW's policy statement about social work intervention in end-of-life decisions. However, both self-determination and the common good must be respected in social work practice and policy regarding end-of-life decisions. This article discusses self-determination in end-of-life decision making, ethical decision making and the NASW Code of Ethics, and professional ethics based on a balanced view of both self-determination and the common good. Recommendations for professional practice and social policy are offered.

Ability of Social Work Students to Determine the Appropriateness of Solutions to Problems Encountered in Social Work Practice.

ERIC Educational Resources Information Center

Sturges, Jack; Yarbrough, Roy D.

The purpose of this study was to determine whether there was an association between the amount of formal social work education completed and ability of students to judge the degree of appropriateness of proposed solutions to problems frequently encountered in social work practice, and secondarily to determine whether students' judgments of problem…

The design of a medical school social justice curriculum.

PubMed

Coria, Alexandra; McKelvey, T Greg; Charlton, Paul; Woodworth, Michael; Lahey, Timothy

2013-10-01

The acquisition of skills to recognize and redress adverse social determinants of disease is an important component of undergraduate medical education. In this article, the authors justify and define "social justice curriculum" and then describe the medical school social justice curriculum designed by the multidisciplinary Social Justice Vertical Integration Group (SJVIG) at the Geisel School of Medicine at Dartmouth. The SJVIG addressed five goals: (1) to define core competencies in social justice education, (2) to identify key topics that a social justice curriculum should cover, (3) to assess social justice curricula at other institutions, (4) to catalog institutionally affiliated community outreach sites at which teaching could be paired with hands-on service work, and (5) to provide examples of the integration of social justice teaching into the core (i.e., basic science) curriculum. The SJVIG felt a social justice curriculum should cover the scope of health disparities, reasons to address health disparities, and means of addressing these disparities. The group recommended competency-based student evaluations and advocated assessing the impact of medical students' social justice work on communities. The group identified the use of class discussion of physicians' obligation to participate in social justice work as an educational tool, and they emphasized the importance of a mandatory, longitudinal, immersive, mentored community outreach practicum. Faculty and administrators are implementing these changes as part of an overall curriculum redesign (2012-2015). A well-designed medical school social justice curriculum should improve student recognition and rectification of adverse social determinants of disease.

Which Social Elements Are Visible in Virtual Groups? Addressing the Categorization of Social Expressions

ERIC Educational Resources Information Center

Perez-Mateo, M.; Guitert, M.

2012-01-01

Learning is a social process. That is why it is extremely important to understand how students interact socially in online courses and how it affects the learning process. However, social aspects, understood as those expressions or comments that go beyond strictly academic interaction, i.e. the need to carry out group work, are not clearly…

A framework for regional primary health care to organise actions to address health inequities.

PubMed

Freeman, Toby; Javanparast, Sara; Baum, Fran; Ziersch, Anna; Mackean, Tamara

2018-06-01

Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015). The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents. The framework encompassed equity in planning, collection of equity data, community engagement, and strategies to address equity in access, health outcomes, and social determinants of health. When the framework was applied to Medicare Locals, their inclusion of equity as a goal, collection of equity data, community engagement, and actions improving equity of access were strong, but there were gaps in broader advocacy, and strategies to address social determinants of health, and equity in quality of care. The equity framework allows a platform for advancing knowledge and international comparison of the health equity efforts of regional primary health-care organisations.

Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes.

PubMed

Walker, Rebekah J; Strom Williams, Joni; Egede, Leonard E

2016-04-01

There is strong evidence that race, ethnicity and social determinants of health significantly influence outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships or associations would improve development of cost-effective, culturally tailored programs for patients with diabetes. This article reviews the current state of the literature on the influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. The literature review shows that racial or ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure (BP) and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support and perceived stress, show consistent associations with self-care, quality of life and glycemic control. Neighborhood factors, such as food insecurity, social cohesion and neighborhood esthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life. Healthcare professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high. Copyright © 2016 Southern Society for Clinical Investigation. All rights reserved.

Adolescent Social Issues: Using Media to Address Crucial Concerns.

ERIC Educational Resources Information Center

Sokoloff, Michele

1987-01-01

This article describes media resources available to help adolescents deal with a variety of social concerns, including substance abuse, dropouts, Acquired Immune Deficiency Syndrome (AIDS), suicide, and pregnancy. A list of 56 companies that provide resources dealing with social issues is also provided. (LRW)

A Social-Ecological Analysis of the Self-Determination Literature

ERIC Educational Resources Information Center

Shogren, Karrie A.

2013-01-01

This paper uses a social-ecological lens to examine self-determination research, attempting to organize what is known (and unknown) about contextual factors that have the potential to impact the development and expression of self-determined behavior in people with disabilities across multiple ecological systems. Identifying and categorizing the…

Social Determinants of Traumatic Brain Injury in the North American Indigenous Population: A Review.

PubMed

Zeiler, Kaitlin J; Zeiler, Frederick A

2017-09-01

Given the difficult to navigate literature on social determinants in Indigenous traumatic brain injury (TBI) we wished to identify all available literature on the social determinants of health linked to TBI in the North American Indigenous populations. We performed a systematically conducted review. We searched MEDLINE, BIOSIS, EMBASE, Global Health, SCOPUS, and Cochrane Library from inception to January 2016. A two-step review process of the search results was performed, applying defined inclusion/exclusion criteria. The final group of articles had the data extracted and summarized. Ten manuscripts were identified to discuss some social determinant linked to TBI in the North American Indigenous populations. Two studies were focused on Canadian populations, with the remaining 8 studies focused on populations within the United States. Six social health determinants were identified within the studies, including: Rural location (Physical Environment) in seven studies, Male gender in five studies and Female gender in one study (in the setting of interpersonal violence) (Gender), Substance use in four studies and failure to utilize personal protective equipment in one study (Personal Health Practices and Coping Skills), Interpersonal Violence in one study (Social Environment), availability of rehabilitation services in one study (Health Services), and lack of family and friend presence during meetings with healthcare professionals in one study (Social Support Network). To date, little literature is available on the social determinants that impact TBI in the North American Indigenous population. Further research is warranted to better determine the incidence and social determinants associated.

Mapping the social determinants of substance use for pregnant-involved young Aboriginal women

PubMed Central

Shahram, Sana Z.; Bottorff, Joan L.; Oelke, Nelly D.; Kurtz, Donna L. M.; Thomas, Victoria; Spittal, Patricia M.

2017-01-01

ABSTRACT There is a dearth of knowledge about the social determinants of substance use among young pregnant-involved Indigenous women in Canada from their perspectives. As part of life history interviews, 17 young pregnant-involved Indigenous women with experiences with substances completed a participant-generated mapping activity CIRCLES (Charting Intersectional Relationships in the Context of Life). As women created their maps, they discussed how different social determinants impacted their experiences with pregnancy and substance use. The social determinants identified and used by women to explain determinants of their substance use were grouped into 10 themes: traumatic life histories; socioeconomic status; culture, identity and spirituality; shame and guilt; mental wellness; family connections; romantic and platonic relationships; strength and hope; mothering; and the intersections of determinants. We conclude that understanding the context and social determinants of substance use from a woman-informed perspective is paramount to informing effective and appropriate programs to support young Indigenous women who use substances. PMID:28140776

Understanding veterinary students' use of and attitudes toward the social networking site, Facebook, to assist in developing curricula to address online professionalism.

PubMed

Coe, Jason B; Weijs, Cynthia A; Muise, Amy; Christofides, Emily; Desmarais, Serge

2012-01-01

Social media is an increasingly common form of communication, with Facebook being the preferred social-networking site among post-secondary students. Numerous studies suggest post-secondary students practice high self-disclosure on Facebook. Research evaluating veterinary students' use of social media found a notable proportion of student-posted content deemed inappropriate. Lack of discretion in posting content can have significant repercussions for aspiring veterinary professionals, their college of study, and the veterinary profession they represent. Veterinarians-in-training at three veterinary colleges across Canada were surveyed to explore their use of and attitude toward the social networking site, Facebook. Students were invited to complete an online survey with questions relating to their knowledge of privacy in relation to using Facebook, their views on the acceptability of posting certain types of information, and their level of professional accountability online. Linear regression modeling was used to further examine factors related to veterinary students' disclosure of personal information on Facebook. Need for popularity (p<.01) and awareness of consequences (p<.001) were found to be positively and negatively associated, respectively, with students' personal disclosure of information on Facebook. Understanding veterinary students' use of and attitudes toward social media, such as Facebook, reveals a need, and provides a basis, for developing educational programs to address online professionalism. Educators and administrators at veterinary schools may use this information to assist in developing veterinary curricula that addresses the escalating issue of online professionalism.

Structural and intermediary determinants of social inequalities in the mental well-being of European workers: a relational approach.

PubMed

De Moortel, Deborah; Vandenheede, Hadewijch; Muntaner, Carles; Vanroelen, Christophe

2014-09-09

The objective of this study is to examine social inequalities in employee mental well-being, using relational social class indicators. Relational social class indicators are based on theoretical insights about the mechanisms generating social (health) inequalities. Additionally, it is examined whether the psychosocial work environment and employment quality act as intermediary determinants of social class inequalities in mental well-being, simultaneously testing the mediation (differential exposure) and moderation (differential vulnerability) hypotheses. Data from the European Social Survey Round 2 (2004/5) and Round 5 (2010) were analysed. Mental well-being was assessed by the WHO Well-being Index. The measure for social class was inspired by E.O. Wright's class scheme. Three-level linear multilevel modelling was used to account for clustering of employees within research years and countries. We found social class inequalities in mental well-being in the European working population for both men and women. Compared to unskilled workers, managers reported the best mental well-being, while supervisors held an intermediary position. As regards the mediation hypothesis, an unfavourable psychosocial work environment and low-quality employment conditions mediated the relation between social class and poor mental well-being in both men and women. However, low quality of employment relations only mediated the "social class-mental well-being" association in the male sample. As regards the moderation hypothesis, modification effects were seen for the psychosocial work environment and employment conditions in both men and women. Relational indicators of social class are related to mental well-being in European employees. Relational accounts of social class are complementary to stratification indicators in social epidemiology. From a policy perspective, better employee mental well-being and less social class inequality could be achieved through initiatives addressing the

[How to reduce health inequities by targeting social determinants: the role of the health sector in Mexico].

PubMed

Martínez Valle, Adolfo; Terrazas, Paulina; Alvarez, Fernando

2014-04-01

To study lines of action implemented in Mexico by the health sector from 2007 to 2012 in order to combat health inequities by targeting social determinants. To contribute to better understanding and knowledge of how health system inequalities in the Region of the Americas can be reduced. To formulate recommendations for designing a future public policy agenda to address the social determinants associated with health inequities in Mexico. The policies and programs established in the National Health Program (PRONASA) 2007 - 2012 were reviewed, and those that met four criteria were selected: i) they affected the social determinants of health (SDH); ii) they developed specific lines of action aimed at reducing health inequities; iii) they set concrete goals; and iv) they had been evaluated to determine whether those goals had been met. Three programs were selected: Seguro Popular, Programa de Desarrollo Humano Oportunidades (PDHO), and Caravanas de la Salud. Once each program's specific lines of action targeting SDH had been identified, the monitoring and evaluation indicators established in PRONASA 2007 - 2012, along with other available evaluations and empirical evidence, were used to measure the extent to which the goals were met. The findings showed that Seguro Popular had had a positive impact in terms of the financial protection of lower-income households. Moreover, the reduction in the gap between workers covered by the social security system and those who were not was more evident. By reducing poverty among its beneficiaries, the PDHO also managed to reduce health inequities. The indicators for Caravanas de la Salud, on the other hand, did not show statistically significant differences between the control localities and the localities covered by the program, except in the case of Pap tests. These findings have important public policy implications for designing an agenda that promotes continued targeting of SDH and heightening its impact in terms of reducing

49 CFR Appendix E to Part 26 - Individual Determinations of Social and Economic Disadvantage

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Individual Determinations of Social and Economic... Appendix E to Part 26—Individual Determinations of Social and Economic Disadvantage The following guidance is adapted, with minor modifications, from SBA regulations concerning social and economic...

49 CFR Appendix E to Part 26 - Individual Determinations of Social and Economic Disadvantage

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false Individual Determinations of Social and Economic... Appendix E to Part 26—Individual Determinations of Social and Economic Disadvantage The following guidance is adapted, with minor modifications, from SBA regulations concerning social and economic...

49 CFR Appendix E to Part 26 - Individual Determinations of Social and Economic Disadvantage

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false Individual Determinations of Social and Economic... Appendix E to Part 26—Individual Determinations of Social and Economic Disadvantage The following guidance is adapted, with minor modifications, from SBA regulations concerning social and economic...

49 CFR Appendix E to Part 26 - Individual Determinations of Social and Economic Disadvantage

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false Individual Determinations of Social and Economic... Appendix E to Part 26—Individual Determinations of Social and Economic Disadvantage The following guidance is adapted, with minor modifications, from SBA regulations concerning social and economic...

49 CFR Appendix E to Part 26 - Individual Determinations of Social and Economic Disadvantage

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Individual Determinations of Social and Economic... Appendix E to Part 26—Individual Determinations of Social and Economic Disadvantage The following guidance is adapted, with minor modifications, from SBA regulations concerning social and economic...

Development of the health literacy on social determinants of health questionnaire in Japanese adults.

PubMed

Matsumoto, Masayoshi; Nakayama, Kazuhiro

2017-01-06

Health inequities are increasing worldwide, with mounting evidence showing that the greatest cause of which are social determinants of health. To reduce inequities, a lot of citizens need to be able to access, understand, appraise, and apply information on the social determinants; that is, they need to improve health literacy on social determinants of health. However, only a limited number of scales focus on these considerations; hence, we developed the Health Literacy on Social Determinants of Health Questionnaire (HL-SDHQ) and examined its psychometric properties. We extracted domains of the social determinants of health from "the solid facts" and related articles, operationalizing the following ten domains: "the social gradient," "early life," "social exclusion," "work," "unemployment," "social support," "social capital," "addiction," "food," and "transport," Next, we developed the scale items in the ten extracted domains based on the literature and included four aspects of health literacy (ability to access, understand, appraise, and apply social determinants of health-related information) in the items. We also evaluated the ease of response and content validity. The self-administered questionnaire consisted of 33 items. The reliability and construct validity were verified among 831 Japanese adults in an internet survey. The scale items had high reliability with a Cronbach's alpha of 0.92, and also adequate results were obtained for the internal consistency of the information-processing dimensions (Cronbach's alpha values were 0.82, 0.91, 0.84, and 0.92 for accessing, understanding, appraising, and applying, respectively). The goodness of fit by confirmatory factor analysis based on the four dimensions was an acceptable value (comparative fit index = 0.901; root mean square error of approximation = 0.058). Furthermore, the bivariate relationship between HL-SDHQ and the frequency of participation in citizen's activities was similar to the theoretical

Emerging Infections Program Efforts to Address Health Equity

PubMed Central

Vugia, Duc J.; Bennett, Nancy M.; Moore, Matthew R.

2015-01-01

The Emerging Infections Program (EIP), a collaboration between (currently) 10 state health departments, their academic center partners, and the Centers for Disease Control and Prevention, was established in 1995. The EIP performs active, population-based surveillance for important infectious diseases, addresses new problems as they arise, emphasizes projects that lead to prevention, and develops and evaluates public health practices. The EIP has increasingly addressed the health equity challenges posed by Healthy People 2020. These challenges include objectives to increase the proportion of Healthy People–specified conditions for which national data are available by race/ethnicity and socioeconomic status as a step toward first recognizing and subsequently eliminating health inequities. EIP has made substantial progress in moving from an initial focus on monitoring social determinants exclusively through collecting and analyzing data by race/ethnicity to identifying and piloting ways to conduct population-based surveillance by using area-based socioeconomic status measures. PMID:26291875

What can Pakistan do to address maternal and child health over the next decade?

PubMed

Bhutta, Zulfiqar A; Hafeez, Assad

2015-11-25

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability.

Caste-, work-, and descent-based discrimination as a determinant of health in social epidemiology.

PubMed

Patil, Rajan R

2014-01-01

Social epidemiology explores health in the context of broad social determinants of health, where the boundary lines between health and politics appear increasingly blurred. Social determinants of health such as caste, discrimination, and social exclusion are inherently political in nature, hence it becomes imperative to look at health through a broader perspective of political philosophy, ideology, and caste that imposes enormous obstacles to a person's full attainment of civil, political, economic, social, and cultural rights. Caste is descent based and hereditary in nature. It is a characteristic determined by one's birth into a particular caste, irrespective of the faith practiced by the individual. Caste denotes a system of rigid social stratification into ranked groups defined by descent and occupation. Under various caste systems throughout the world, caste divisions also dominate in housing, marriage, and general social interaction divisions that are reinforced through the practice and threat of social ostracism, economic boycotts, and even physical violence-all of which undermine health equality.

Confidentiality Considerations for Use of Social-Spatial Data on the Social Determinants of Health: Sexual and Reproductive Health Case Study

PubMed Central

Haley, Danielle F.; Matthews, Stephen A.; Cooper, Hannah LF; Haardörfer, Regine; Adimora, Adaora A.; Wingood, Gina M.; Kramer, Michael R.

2016-01-01

Understanding whether and how the places where people live, work, and play are associated with health behaviors and health is essential to understanding the social determinants of health. However, social-spatial data which link a person and their attributes to a geographic location (e.g., home address) create potential confidentiality risks. Despite the growing body of literature describing approaches to protect individual confidentiality when utilizing social-spatial data, peer-reviewed manuscripts displaying identifiable individual point data or quasi-identifiers (attributes associated with the individual or disease that narrow identification) in maps persist, suggesting that knowledge has not been effectively translated into public health research practices. Using sexual and reproductive health as a case study, we explore the extent to which maps appearing in recent peer-reviewed publications risk participant confidentiality. Our scoping review of sexual and reproductive health literature published and indexed in PubMed between January 1, 2013 and September 1, 2015 identified 45 manuscripts displaying participant data in maps as points or small-population geographic units, spanning 26 journals and representing studies conducted in 20 countries. Notably, 56% (13/23) of publications presenting point data on maps either did not describe approaches used to mask data or masked data inadequately. Furthermore, 18% (4/22) of publications displaying data using small-population geographic units included at least two quasi-identifiers. These findings highlight the need for heightened education for researchers, reviewers, and editorial teams. We aim to provide readers with a primer on key confidentiality considerations when utilizing linked social-spatial data for visualizing results. Given the widespread availability of place-based data and the ease of creating maps, it is critically important to raise awareness on when social-spatial data constitute protected health

Confidentiality considerations for use of social-spatial data on the social determinants of health: Sexual and reproductive health case study.

PubMed

Haley, Danielle F; Matthews, Stephen A; Cooper, Hannah L F; Haardörfer, Regine; Adimora, Adaora A; Wingood, Gina M; Kramer, Michael R

2016-10-01

Understanding whether and how the places where people live, work, and play are associated with health behaviors and health is essential to understanding the social determinants of health. However, social-spatial data which link a person and their attributes to a geographic location (e.g., home address) create potential confidentiality risks. Despite the growing body of literature describing approaches to protect individual confidentiality when utilizing social-spatial data, peer-reviewed manuscripts displaying identifiable individual point data or quasi-identifiers (attributes associated with the individual or disease that narrow identification) in maps persist, suggesting that knowledge has not been effectively translated into public health research practices. Using sexual and reproductive health as a case study, we explore the extent to which maps appearing in recent peer-reviewed publications risk participant confidentiality. Our scoping review of sexual and reproductive health literature published and indexed in PubMed between January 1, 2013 and September 1, 2015 identified 45 manuscripts displaying participant data in maps as points or small-population geographic units, spanning 26 journals and representing studies conducted in 20 countries. Notably, 56% (13/23) of publications presenting point data on maps either did not describe approaches used to mask data or masked data inadequately. Furthermore, 18% (4/22) of publications displaying data using small-population geographic units included at least two quasi-identifiers. These findings highlight the need for heightened education for researchers, reviewers, and editorial teams. We aim to provide readers with a primer on key confidentiality considerations when utilizing linked social-spatial data for visualizing results. Given the widespread availability of place-based data and the ease of creating maps, it is critically important to raise awareness on when social-spatial data constitute protected health

Social Determinants of Health, Violent Radicalization, and Terrorism: A Public Health Perspective.

PubMed

Alcalá, Héctor E; Sharif, Mienah Zulfacar; Samari, Goleen

2017-01-01

Background: Terrorism-related deaths are at an all-time high as there were 32,685 and 29,376 terrorism-related deaths in 2014 and 2015, respectively. Terrorism is defined as the use of violence and intimidation in the pursuit of political aims. Terrorism is detrimental for mental health, premature mortality, and economic losses and undermines the central tenets of public health to improve the health and well-being of populations. Despite the impact terrorism has on avoidable morbidity and mortality, population health research largely overlooks social determinants of terrorism and risk factors that contribute to terrorist activities. Methods: Drawing from what is known about commonly studied social determinants of health topics, including the relationships between structural and interpersonal discrimination, social cohesion, and gang violence and health, we present a public health framework, rooted in the social determinants of health, for identifying potential factors influencing terrorism and violent radicalization. Results: Social determinants of health provide unique insight into how interpersonal and structural factors can influence risk for violent radicalization and terrorist activity. Each of the topics we review provides an entry point for existing public health and behavioral science knowledge to be used in preventing and understanding violent radicalization and terrorism. For example, anti-Muslim sentiment has promoted discrimination against Muslims, while also serving to marginalize and stigmatize Muslim communities. These conditions limit the social resources, like social cohesion, that Muslims have access to and make political violence more appealing to some. Conclusions: Public health can contribute much to the ongoing debate around terrorism. The field must take a more prevention-focused approach to the problem of terrorism. Failure to do so only perpetuates approaches that have not been successful.

All Health Is Global Health, All Medicine Is Social Medicine: Integrating the Social Sciences Into the Preclinical Curriculum.

PubMed

Kasper, Jennifer; Greene, Jeremy A; Farmer, Paul E; Jones, David S

2016-05-01

As physicians work to achieve optimal health outcomes for their patients, they often struggle to address the issues that arise outside the clinic. Social, economic, and political factors influence patients' burden of disease, access to treatment, and health outcomes. This challenge has motivated recent calls for increased attention to the social determinants of health. At the same time, advocates have called for increased attention to global health. Each year, more U.S. medical students participate in global health experiences. Yet, the global health training that is available varies widely. The discipline of social medicine, which attends to the social determinants of disease, social meanings of disease, and social responses to disease, offers a solution to both challenges. The analyses and techniques of social medicine provide an invaluable toolkit for providing health care in the United States and abroad.In 2007, Harvard Medical School implemented a new course, required for all first-year students, that teaches social medicine in a way that integrates global health. In this article, the authors argue for the importance of including social medicine and global health in the preclinical curriculum; describe Harvard Medical School's innovative, integrated approach to teaching these disciplines, which can be used at other medical schools; and explore the barriers that educators may face in implementing such a curriculum, including resistance from students. Such a course can equip medical students with the knowledge and tools that they will need to address complex health problems in the United States and abroad.

Tracing the social gradient in the health of Canadians: primary and secondary determinants.

PubMed

Kosteniuk, Julie G; Dickinson, Harley D

2003-07-01

The social gradient in heath refers to the fact that inequalities in population health status are related to inequalities in social status. This study advances and tests a model of the relationships between what we term primary and secondary determinants of the social gradient in health. The primary determinants of health include socioeconomic and demographic indicators. Secondary determinants include stressors, control, self-esteem, social support, and social involvement. Health status is indicated by measures of physical health, self-reported health status, and mental distress. Data are taken from the Canadian National Population Health (NPH) Survey (1994-1995). The study sample consists of 7720 men and 9269 women 15 to over 80 years of age. Using path analysis, we found that higher household income, being retired and growing older are significantly associated with lower stressor levels. Higher stressor levels are associated with lower levels of control, self-esteem, and social support. Higher income Canadians experience greater levels of control and social support, while older Canadians experience lower rates of social support but higher rates of social involvement. Being employed and caring for one's family are positively associated with better physical and self-reported health status. Higher household income, being retired, and aging are associated with better physical health and lower mental distress when accounting for their role in lowering stressor levels and bolstering control, self-esteem, social support, and social involvement. Replicating this study with future samples of the NPH Survey should be of benefit in ascertaining whether the social gradient in Canadians' health status shows signs of declining.

Addressing the Social Determinants of Health of Children and Youth: A Role for SOPHE Members

ERIC Educational Resources Information Center

Allensworth, Diane D.

2011-01-01

The determinants of youth health disparities include poverty, unequal access to health care, poor environmental conditions, and educational inequities. Poor and minority children have more health problems and less access to health care than their higher socioeconomic status cohorts. Having more health problems leads to more absenteeism in school,…

Thanksgiving Address of the North American Indian Ohenton Kariwatehkwen.

ERIC Educational Resources Information Center

Mitchell, Watenriio (Michael), Comp.; And Others

Translated by the North American Indian Travelling College, this traditional Thanksgiving Address is delivered before and after all meetings and ceremonies of the Iroquois people. Through this address, the Creator is introduced into a ceremony, social dance, or council, and, at the end of the meeting, the address brings the minds of the people…

[Social and cultural determinants of juvenile deliquency].

PubMed

Roché, Sébastian

2004-01-01

Our knowledge of juvenile delinquency has progressed considerably since the early 1980s, thanks to self-reported delinquency surveys. They teach us that the determinants of delinquent behaviors among teenagers are dependent on the facility with which the offense is committed, the internal motivation (frustration in the family and school, observational learning of the use of violence in the media) and the weakness of social reactions.

[A quantitative approach to sports training-adapted social determinants concerning sport].

PubMed

Alvis-Gómez, Martina K; Neira-Tolosa, Nury A

2013-01-01

Identifying and quantitatively analysing social determinants affecting disabled teenagers' inclusion/exclusion in high-performance sports. This was a descriptive cross-sectional study involving 19 12- to 19-year-old athletes suffering physical and sensory disability and 17 staff from the District Institute of Recreation and Sport. Likert-type rating scales were used, based on four analysis categories, i.e. social structure, socio-economic, educational and living condition determinants. Social inequity pervades the national paralympic sports' system. This is because 74 % of individuals only become recognised as sportspeople when they have obtained meritorious results in set competition without appropriate conditions having been previously provided by such paralympic sports institution to enable them to overcome structural and intermediate barriers. The social structure imposed on district-based paralympic sport stigmatises individuals regarding their individual abilities, affects their empowerment and freedom due to the discrimination experienced by disabled teenagers regarding their competitive achievements.

A social-ecological analysis of the self-determination literature.

PubMed

Shogren, Karrie A

2013-12-01

This paper uses a social-ecological lens to examine self-determination research, attempting to organize what is known (and unknown) about contextual factors that have the potential to impact the development and expression of self-determined behavior in people with disabilities across multiple ecological systems. Identifying and categorizing the contextual factors that researchers suggest influence self-determination have the potential to allow for the development of a framework that promotes systematic consideration of contextual factors when designing, implementing, and evaluating supports to promote self-determination. Directions for future research and practice are discussed.

[Contextual indicators to assess social determinants of health and the Spanish economic recession].

PubMed

Cabrera-León, Andrés; Daponte Codina, Antonio; Mateo, Inmaculada; Arroyo-Borrell, Elena; Bartoll, Xavier; Bravo, María José; Domínguez-Berjón, María Felicitas; Renart, Gemma; Álvarez-Dardet, Carlos; Marí-Dell'Olmo, Marc; Bolívar Muñoz, Julia; Saez, Marc; Escribà-Agüir, Vicenta; Palència, Laia; López, María José; Saurina, Carme; Puig, Vanessa; Martín, Unai; Gotsens, Mercè; Borrell, Carme; Serra Saurina, Laura; Sordo, Luis; Bacigalupe, Amaia; Rodríguez-Sanz, Maica; Pérez, Glòria; Espelt, Albert; Ruiz, Miguel; Bernal, Mariola

To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organisations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Teaching Health Disparities, the Social Determinants of Health, and the Social Ecological Model through HBO's "The Wire"

ERIC Educational Resources Information Center

Tettey, Naa-Solo

2018-01-01

Understanding the social determinants of health, health equity, and social justice from a social ecological perspective is vital for public health students. This paper provides an example of a creative method for teaching health disparities, using the HBO television series "The Wire." Methods: The pedagogical strength of "The…

Socialization and Self- Determination in Different-Age Dyads of Students Who Are Deafblind

ERIC Educational Resources Information Center

Bruce, Susan M.; Zatta, Mary C.; Gavin, Mary; Stelzer, Sharon

2016-01-01

Introduction: Deafblindness limits access to social cues and social feedback, thus restricting the development of social skills. Many children with CHARGE syndrome, a leading cause of deafblindness, experience challenges with emotional self-regulation and anxiety that may interfere with socialization. Learning about self-determination skills such…

Quality of life, functional impairment and social factors as determinants of nutritional status in older adults: The VERISAÚDE study.

PubMed

Maseda, Ana; Diego-Diez, Clara; Lorenzo-López, Laura; López-López, Rocío; Regueiro-Folgueira, Laura; Millán-Calenti, José C

2018-06-01

Malnutrition is an important and growing health problem in elderly people. The main aim of this research was to examine the relationship between socio-demographic factors, social resources, functional status and quality of life and malnutrition or risk of malnutrition in elders. A cross-sectional study was conducted with a representative sample of 749 community-dwelling elders aged 65 years and over. A comprehensive assessment was carried out, including the collection of socio-demographic factors, social resources by the Older Americans Resources and Services Scale, nutritional status by the Mini-Nutritional Assessment-Short Form, functional status by the Lawton's instrumental activities of daily living scale and quality of life by the World Health Organizations's Quality of Life measure-brief version (WHOQOL-BREF). Being female, the presence of totally impaired social resources and low scores in the physical health domain of the WHOQOL-BREF were the strongest determinants of malnutrition/risk of malnutrition. This model predicted 85.7% of the cases correctly. In men, the best determinants were being unmarried and having poor satisfaction with their health, with a percentage of 89.8% of cases of poor nutritional status correctly predicted. The best determinant for women was also the physical health domain of the WHOQOL-BREF, reaching a correct prediction of 83.0% of malnutrition/risk of it. Nutritional status assessment and potential determinant factors should be incorporated as part of comprehensive assessments for early identification of malnutrition and to determine appropriate intervention strategies to address this public health problem in older adults. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Non-communicable diseases and the social determinants of health in the Nordic countries: Findings from the European Social Survey (2014) special module on the social determinants of health.

PubMed

Balaj, Mirza; Huijts, Tim; McNamara, Courtney L; Stornes, Per; Bambra, Clare; Eikemo, Terje A

2017-03-01

Comparative studies examining non-communicable diseases (NCDs) and determinants of health in the Nordic countries are scarce, outdated and focus only on a limited range of NCDs and health determinants. This study is the first to present a comprehensive overview of the distribution of social and behavioural determinants of health and of physical and mental NCDs in the Nordic population. We examined regional, country and gender differences for 17 health outcomes and 20 determinants of health. We use data from the 7th wave of the European Social Survey. All results were age-standardised by weighting up or down the unstandardized (crude) prevalence rates for five year age groups in each country to a common standard. We present pooled estimates for the combined regional samples as well as country-specific results for the Nordic region. Overall, the population of the Nordic region reported among the highest prevalence for one or both genders in 10 out of 17 health outcomes. Despite being the region with the highest prevalence for most health outcomes, overall self-rated health levels tend to be better in the Nordic region. Similarly, we found that the Nordic countries adhere to a healthier lifestyle and have better access to health care. Future studies should consider investigating further the association between health outcomes and determinants of health and how they are distributed in the Nordic societies.

Social Determinants of Infectious Diseases in South Asia

PubMed Central

Bishwajit, Ghose; Ide, Seydou; Ghosh, Sharmistha

2014-01-01

South Asian countries have developed infectious disease control programs such as routine immunization, vaccination, and the provision of essential drugs which are operating nationwide in cooperation with many local and foreign NGOs. Most South Asian countries have a relatively low prevalence of HIV/AIDS until now, but issues like poverty, food insecurity, illiteracy, poor sanitation, and social stigma around AIDS are widespread and are creating formidable challenges to prevention of further spread of this epidemic. Besides that, resurgence of tuberculosis along with the emergence of the drug resistant (MDR-TB and XDRTB) strains and the coepidemic of TB and HIV are posing ever-growing threats to the underdeveloped healthcare infrastructure. The countries are undergoing an epidemiological transition where the disease burden is gradually shifting to noncommunicable diseases, but the infectious diseases still account for almost half of the total disease burden. Despite this huge burden of infectious diseases in South Asia, which is second only to Africa, there is yet any study on the social determinants of infectious diseases in a local context. This paper examines various issues surrounding the social determinants of infectious diseases in South Asian countries with a special reference to HIV and tuberculosis. And, by doing so, it attempts to provide a framework for formulating more efficient prevention and intervention strategies for the future. PMID:27350969

Social Determinants of Health, Violent Radicalization, and Terrorism: A Public Health Perspective

PubMed Central

Alcalá, Héctor E.; Sharif, Mienah Zulfacar; Samari, Goleen

2017-01-01

Abstract Background: Terrorism-related deaths are at an all-time high as there were 32,685 and 29,376 terrorism-related deaths in 2014 and 2015, respectively. Terrorism is defined as the use of violence and intimidation in the pursuit of political aims. Terrorism is detrimental for mental health, premature mortality, and economic losses and undermines the central tenets of public health to improve the health and well-being of populations. Despite the impact terrorism has on avoidable morbidity and mortality, population health research largely overlooks social determinants of terrorism and risk factors that contribute to terrorist activities. Methods: Drawing from what is known about commonly studied social determinants of health topics, including the relationships between structural and interpersonal discrimination, social cohesion, and gang violence and health, we present a public health framework, rooted in the social determinants of health, for identifying potential factors influencing terrorism and violent radicalization. Results: Social determinants of health provide unique insight into how interpersonal and structural factors can influence risk for violent radicalization and terrorist activity. Each of the topics we review provides an entry point for existing public health and behavioral science knowledge to be used in preventing and understanding violent radicalization and terrorism. For example, anti-Muslim sentiment has promoted discrimination against Muslims, while also serving to marginalize and stigmatize Muslim communities. These conditions limit the social resources, like social cohesion, that Muslims have access to and make political violence more appealing to some. Conclusions: Public health can contribute much to the ongoing debate around terrorism. The field must take a more prevention-focused approach to the problem of terrorism. Failure to do so only perpetuates approaches that have not been successful. PMID:28905048

Social gradient in intermediary determinants of oral health at school level in Finland.

PubMed

Anttila, J; Tolvanen, M; Kankaanpää, R; Lahti, S

2018-05-30

An adapted framework for oral health inequalities suggests that structural determinants cause oral health inequalities through socio-economic position (SEP) and intermediary determinants. We applied this framework to examine whether there is a social gradient in the intermediary determinants at the school level, even when adjusted for school size, geographical location and teaching language. Cross-sectional survey. This study combined data from two independent studies focusing on Finnish upper comprehensive schools (N=970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). All schools that took part in the SSSS and whose pupils answered the SHPS were included in the analysis (n=360, response rate=37%). From the questions of the SHPS and the SSSS suitable for the theoretical framework, attitudes and access to intoxicants, school health services, school environment, home environment, the school's oral health-related actions and the pupil's own behaviour were selected as the intermediary determinants and as the factors determining the school-level SEP. The social gradient in the intermediary determinants of oral health was investigated with Pearson's and Spearman's correlation coefficients between those and the school-level SEP. In the multivariable analysis, the General Linear Model with manual backward elimination was used. A social gradient was observed in the intermediary determinants 'home environment' and 'the pupils' tooth brushing frequency' and an inverse social gradient in 'attitudes and access to intoxicants' and 'school health services'. Social gradient between schools could increase Finnish adolescents' oral health inequalities. Copyright© 2018 Dennis Barber Ltd.

Migration and social determinants of mental health: Results from the Canadian Health Measures Survey.

PubMed

Salami, Bukola; Yaskina, Maryna; Hegadoren, Kathleen; Diaz, Esperanza; Meherali, Salima; Rammohan, Anu; Ben-Shlomo, Yoav

2017-11-09

Studies worldwide point to increased risk of mental health problems among immigrants. However, the data on Canadian immigrants' mental health are ambiguous. To address this, we examined the relationship of both self-perceived mental health and reported diagnosis of mood disorders with age, gender, migration status, time since migration, and social determinants of health factors. We analyzed three cycles of the Canadian Health Measures Survey. Our outcome variables were self-perceived mental health and reported diagnosis of mood disorders. We used weighted logistic regression to model time since migration conditional on age, gender, income, community belonging, education, and employment status for 12 160 participants aged 15-79 years. Recent (within 5 years) migrants reported better self-perceived mental health (odds ratio 3.98, 95% confidence interval [CI]: 2.06-7.70) but this effect disappeared with longer time since immigration. Other predictors were older age, higher income, better sense of community belonging, and being employed. Similarly, diagnosis of mood disorders was less likely to be reported in recent migrants (odds ratio 0.23, 95% CI: 0.10-0.53) with some weak evidence that this was also seen among longer-term migrant residents (>10 years). Diagnosis was also associated with older age, being a woman, lower income, weak sense of community belonging, and being unemployed. Our findings indicate that migrants to Canada do not have worse mental health in general, though health and social policies need to attend to the socio-economic determinants, such as low income, unemployment, and a poor sense of community belonging, which contribute to population health outcomes.

Social class, gender, and time use: implications for the social determinants of body weight?

PubMed

McLaren, Lindsay; Godley, Jenny; MacNairn, Ian A S

2009-12-01

The social gradient in body weight (for example, obesity) departs from the social gradient in other health outcomes. Innovative approaches are needed to understand the observed patterns. This study examines time-use patterns by indicators of socio-economic position, and considers the implications of variations in time use for the social gradient in weight reported in other studies. The data are from respondents aged 25 to 64 to Canada's 1986 and 2005 General Social Surveys, which focused on time use. Participation in various activities was examined by sex, and by personal income and education, stratified by sex, in both years. Higher-income men and women were more likely than those of lower income to spend time in paid work, commuting and eating out, and less likely to spend time sleeping. Men and women with higher education were more likely than those with lower education to spend time in physical activity (2005 only) and reading. These time-use patterns plausibly contribute to the social gradient in obesity reported in other Canadian studies. The findings suggest that there is value in looking beyond a narrow range of health behaviours toward broader measures of daily routines to gain insight into the social determinants of weight and health.

Social Welfare Control in Mobile Crowdsensing Using Zero-Determinant Strategy.

PubMed

Hu, Qin; Wang, Shengling; Bie, Rongfang; Cheng, Xiuzhen

2017-05-03

As a promising paradigm, mobile crowdsensing exerts the potential of widespread sensors embedded in mobile devices. The greedy nature of workers brings the problem of low-quality sensing data, which poses threats to the overall performance of a crowdsensing system. Existing works often tackle this problem with additional function components. In this paper, we systematically formulate the problem into a crowdsensing interaction process between a requestor and a worker, which can be modeled by two types of iterated games with different strategy spaces. Considering that the low-quality data submitted by the workers can reduce the requestor's payoff and further decrease the global income, we turn to controlling the social welfare in the games. To that aim, we take advantage of zero-determinant strategy, based on which we propose two social welfare control mechanisms under both game models. Specifically, we consider the requestor as the controller of the games and, with proper parameter settings for the to-be-adopted zero-determinant strategy, social welfare can be optimized to the desired level no matter what strategy the worker adopts. Simulation results demonstrate that the requestor can achieve the maximized social welfare and keep it stable by using our proposed mechanisms.

[Social determinants of contraceptive use in Tunisia].

PubMed

Dimassi, K; Douik, F; Douzi, M A; Saidi, O; Ben Romdhane, H

2017-02-01

In Tunisia, the "Revolution" of January 2011 highlighted significant regional disparities and social inequalities in access to health care, including reproductive health services. The purpose of this study was to analyze the social determinants of the use of contraception in Tunisia. A cross-sectional national study conducted in 2012; on a sample of 15 to 49-year married women (n=4374) drawn by a two levels random sampling. Prevalence of contraception and its association factors were assessed. Logistic regression was used to evaluate the variation of contraception prevalence with area of residence, age, level of education, number of children and household income. The prevalence of contraception was 66.4 %. Eighty-two percent of women used a modern contraceptive method. The use of contraceptive methods was significantly dependent on the age (P<0.001), area of residence (P=0.008), education (P<0.001). The prevalence of contraception was higher in North West (OR=1.1 [0.81-1.5]; P<0.001), among multiparous women (OR=4.49 [3.57-5.66]; P<0.001), among the youngest women (OR=1.4 [0.9-2,19]; P<0.001) and among those with higher levels of education (OR=1.62 [1.19-2.21]; P=0.008). Tunisia, precursor Arab country in family planning, is recording a slowdown in the use of contraception in comparison with other countries of North Africa. Social determinants, such as, age, living conditions, area of residence and level of education are indicators to consider when targeting interventions. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Thinking Socially: Teaching Social Knowledge to Foster Social Behavioral Change

ERIC Educational Resources Information Center

Crooke, Pamela J.; Winner, Michelle Garcia; Olswang, Lesley B.

2016-01-01

This article addresses the complexity of what it means to "be social" from the perspective of social thinking. This perspective recognizes social cognitive processing abilities as the foundation for social knowledge and, in turn, social behaviors. The article further describes variables that influence how one understands how to do what…

Seeing Context through Metaphor: Using Communications Research to Bring a Social Determinants Perspective to Public Thinking about Child Abuse and Neglect

PubMed Central

Kendall-Taylor, Nathaniel; Stanley, Kate

2018-01-01

Human beings think in metaphor and reason through analogy. The metaphors through which we think influence how we understand and feel about social issues as well as the actions that we see as appropriate and important. Metaphors can be used to increase understanding of how issues work and increase the salience of a given issue, build support for programs and policies necessary to address the issue, and instigate demand for change and civic action. In this paper, we use a mixed methods research design, including brief qualitative interviews, experimental surveys, and focus groups, to test the ability of different metaphors to influence public understanding of the social determinants of child abuse and neglect in the UK. We find one metaphor in particular that improves people’s understanding of the social causes of child maltreatment and increases support for structural solutions. This metaphor can be used to build support for preventative public health solutions. PMID:29351195

Seeing Context through Metaphor: Using Communications Research to Bring a Social Determinants Perspective to Public Thinking about Child Abuse and Neglect.

PubMed

Kendall-Taylor, Nathaniel; Stanley, Kate

2018-01-19

Human beings think in metaphor and reason through analogy. The metaphors through which we think influence how we understand and feel about social issues as well as the actions that we see as appropriate and important. Metaphors can be used to increase understanding of how issues work and increase the salience of a given issue, build support for programs and policies necessary to address the issue, and instigate demand for change and civic action. In this paper, we use a mixed methods research design, including brief qualitative interviews, experimental surveys, and focus groups, to test the ability of different metaphors to influence public understanding of the social determinants of child abuse and neglect in the UK. We find one metaphor in particular that improves people's understanding of the social causes of child maltreatment and increases support for structural solutions. This metaphor can be used to build support for preventative public health solutions.

A Systematic Review of Interventions on Patients' Social and Economic Needs.

PubMed

Gottlieb, Laura M; Wing, Holly; Adler, Nancy E

2017-11-01

Healthcare systems are experimenting increasingly with interventions to address patients' social and economic needs. This systematic review examines how often and how rigorously interventions bridging social and medical care have been evaluated. The review included literature from PubMed published between January 2000 and February 2017. Additional studies were identified by reference searches and consulting local experts. Included studies were based in the U.S.; addressed at least one social or economic determinant of health (e.g., housing, employment, food insecurity); and were integrated within the medical care delivery system. Data from included studies were abstracted in June 2015 (studies published January 2000-December 2014) and in March 2017 (studies published January 2015-February 2017). Screening of 4,995 articles identified 67 studies of 37 programs addressing social needs. Interventions targeted a broad range of social needs and populations. Forty studies involved non-experimental designs. There was wide heterogeneity in outcome measures selected. More studies reported findings associated with process (69%) or social or economic determinants of health (48%) outcomes than health (30%) or healthcare utilization or cost (27%) outcomes. Studies reporting health, utilization, or cost outcomes reported mixed results. Healthcare systems increasingly incorporate programs to address patients' social and economic needs in the context of care. But evaluations of these programs to date focus primarily on process and social outcomes and are often limited by poor study quality. Higher-quality studies that include common health and healthcare utilization outcomes would advance effectiveness research in this rapidly expanding field. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Social media, knowledge translation, and action on the social determinants of health and health equity: A survey of public health practices.

PubMed

Ndumbe-Eyoh, Sume; Mazzucco, Agnes

2016-11-01

The growth of social media presents opportunities for public health to increase its influence and impact on the social determinants of health and health equity. The National Collaborating Centre for Determinants of Health at St. Francis Xavier University conducted a survey during the first half of 2016 to assess how public health used social media for knowledge translation, relationship building, and specific public health roles to advance health equity. Respondents reported that social media had an important role in public health. Uptake of social media, while relatively high for personal use, was less present in professional settings and varied for different platforms. Over 20 per cent of those surveyed used Twitter or Facebook at least weekly for knowledge exchange. A lesser number used social media for specific health equity action. Opportunities to enhance the use of social media in public health persist. Capacity building and organizational policies that support social media use may help achieve this.

Social determinants of health: a veil that hides socioeconomic position and its relation with health.

PubMed

Regidor, Enrique

2006-10-01

The emergence of theoretical models of social determinants of health has added conceptual ambiguity to the understanding of social inequalities in health, as it is often not possible to clearly distinguish between socioeconomic position and these determinants. Whether the existence of social inequalities in health is based on differences in health or on differences in social determinants of health that are systematically associated with socioeconomic position, policymakers should be clearly informed of the importance of socioeconomic position for health. Thus, the following three basic requirements are proposed: to reach a consensus about the dimensions that reflect socioeconomic position; to agree about what are to be considered the social determinants of health and whether or not these determinants are a construct that can be distinguished from socioeconomic position; and finally, to establish which dimensions and measures of socioeconomic position are most appropriate for the evaluation of interventions that aim to reduce these inequalities.

Position of Social Determinants of Health in Urban Man-Made Lakes

PubMed Central

Shojaei, Parisa; Karimlou, Masoud; Mohammadi, Farahnaz; Afzali, Hosein Malek; Forouzan, Ameneh Setareh

2013-01-01

Background and Objective: A social determinants approach proposes that enhancing living conditions in areas such as income, housing, transportation, employment, education, social support, and health services is central to improving the health of urban populations. Urban development projects can be costly but have health impacts. The benefit derived from the creation of man-made lakes in developing countries is usually associated with great risks; however, the evidence for physical and non-physical health benefits of urban man-made lake is unclear. The aim of this paper is to formulate a conceptual framework of associations between urban man-made lakes and social determinants of health. Method: This study was a qualitative study carried out using one focus group discussion and 16 individual interviews. Data were analyzed based on deductive-inductive content analysis approach. Results: Participants’ points of view were analyzed within 261 codes. Data analysis matrix was the conceptual framework of social determinants of health commission and its sub-groups, thus, two structural and mediating determinants categories as well as their sub-sets were created accordingly. In addition, some extra sub-sets including environment, air quality, weather changes, noise pollution, pathogenesis, quality of life, shortage of available resources, region popularity, ethnicity, tourism, social and physical development of children, unintentional injuries, aesthetic, and spirituality were extracted beyond the matrix factors, which were placed in each of above categories based on their thematic content. Conclusion: This paper has illustrated that the quality and type of man-made lake provided within communities can have a significant and sustained impact on community’s health and wellbeing. Therefore, in order to strengthen positive effects and reduce negative effects of any developmental projects within community, their impacts on public health should be taken into consideration

Social Determinants of Educational Outcomes in Indigenous Learners

ERIC Educational Resources Information Center

Chandler, Michael J.

2010-01-01

For the better part of two decades, the author and his research colleagues have been engaged in a broad program of research aimed at identifying certain of the "social determinants of health and wellbeing" common to Canadian First Nation, Metis, and Inuit youth. The present account samples from these ongoing research efforts by recapping…

Religious social capital: Its measurement and utility in the study of the social determinants of health

PubMed Central

Maselko, Joanna; Hughes, Cayce; Cheney, Rose

2014-01-01

As a social determinant of health, religiosity remains not well understood, despite the prevalence of religious activity and prominence of religious institutions in most societies. This paper introduces a working measure of Religious Social Capital and presents preliminary associations with neighborhood social capital and urban stressors. Religious social capital is defined as the social resources available to individuals and groups through their social connections with a religious community. Domains covered include group membership, social integration, values/norms, bonding/bridging trust as well as social support. Cross-sectional data come from a convenience sample of 104 community dwelling adults residing in a single urban neighborhood in a large US city, who also provided information on neighborhood social capital, and experiences of urban stressors. Results suggest that religious social capital is a valid construct that can be reliably measured. All indicators of religious social capital were higher among those who frequently attended religious services, with the exception of bridging trust (trust of people from different religious groups). A weak, inverse, association was also observed between religious and neighborhood social capital levels. Levels of religious social capital were correlated with higher levels of reported urban stressors, while neighborhood social capital was correlated with lower urban stressor levels. A significant percent of the sample was unaffiliated with a religious tradition and these individuals were more likely to be male, young and more highly educated. Social capital is a promising construct to help elucidate the influence of religion on population health. PMID:21802182

Determinants of Social Accountability in Iranian Nursing and Midwifery Schools: A Delphi Study.

PubMed

Salehmoghaddam, Amir Reza; Mazloom, Seyed Reza; Sharafkhani, Mohammad; Gholami, Hassan; Emami Zeydi, Amir; Khorashadizadeh, Fatemeh; Emadzadeh, Ali

2017-04-01

Revising the medical education programs to meet the needs of society has become both a necessity and an important priority due to the considerable increase of population, changing patterns of diseases, and new health priorities. While this necessity has been highlighted in Iran's Fifth Development Plan as well as its National 2025 Vision Plan, the determinants of social accountability have not been explained yet. This study aimed to develop determinants of social accountability in the Iranian Nursing and Midwifery Schools. This classic Delphi study included thirty experts in Nursing and Midwifery Education, Research and Services selected based on purposive sampling and three rounds of Delphi technique and conducted in Nursing and Midwifery School of Mashhad University of Medical Sciences. The primary data were collected using an initial structured questionnaire prepared through extensive review of literature. SPSS 11.5 software was used to analyze the data. The interquartile deviation and percentage of agreement were also used to study the consensus of opinion by experts. Finding obtained from the rounds of Delphi resulted in selecting 69 determinants out of the initial pool of 128 primary determinants of social accountability. The items were selected based on experts' consensus and categorized under three main activities of Nursing and Midwifery School, namely education, research, and service. Social accountability determinants were explained by 69 items for Schools of Nursing and Midwifery in Iran. The proposed determinants can be used by managers and authorities of Nursing and Midwifery School, policy makers, and evaluating institutions associated with them to ensure realizing social accountability goals.

Interventions to improve social determinants of health among elderly ethnic minority groups: a review.

PubMed

Pool, Michelle S; Agyemang, Charles O; Smalbrugge, Martin

2017-12-01

Like the European general population, ethnic minorities are aging. In this group, important social determinants of health (social participation, social isolation and loneliness) that lead to negative health outcomes frequently occur. Interventions targeting these determinants may decrease negative health outcomes. The goal of this article was to identify effective interventions that improve social participation, and minimise social isolation and loneliness in community dwelling elderly ethnic minorities. An electronic database (PubMed) was systematically searched using an extensive search strategy, for intervention studies in English, French, Dutch of German, without time limit. Additional articles were found using references. Articles were included if they studied an intervention aimed to improve social participation or minimise social isolation or loneliness and were focusing on community dwelling elderly ethnic minorities. Data regarding studies characteristics and results were extracted. Six studies (three randomized controlled trials, three non-controlled intervention studies) were included in the review. All studies were group-based interventions and had a theoretical basis. Five out of six studies showed improvement on a social participation, -isolation or loneliness outcome. Type of intervention included volunteering-, educational- and physical activities. In three studies active participation of the participant was required, these interventions were not more effective than other interventions. Some interventions improved the included social determinants of health in community dwelling elderly ethnic minorities. Investment in further development and implementation of these interventions may help to improve social determinants of health in these populations. It is necessary to evaluate these interventions in the European setting. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Doing good and doing well: corporate social responsibility in post Obamacare America.

PubMed

Corbett, James; Kappagoda, Manel

2013-03-01

This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations (ACOs) touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health--"the conditions into which people are born, grow, live, work, and age"-- are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system. © 2013 American Society of Law, Medicine & Ethics, Inc.

Integrating Social Theory Into Public Health Practice

PubMed Central

Potvin, Louise; Gendron, Sylvie; Bilodeau, Angèle; Chabot, Patrick

2005-01-01

The innovative practice that resulted from the Ottawa Charter challenges public health knowledge about programming and evaluation. Specifically, there is a need to formulate program theory that embraces social determinants of health and local actors’ mobilization for social change. Likewise, it is imperative to develop a theory of evaluation that fosters reflexive understanding of public health programs engaged in social change. We believe advances in contemporary social theory that are founded on a critique of modernity and that articulate a coherent theory of practice should be considered when addressing these critical challenges. PMID:15798114

Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

PubMed

Williams, Allison M; Eby, Jeanette A; Crooks, Valorie A; Stajduhar, Kelli; Giesbrecht, Melissa; Vuksan, Mirjana; Cohen, S Robin; Brazil, Kevin; Allan, Diane

2011-05-18

An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the

Canada's Compassionate Care Benefit: Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

PubMed Central

2011-01-01

Background An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. Methods As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Results Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. Conclusions This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to

Social Welfare Control in Mobile Crowdsensing Using Zero-Determinant Strategy

PubMed Central

Hu, Qin; Wang, Shengling; Bie, Rongfang; Cheng, Xiuzhen

2017-01-01

As a promising paradigm, mobile crowdsensing exerts the potential of widespread sensors embedded in mobile devices. The greedy nature of workers brings the problem of low-quality sensing data, which poses threats to the overall performance of a crowdsensing system. Existing works often tackle this problem with additional function components. In this paper, we systematically formulate the problem into a crowdsensing interaction process between a requestor and a worker, which can be modeled by two types of iterated games with different strategy spaces. Considering that the low-quality data submitted by the workers can reduce the requestor’s payoff and further decrease the global income, we turn to controlling the social welfare in the games. To that aim, we take advantage of zero-determinant strategy, based on which we propose two social welfare control mechanisms under both game models. Specifically, we consider the requestor as the controller of the games and, with proper parameter settings for the to-be-adopted zero-determinant strategy, social welfare can be optimized to the desired level no matter what strategy the worker adopts. Simulation results demonstrate that the requestor can achieve the maximized social welfare and keep it stable by using our proposed mechanisms. PMID:28467370

Social determinants of health in India: progress and inequities across states.

PubMed

Cowling, Krycia; Dandona, Rakhi; Dandona, Lalit

2014-10-08

Despite the recognized importance of social determinants of health (SDH) in India, no compilation of the status of and inequities in SDH across India has been published. To address this gap, we assessed the levels and trends in major SDH in India from 1990 onwards and explored inequities by state, gender, caste, and urbanicity. Household- and individual-level SDH indicators were extracted from national household surveys conducted between 1990 and 2011 and means were computed across population subgroups and over time. The multidimensional poverty index (MPI), a composite measure of health, education, and standard of living, was calculated for all three rounds of the National Family Health Survey, adjusting the methodology to generate comparable findings from the three datasets. Data from government agencies were analyzed to assess voting patterns, political participation, and air and water pollution. Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children. There are large, but narrowing, gender gaps in education indicators, but no measurable change in women's participation in governance or the labor force. Less than 25% of workers have job security and fewer than 15% have any social security benefit. Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations. This assessment indicates that air pollution (indoor and outdoor), child undernutrition, unimproved sanitation, employment conditions, and gender inequality are priority areas for public policy related to SDH in India.

Career Psychology in South Africa: Addressing and Redressing Social Justice

ERIC Educational Resources Information Center

Watson, Mark

2010-01-01

This paper explores the definition of social justice in career psychology and how this might be understood in the South African context. In particular, macro-contextual factors that define social justice issues in South African career psychology are described. The extent to which the discipline of career psychology in South Africa has addressed…

Identities and Social Structure: The 2003 Cooley-Mead Award Address

ERIC Educational Resources Information Center

Burke, Peter J.

2004-01-01

The present paper examines existing links between identities and the social structure in the context of identity control theory. I point out that, whether social structure is conceived as positions (roles and group memberships) to which identities are tied, or as the human organization of resource flows and transfers that are controlled by the…

Equity, social determinants and public health programmes--the case of oral health.

PubMed

Petersen, Poul Erik; Kwan, Stella

2011-12-01

The WHO Commission on Social Determinants of Health issued the 2008 report 'Closing the gap within a generation - health equity through action on the social determinants of health' in response to the widening gaps, within and between countries, in income levels, opportunities, life expectancy, health status, and access to health care. Most individuals and societies, irrespective of their philosophical and ideological stance, have limits as to how much unfairness is acceptable. In 2010, WHO published another important report on 'Equity, Social Determinants and Public Health Programmes', with the aim of translating knowledge into concrete, workable actions. Poor oral health was flagged as a severe public health problem. Oral disease and illness remain global problems and widening inequities in oral health status exist among different social groupings between and within countries. The good news is that means are available for breaking poverty and reduce if not eliminate social inequalities in oral health. Whether public health actions are initiated simply depends on the political will. The Ottawa Charter for Health Promotion (1986) and subsequent charters have emphasized the importance of policy for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined. © 2011 John Wiley & Sons A/S.

Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S.

PubMed

Penman-Aguilar, Ana; Carter, Marion; Snead, M Christine; Kourtis, Athena P

2013-01-01

We reviewed the literature focused on socioeconomic influences on teen childbearing and suggested directions for future research and practice related to this important indicator of teen sexual health. We conducted an electronic search of Medline, ERIC, PsychLit, and Sociological Abstracts databases for articles published from January 1995 to November 2011. Selected articles from peer-reviewed journals included original quantitative analyses addressing socioeconomic influences on first birth among teen women in the U.S. Articles were abstracted for key information, ranked for quality according to the U.S. Preventive Services Task Force guidelines, assessed for bias, and synthesized. We selected articles with a range of observational study designs. Risk for bias varied across studies. All 12 studies that considered socioeconomic factors as influences on teen childbearing (vs. moderators or mediators of other effects) reported at least one statistically significant association relating low socioeconomic status, underemployment, low income, low education levels, neighborhood disadvantage, neighborhood physical disorder, or neighborhood-level income inequality to teen birth. Few reports included any associations contradicting this pattern. This review suggests that unfavorable socioeconomic conditions experienced at the community and family levels contribute to the high teen birth rate in the U.S. Future research into social determinants of sexual health should include multiple levels of measurement whenever possible. Root causes of teen childbearing should be evaluated in various populations and contexts. Interventions that address socioeconomic influences at multiple levels could positively affect large numbers of teens and help eliminate disparities in teen childbearing.

Developing Social Marketing Capacity to Address Health Issues

ERIC Educational Resources Information Center

Whitelaw, S.; Smart, E.; Kopela, J.; Gibson, T.; King, V.

2011-01-01

Purpose: Social marketing is increasingly being seen as a potentially effective means of pursuing health education practice generally and within various specific areas such as mental health and wellbeing and more broadly in tackling health inequalities. This paper aims to report and reflect on the authors' experiences of undertaking a health…

Social determinants of health and quality of life of caregivers of children with cancer.

PubMed

Rocha, Rebeca Silveira; Pinheiro, Larissa Pereira; Oriá, Mônica Oliveira Batista; Ximenes, Lorena Barbosa; Pinheiro, Ana Karina Bezerra; Aquino, Priscila de Souza

2016-09-29

to associate the social determinants of health and quality of life of caregivers of children with cancer. a cross-sectional study conducted in a paediatric cancer centre in Fortaleza, Brazil, with 176 participants in November and December 2013. Data were collected using a questionnaire with social determinants of health, and quality of life was assessed using the World Health Organization Quality of Life-Bref. The determinants were correlated with the averages of the quality of life domains using analysis of variance (ANOVA). there was a statistically significant association between the domains of social relations and education (p = 0.01792) and between the psychosocial domain and the gender of the caregiver (p = 0.01901). The male caregivers that were highly educated, younger, married, stay-at-home dads from the interior had a better quality of life. the study sheds light on the influence of social determinants of health in the quality of life of caregivers of children with cancer.

'We talk, we do not have shame': addressing stigma by reconstructing identity through enhancing social cohesion among female sex workers living with HIV in the Dominican Republic.

PubMed

Carrasco, Maria Augusta; Barrington, Clare; Kennedy, Caitlin; Perez, Martha; Donastorg, Yeycy; Kerrigan, Deanna

2017-05-01

This study explores social cohesion as a strategy used by female sex workers to address layered HIV and sex work-related stigma. Data derive from a thematic analysis of 23 in-depth interviews and 2 focus groups with female sex workers living with HIV enrolled in a multi-level HIV/STI prevention, treatment and care intervention in Santo Domingo, Dominican Republic. Drawing on Foucault's conceptualisation of modern power, discipline and resistance, we argue that social cohesion provides the psychosocial space (of trust, solidarity and mutual aid) to subvert oppressive societal norms, enabling the reconstruction of identity. Among study participants, identity reconstruction happened through the production, repetition and performance of new de-stigmatised narratives that emerged and were solidified through collective interaction. Findings highlight that enabling the collective reconstruction of identity through social cohesion - rather than solely attempting to change individual beliefs - is a successful approach to addressing stigma.

Social Functioning among Girls with Fragile X or Turner Syndrome and Their Sisters.

ERIC Educational Resources Information Center

Mazzocco, Michele M. M.; Baumgardner, Thomas; Freund, Lisa S.; Reiss, Allan L.

1998-01-01

Social behaviors among girls (ages 6-16) with fragile X (n=8) or Turner syndrome (n=9) were examined to address the role of family environment versus biological determinants of social dysfunction. Compared to their sisters, subjects had lower IQS and higher rating of social and attention problems. (Author/CR)

Addressing Parents' Vaccine Concerns: A Randomized Trial of a Social Media Intervention.

PubMed

Daley, Matthew F; Narwaney, Komal J; Shoup, Jo Ann; Wagner, Nicole M; Glanz, Jason M

2018-05-08

Successful strategies are needed to address parental vaccine hesitancy, a significant public health issue. The study objective was to assess whether an Internet-based platform with vaccine information and interactive social media components improved parents' vaccine-related attitudes. A three-arm RCT. The study was conducted in a large Colorado integrated healthcare organization. Parents were enrolled during September 2013 through October 2015 and followed through November 2016; data were analyzed in 2017. Parents, recruited during pregnancy, were given a survey about vaccine-related attitudes at enrollment (i.e., baseline) and when their child was aged 3-5 months and 12-15 months (Timepoints 1 and 2, respectively). Parental vaccine hesitancy was assessed at baseline. Study participants were randomized to the following: a study website with vaccine information and social media components (VSM arm); a website with vaccine information only (VI); or usual care. Change in parental vaccine attitudes over time by baseline degree of vaccine hesitancy. Among 1,093 study participants, 945 (86.5%) completed all three surveys. Comparing baseline with Timepoint 1 among vaccine-hesitant parents, the VSM and VI arms were associated with significant improvements in attitudes regarding vaccination benefits compared to usual care (VSM mean change 0.23 on a 5-point scale, 95% CI=0.05, 0.40, VI mean change 0.22, 95% CI=0.04, 0.40). Comparing baseline with Timepoint 2 among hesitant parents, the VSM and VI arms were also associated with significant reductions in parental concerns about vaccination risks compared to usual care (VSM mean change -0.37, 95% CI= -0.60, -0.14, VI mean change -0.31, 95% CI= -0.55, -0.07). Self-efficacy around vaccine decision making also improved among vaccine-hesitant parents. No intervention effect was observed among parents not vaccine-hesitant at baseline. Among vaccine-hesitant parents, an Internet-based intervention improved parents' attitudes about

Efforts to Bridge the Gap between Research and Practice in Social Work: Precedents and Prospects: Keynote Address at the Bridging the Gap Symposium

ERIC Educational Resources Information Center

Rubin, Allen

2015-01-01

This keynote address discusses previous and ongoing efforts to reduce the persistent gap between research and practice in social work and offers recommendations for further bridging that gap. Key among those recommendations is the need to conduct descriptive outcome studies of efforts to adapt research-supported interventions in everyday practice…

Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007.

PubMed

Koller, Theadora; Morgan, Antony; Guerreiro, Ana; Currie, Candace; Ziglio, Erio

2009-09-01

Over the past 25 years, the WHO collaborative cross-national Health Behaviour in School-aged Children (HBSC) study has been accumulating evidence that provides insights into how to promote the health and well-being of young people. HBSC has increased understanding of the determinants of young people's health, particularly in relation to the social contexts in which they live, learn and play. The study now spans 43 countries and regions in Europe and North America. HBSC provides intelligence for the development and evaluation of public health policy and practice at national, sub-national and international levels. However, the mere existence of evidence does not automatically change policy nor necessarily improve the lives of young people. Effective mechanisms to ensure use of evidence in policy-making and practice are needed. The WHO/HBSC Forum series is a platform designed to facilitate the translation of evidence into action. Forum processes convene researchers, policy-makers and practitioners from across Europe to analyse data, review policies and interventions, and identify lessons learned to improve the health of adolescents through actions that address the social contexts that influence their health. Each Forum process consists of case studies produced by interdisciplinary teams in countries and regions, cross-country evidence reviews, a European consultation, an outcomes statement within a final publication, and a Web-based knowledge platform. In addition to emphasizing the translation of research into action, the Forum series focuses on increasing know-how to scale up intersectoral policies and interventions; reduce health inequities; and involve young people in the design, implementation and evaluation of policies and interventions. Interviews with selected participants in the 2007 Forum process revealed that national-level impacts of involvement were: brokering new or strengthening existing working relationships among members of case study drafting teams

Assessment of determinants and quality of life of university students with social phobias in a coastal city of south India.

PubMed

Joseph, Nitin; Rasheeka, V P; Nayar, Vhaishakh; Gupta, Purnima; Manjeswar, Mukund Pai; Mohandas, Anjali

2018-03-01

Social phobia is a common psychiatric disorder, and its onset happens usually around late adolescence period. Therefore, early diagnosis and its management is essential in any educational setting. To identify university students with social phobia, to find out its determinants and to observe its impact on their quality of life. The data was collected using a self-administered questionnaire. Social Phobia Inventory Questionnaire and Quality of Life Enjoyment and Satisfaction Questionnaire were used. The mean age of the 450 student participants was 20.6 ± 1.6 years. Majority [312(69.3%)] were males and majority [305(67.8%)] were native of urban areas. Of the total, 169(37.6%) were found to have social phobia. Among them, 114(67.5%) had mild, 47(27.8%) had moderate and 8(4.7%) had severe social phobia. Family history of anxiety disorders (P = 0.006), embarrassment with own socio-economic status (P = 0.001) and past history of failure in academic examinations (P < 0.001) were significantly associated with the presence of social phobia among the participants. Preference of interaction using social media instead of face to face communication with people (P = 0.013), and by texting rather than calling the person (P = 0.002) were seen significantly more among those with social phobia. The mean quality of life scores was found to be deteriorating significantly with increasing intensity of social phobia among students (P < 0.001). Social phobia was seen among more than one-third of the participants. Counselling centers are therefore required to address this problem at universities. This will also help to improve the quality of life and the socializing skills of those affected. Copyright © 2018 Elsevier B.V. All rights reserved.

[A global view of population health in Colombia: role of social macro-determinants].

PubMed

Idrovo, Alvaro J; Ruiz-Rodríguez, Myriam

2007-09-01

The social environment is an important determinant of population and individual health. However, its impact is often not considered in national health policies and generally its attributes are considered as constants. For this reason, contemporary health policies place greater emphasis on individual risk factors. Colombias position in the world ranking is described with respect to several social macro-determinants of health, previously characterized as components of class/welfare regime model. The exploratory study included all countries with comparable data including the following: (1) economic development [gross domestic product per capita adjusted for purchasing power parity], (2) income inequality [Gini coefficient], (3) social capital corruption perceptions index and generalized trust, and (4) political regime index of freedom. First, correlations between these macro-determinants were estimated, and second, the relationship between them and life expectancy at birth was explored. Finally, the position of Colombia in global context was determined. Important correlations occurred among the macro-determinants. Colombia tended to have intermediate to low positions in the global context in all macro-determinants, with the exception of gross domestic product per capita adjusted for purchasing power parity. The macro-determinant of population health with the highest potential of effecting improvement in health conditions is to modify income inequality.

The Role of Sport as a Social Status Determinant for Children: Thirty Years Later

ERIC Educational Resources Information Center

Chase, Melissa A.; Machida, Moe

2011-01-01

The purpose of this study was to examine the role of sport as a social status determinant among racially diverse children. Participants were 1,233 fourth- to seventh-grade children. Results indicated there were gender, grade, and racial differences for the selection of social status determinants. Boys placed more importance than girls on being…

The social and economic context and determinants of schistosomiasis japonica.

PubMed

Huang, Yi-Xin; Manderson, Lenore

2005-01-01

A variety of biological and social factors govern schistosomiasis japonica in China. Social factors include those at a national and regional level, such as policies and patterns of development, which impact on local economic activities, and affect community, household and personal risk factors of infection. Drawing on research conducted in China, we illustrate how social structural and related factors influence individual risk and prevalence of infection. At a macro-level, political changes have occurred resulting in the shift from collective to family-based production, leading to clustering of infection in families. Industrialization and urbanization, and associated increased population mobility, have also influenced patterns of transmission and infection. Types of activities and local production patterns determine the exposure of individuals to schistosome-infested water sources. Fishermen have the most frequent water contact, aquatic workers the second and farmers the third; the relative risk of Schistosoma japonicum infection follows the same order. Among farmers, human infection is significantly related to agricultural production in rice fields infested with the intermediate host snail, and to rates of the infection in livestock. Risk of S. japonicum infection is also influenced by the domestic environment, including both the location of the house in relation to snail-colonized water sources, access to safe water, and improved sanitation. Household wealth and income determine family ability to provide and maintain safe water and sanitation, while determining or interacting with other variables. At an individual level, sex, age, educational level and ethnicity are all associated with different patterns of water use and water contact behaviour thereby affecting infection rates. Schistosomiasis impairs the growth and nutrition of children and the physical work capacity of adults, and so affects economic development. Given this, we note the importance of further

Social and individual determinants of adolescents' acceptance of novel healthy and cool snack products.

PubMed

Nørgaard, Maria Kümpel; Sørensen, Bjarne Taulo; Grunert, Klaus G

2014-12-01

Four new, healthy snack products, consisting of fruit, vegetables, bread, dip and topping, were tested with 600 Danish adolescents aged 9-16. Participants could view, handle, and test the products in a school setting. Acceptance was measured by overall buying intention, as well as buying intention contingent on specific substitutes and on the social situation. Price consciousness, health consciousness, snack neophobia, peer influence, social activities and word-of-mouth were measured as potential determinants of acceptance of the novel products. An exploratory analysis in TETRAD suggested that the measured constructs form three layers, with overall buying intention as the terminal causal effect, health consciousness, word of mouth, snack neophobia and peer influence as endogenous determinants, and social activities and the contingent buying intentions as mediators. Estimation of the causal relationships was conducted in LISREL. Findings show a predominance of social factors as determinants of novel snack acceptance, whereas health consciousness had only a weak and indirect effect on buying intentions and the effect of snack neophobia was partly mediated by social factors. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social Determinants of Population Health: A Systems Sciences Approach

PubMed Central

Fink, David S.; Keyes, Katherine M.; Cerdá, Magdalena

2016-01-01

Population distributions of health emerge from the complex interplay of health-related factors at multiple levels, from the biological to the societal level. Individuals are aggregated within social networks, affected by their locations, and influenced differently across time. From aggregations of individuals, group properties can emerge, including some exposures that are ubiquitous within populations but variant across populations. By combining a focus on social determinants of health with a conceptual framework for understanding how genetics, biology, behavior, psychology, society, and environment interact, a systems science approach can inform our understanding of the underlying causes of the unequal distribution of health across generations and populations, and can help us identify promising approaches to reduce such inequalities. In this paper, we discuss how systems science approaches have already made several substantive and methodological contributions to the study of population health from a social epidemiology perspective. PMID:27642548

Position of social determinants of health in urban man-made lakes plans.

PubMed

Shojaei, Parisa; Karimloo, Masoud; Mohammadi, Farahnaz; Malek Afzali, Hossein; Forouzan, Ameneh Setareh

2013-09-04

A social determinants approach proposes that enhancing living conditions in areas such as income, housing, transportation, employment, education, social support, and health services is central to improving the health of urban populations. Urban development projects can be costly but have health impacts. The benefit derived from the creation of man-made lakes in developing countries is usually associated with great risks; however, the evidence for physical and non-physical health benefits of urban man-made lake is unclear. The aim of this paper is to formulate a conceptual framework of associations between urban man-made lakes and social determinants of health. This study was a qualitative study carried out using one focus group discussion and 16 individual interviews. Data were analyzed based on deductive-inductive content analysis approach. Participants' points of view were analyzed within 261 codes. Data analysis matrix was the conceptual framework of social determinants of health commission and its sub-groups, thus, two structural and mediating determinants categories as well as their sub-sets were created accordingly. In addition, some extra sub-sets including environment, air quality, weather changes, noise pollution, pathogenesis, quality of life, shortage of available resources, region popularity, ethnicity, tourism, social and physical development of children, unintentional injuries, aesthetic, and spirituality were extracted beyond the matrix factors, which were placed in each of above categories based on their thematic content. This paper has illustrated that the quality and type of man-made lake provided within communities can have a significant and sustained impact on community's health and wellbeing. Therefore, in order to strengthen positive effects and reduce negative effects of any developmental projects within community, their impacts on public health should be taken into consideration.

Catholic Social Teaching: Addressing Globalization in Catholic Business Education

ERIC Educational Resources Information Center

Ball, James B.; Martinez, Zaida; Toyne, Brian

2009-01-01

Although business schools are increasingly aware of the importance of globalization in educating future business leaders, their business programs have addressed globalization from a limited perspective that fails to provide students with a broader understanding of its impact on societies and its moral consequences. The conventional approach to the…

Barriers to Teaching Social Determinants of Health: Nursing Study-Abroad Programs in a Digital Age.

PubMed

de Ruiter, Hans-Peter

2016-11-01

The social determinants of health are the conditions in which humans are born, grow up, live, work, and age (World Health Organization [WHO], 2012). In nursing programs, this content is typically taught in community health courses. Another strategy for teaching students how to understand the social determinants of health is study-abroad courses. Budding nurses can learn how to assess conditions that influence the health of a community. Conducting this assessment in a culture that differs from the student's own can help highlight what factors impact one's own health. For the past eight years, the author has been teaching the social and cultural determinants of health to nursing students by taking them on 3-week cultural immersion/community health studyabroad programs. Destinations have included Ghana, Austria, the Netherlands, and Thailand. This article presents observations on how the teaching of social determinants of health has changed during the period 2008-2016.

Pronominal Address in German: Rules, Anarchy and Embarrassment Potential

ERIC Educational Resources Information Center

Kretzenbacher, Heinz L.; Clyne, Michael; Schupbach, Doris

2006-01-01

Choice of address forms, a socially crucial feature in German communication, is context-dependent on situations (a) where the unmarked form of address is "du" (T), (b) where it is "Sie" (V), and (c) where the two systems (a and b) coexist. The first two situations are, apart from their fuzzy edges, rather clearcut. The third situation, however,…

A model for a drug distribution system in remote Australia as a social determinant of health using event structure analysis.

PubMed

Rovers, John P; Mages, Michelle D

2017-09-25

staffing, cold chain integrity, medication shortages and wastage, and adherence to policies. The model illustrates how pharmacists address medication access as a social determinant of health, and may be helpful for policy setting, system design, benchmarking, and quality assurance by health system designers. ESA is an effective and novel method of developing such models.

Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances

PubMed Central

Short, Susan E.; Mollborn, Stefanie

2015-01-01

Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied “social determinants” approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity. PMID:26213711

Imaginative Thinking: Addressing Social Justice Issues through MovieMaker

ERIC Educational Resources Information Center

Boske, Christa A.

2009-01-01

Purpose: The purpose of this paper is to examine the experiences of aspiring school leaders who utilized artmaking in this case, photography, poetry, music, collage, and short films through Microsoft MovieMaker as a means for addressing injustices within surrounding school communities. The paper aims to explore how aspiring school leaders…

The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks.

PubMed

Newton, J Timothy; Bower, Elizabeth J

2005-02-01

Oral epidemiological research into the social determinants of oral health has been limited by the absence of a theoretical framework which reflects the complexity of real life social processes and the network of causal pathways between social structure and oral health and disease. In the absence of such a framework, social determinants are treated as isolated risk factors, attributable to the individual, having a direct impact on oral health. There is little sense of how such factors interrelate over time and place and the pathways between the factors and oral health. Features of social life which impact on individuals' oral health but are not reducible to the individual remain under-researched. A conceptual framework informing mainstream epidemiological research into the social determinants of health is applied to oral epidemiology. The framework suggests complex causal pathways between social structure and health via interlinking material, psychosocial and behavioural pathways. Methodological implications for oral epidemiological research informed by the framework, such as the use of multilevel modelling, path analysis and structural equation modelling, combining qualitative and quantitative research methods, and collaborative research, are discussed. Copyright Blackwell Munksgaard, 2005.

Addressing Psychosocial Factors with Library Mentoring

ERIC Educational Resources Information Center

Farrell, Bridget; Alabi, Jaena; Whaley, Pambanisha; Jenda, Claudine

2017-01-01

The majority of articles on mentoring in the library and information science field address career development by emphasizing the orientation process for new librarians and building the requisite skills for a specific job. Few articles deal with the psychological and social challenges that many early-career and minority librarians face, which can…

Addressing social influences reduces antibiotic duration in complicated abdominal infection: a mixed methods study.

PubMed

Broom, Jennifer; Tee, Chin Li; Broom, Alex; Kelly, Mark D; Scott, Tahira; Grieve, David A

2018-03-06

Antimicrobial therapy for intra-abdominal infections is often inappropriately prolonged. An intervention addressing factors influencing the duration of intravenous antibiotic use was undertaken. This study reports the antibiotic prescribing patterns before and after the intervention and a qualitative analysis of the experience of the intervention. Quantitative: A retrospective audit of patients with complicated intra-abdominal infection before and after a multifaceted persuasive intervention was performed. Qualitative: Semi-structured interviews were performed to evaluate which elements of the intervention were perceived to be effective. An intervention including collaborative inter-specialty and inter-professional educational meetings, and education of all professional streams was undertaken. Quantitative: Twenty-three patients before and 22 patients after the intervention were included. The total duration of antibiotics decreased significantly following the intervention (9.2 versus 6.6 days P = 0.02). The duration of intravenous antibiotics did not change significantly (5.4 versus 4.5 days, P = 0.06). Qualitative: Eighteen health-care professionals participated. Thematic analysis indicated that a collaborative approach between senior surgical and infectious disease specialists in the pre-intervention stage led to perceived ownership and leadership of the intervention by the surgical team, which was thought critical to the success of the intervention. Conversely, the ability of nurses and pharmacists to influence antibiotic practice was considered limited and a poster promoting the intervention was perceived as ineffective. Consultant leadership and specialty ownership of the process were perceived to be critical in the success of the intervention. Antibiotic stewardship programs which address social factors may have greater efficacy to optimize antimicrobial prescribing. © 2018 Royal Australasian College of Surgeons.

Social Entrepreneurship in Religious Congregations’ Efforts to Address Health Needs

PubMed Central

Werber, Laura; Mendel, Peter J.; Derose, Kathryn Pitkin

2013-01-01

Purpose Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Design Multiple case studies. Setting Los Angeles County, California. Participants Purposive sample of 14 congregations representing diverse races-ethnicities (African American, Latino, and white) and faith traditions (Jewish and various Christian). Method Congregations were recruited based on screening data and consultation of a community advisory board. In each congregation, researchers conducted interviews with clergy and lay leaders (n=57); administered a congregational questionnaire; observed health activities, worship services, and neighborhood context; and reviewed archival information. Interviews were analyzed using a qualitative, code-based approach. Results Congregations’ health-related activities tended to be episodic, small in scale, and local in scope. Trust and social capital played important roles in congregations’ health initiatives, providing a safe, confidential environment and leveraging resources from – and for – faith-based and secular organizations in their community networks. Congregations also served as “incubators” for members to engage in social entrepreneurship. Conclusion Although the small scale of congregations’ health initiatives suggest they may not have the capacity to provide the main infrastructure for service provision, congregations can complement the efforts of health and social providers with their unique strengths. Specifically, congregations are distinctive in their ability to identify unmet local needs, and congregations’ position in their communities permit them to network in productive ways. PMID:23875986

Social entrepreneurship in religious congregations' efforts to address health needs.

PubMed

Werber, Laura; Mendel, Peter J; Derose, Kathryn Pitkin

2014-01-01

Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Multiple case studies. Los Angeles County, California. Purposive sample of 14 congregations representing diverse races/ethnicities (African-American, Latino, and white) and faith traditions (Jewish and various Christian). Congregations were recruited based on screening data and consultation of a community advisory board. In each congregation, researchers conducted interviews with clergy and lay leaders (n = 57); administered a congregational questionnaire; observed health activities, worship services, and neighborhood context; and reviewed archival information. Interviews were analyzed by using a qualitative, code-based approach. Congregations' health-related activities tended to be episodic, small in scale, and local in scope. Trust and social capital played important roles in congregations' health initiatives, providing a safe, confidential environment and leveraging resources from-and for-faith-based and secular organizations in their community networks. Congregations also served as "incubators" for members to engage in social entrepreneurship. Although the small scale of congregations' health initiatives suggest they may not have the capacity to provide the main infrastructure for service provision, congregations can complement the efforts of health and social providers with their unique strengths. Specifically, congregations are distinctive in their ability to identify unmet local needs, and congregations' position in their communities permit them to network in productive ways.

Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the U.S.

PubMed Central

Penman-Aguilar, Ana; Carter, Marion; Snead, M. Christine; Kourtis, Athena P.

2013-01-01

Objectives We reviewed the literature focused on socioeconomic influences on teen childbearing and suggested directions for future research and practice related to this important indicator of teen sexual health. Methods We conducted an electronic search of Medline, ERIC, PsychLit, and Sociological Abstracts databases for articles published from January 1995 to November 2011. Selected articles from peer-reviewed journals included original quantitative analyses addressing socioeconomic influences on first birth among teen women in the U.S. Articles were abstracted for key information, ranked for quality according to the U.S. Preventive Services Task Force guidelines, assessed for bias, and synthesized. Results We selected articles with a range of observational study designs. Risk for bias varied across studies. All 12 studies that considered socioeconomic factors as influences on teen childbearing (vs. moderators or mediators of other effects) reported at least one statistically significant association relating low socioeconomic status, underemployment, low income, low education levels, neighborhood disadvantage, neighborhood physical disorder, or neighborhood-level income inequality to teen birth. Few reports included any associations contradicting this pattern. Conclusions This review suggests that unfavorable socioeconomic conditions experienced at the community and family levels contribute to the high teen birth rate in the U.S. Future research into social determinants of sexual health should include multiple levels of measurement whenever possible. Root causes of teen childbearing should be evaluated in various populations and contexts. Interventions that address socioeconomic influences at multiple levels could positively affect large numbers of teens and help eliminate disparities in teen childbearing. PMID:23450881

Social Presence in Synchronous Virtual Learning Situations: The Role of Nonverbal Signals Displayed by Avatars

ERIC Educational Resources Information Center

Allmendinger, Katrin

2010-01-01

Social factors play an important role in determining whether instructional communication in computer-supported settings will be successful. "Social presence" is a social factor, specifically addressing the feeling of being present with another person in a virtual environment. This article describes possibilities to influence the feeling of social…

Can a Social Networking Site Support Afterschool Group Learning of Mandarin?

ERIC Educational Resources Information Center

Yang, Yang; Crook, Charles; O'Malley, Claire

2014-01-01

Schools are often encouraged to facilitate extra-curricular learning within their own premises. This study addresses the potential of social networking sites (SNS) for supporting such out-of-class study. Given concerns that learning on these sites may happen at a surface level, we adopted self-determination theory for designing a social networking…

Local decision makers’ awareness of the social determinants of health in Turkey: a cross-sectional study

PubMed Central

2012-01-01

Background Social determinants have been described as having a greater influence than other determinants of health status. The major social determinants of health and the necessary policy objectives have been defined; it is now necessary to evaluate the effectiveness of these policies. Previous studies have shown that descriptions of the awareness level of citizens and local decision makers, practice-based research and evidence, and intersectoral studies are the best options for investigating the social determinants of health at the community level. The objective of the present study was to define local decision makers’ awareness of the social determinants of health in the Aydin province of Turkey. Methods A total of 53 mayors serve the Aydin city center, districts and towns. Aydin city center has 22 neighborhoods and 22 headmen responsible for them. The present study targeted all mayors and headmen in Aydin - a total of 75 possible participants. A questionnaire was used to collect the data. The questionnaire was faxed to the mayors and administered face-to-face with the headmen. Results Headmen identified the three most important determinants of public health as environmental issues, addictions (smoking, alcohol) and malnutrition. According to the mayors, the major determinant of public health is stress, followed by malnutrition, environmental issues, an inactive lifestyle, and the social and economic conditions of the country. Both groups expressed that the Turkish Ministry of Health, municipalities and universities are the institutions responsible for developing health policy. Headmen were found to be unaware and mayors were aware of the social determinants of health as classified by the World Health Organisation. Both groups were classified as unaware with regard to their awareness of the Marmot Review policy objectives. Conclusions Studies such as the present study provide important additional information on the social determinants of health, and help to

Social support and marginalization as determinants of prenatal care in women with social security in Mexico.

PubMed

Maldonado-Cisneros, Maritza; Medina-Gómez, Oswaldo Sinoe

2018-01-01

Prenatal care ensures favorable results for maternal-fetal health and, to that end, it must be provided early, periodically, comprehensively and with high coverage. To find out the social determinants of prenatal care in women affiliated to the Mexican Institute of Social Security during 2014. Cross-sectional study where the association of social conditions, social support and family functioning with inadequate prenatal care was analyzed. A descriptive analysis was performed; hypothesis tests were used with chi-square (95% level of confidence). The prevalence ratio and Mann-Whitney's U-test were estimated to compare medians and logistic regression. Of the interviewed women, 58.1% had inadequate prenatal care, mainly associated with unplanned pregnancy, poor social support, low level of education and higher marginalization. Not having leaves of absence granted by employers was the main barrier in those women who did not attend health services. There is a need for strategies to be designed and implemented to enable understanding the interaction between different biological and social dimensions of the health-disease process and reduce health inequities that affect pregnant women, in order to achieve good prenatal care and to implement alternative models guaranteeing its efficiency. Copyright: © 2018 SecretarÍa de Salud.

Enhancing John Rawls's Theory of Justice to Cover Health and Social Determinants of Health.

PubMed

Ekmekci, Perihan Elif; Arda, Berna

2015-11-01

The vast improvements in medical technology reviled the crucial role of social determinants of health for the etiology, prevalence and prognosis of diseases. This changed the content of the right to health concept from a demand of health services, to a claim of having access to all social determinants of health. Thus, the just allocation of scarce resources of health and social determinants of health became an issue of ethical theories. John Rawls developed a theory of justice. His theory suggests that the principles of justice should be determined by individuals in a hypothetic initial position. In the initial position, individuals agree on principles of justice. Rawls puts forth that the institutions of the society should be structured in compliance with these principles to reach a fair social system. Although Rawls did not justify right to health in his theory, the efforts to enlarge the theory to cover right to health flourished quite fast. In this paper first the basic components of Rawls theory is explained. Then the most outstanding approaches to enlarge his theory to cover right to health is introduced and discussed within the discourse of Rawls theory of justice.

Political Socialization and Social Studies Education: Reassessing the Conventional Wisdom.

ERIC Educational Resources Information Center

Nelson, Murry R.

1989-01-01

Critically examines the political socialization research over the past 30 years as to method, sample, size, and results. Reassesses studies that have been most cited and those that have been ignored. Raises questions about political socialization that have not been addressed or have been inadequately addressed. (KO)

The Ability of Narrative Communication to Address Health-related Social Norms

PubMed Central

Moran, Meghan Bridgid; Murphy, Sheila T.; Frank, Lauren; Baezconde-Garbanati, Lourdes

2013-01-01

Social norms are an important predictor of health behavior and have been targeted by a variety of health communication campaigns. However, these campaigns often encounter challenges related to the socially specific context in which norms exist: specifically, the extent to which the target population identifies with the reference group presented in the ad and the extent to which the target population believes the campaign's message. We argue that because of its capacity to effect identification among viewers, narrative communication is particularly appropriate for impacting social norms and, consequently, behavioral intention. This manuscript presents the results of a randomized trial testing the effectiveness of two films – one narrative, one non-narrative – in changing perceived social norms and behavioral intention regarding Pap testing to detect cervical cancer. Results of the study indicate that the narrative film was in fact more effective at producing positive changes in perceived norm and intention. PMID:24179677

Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

ERIC Educational Resources Information Center

Mitchell, Jamie Ann

2012-01-01

The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training…

Chaos as a Social Determinant of Child Health: Reciprocal Associations?

PubMed Central

Schmeer, Kammi K.; Taylor, Miles

2013-01-01

This study informs the social determinants of child health by exploring an understudied aspect of children’s social contexts: chaos. Chaos has been conceptualized as crowded, noisy, disorganized, unpredictable settings for child development (Evans et al., 2010). We measure chaos at two levels of children’s ecological environment - the microsystem (household) and the mesosystem (work-family-child care nexus) – and at two points in early childhood (ages 3 and 5). Using data from the Fragile Families and Child Wellbeing Study (N=3288), a study of predominantly low-income women and their partners in large US cities, we develop structural equation models that assess how maternal-rated child health (also assessed at ages 3 and 5) is associated with latent constructs of chaos, and whether there are important reciprocal effects. Autoregressive crosslagged path analysis suggest that increasing chaos (at both the household and maternal work levels) is associated with worse child health, controlling for key confounders like household economic status, family structure, and maternal health status. Child health has little effect on chaos, providing further support for the hypothesis that chaos is an important social determinant of child health in this sample of relatively disadvantaged children. This suggests child health may be improved by supporting families in ways that reduce chaos in their home and work/family environments, and that as researchers move beyond SES, race, and family structure to explore other sources of health inequalities, chaos and its proximate determinants may be a promising avenue for future research. PMID:23541250

Modeling the determinants of the social impacts of agricultural development projects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmadvand, Mostafa, E-mail: Ahmadvand_2000@yahoo.co; Karami, Ezatollah, E-mail: ekarami@shirazu.ac.i; Iman, Mohammad Taghi, E-mail: Iman@shirazu.ac.i

2011-01-15

In an attempt to help policy-makers improve the social sustainability of development projects, this study identifies the key determinants of farmers' attitudes relating to the social impacts of the floodwater spreading project (FWSP) on the Gareh-Bygone plain in Iran. In order to analyze the links between the various factors that affect the experience of social impact, a theoretical framework was developed. Stratified random sampling was used to survey 138 farm households from the four villages in the region. One male and one female from each house were interviewed face-to-face using a questionnaire, resulting in a total of 276 interviews. Structuralmore » factors were found to be the largest contribution to stakeholders' attitudes relating to the social impacts of the project. Results from a cluster analysis suggested that the level of floodwater information, level of participation, water access, ownership change, and environmental worldview were the most important factors explaining attitude towards social impact of the FWSP.« less

Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes.

PubMed

Walker, Rebekah J; Gebregziabher, Mulugeta; Martin-Harris, Bonnie; Egede, Leonard E

2015-02-01

The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ(2)(275)=450.07, P<0.001, R(2)=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.

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Social psychological determinants of the use of performance-enhancing drugs by gym users.

PubMed

Wiefferink, C H; Detmar, S B; Coumans, B; Vogels, T; Paulussen, T G W

2008-02-01

The aim of this study is to identify the social psychological determinants of the use of performance-enhancing drugs by gym users who practice bodybuilding, fitness, powerlifting or combat sports. In this questionnaire-based study, 144 respondents answered questions on their actual use and intention to use such drugs and also on their background characteristics and beliefs, such as their attitudes, social influences and self-efficacy. While all social psychological determinants correlated with intention to use these drugs, the most important predictors were personal norms, beliefs about performance outcomes and the perceived behavior of others. Non-users held more restrictive norms about using performance-enhancing drugs, were less optimistic about the performance-enhancing outcomes and believed that fewer significant others used performance-enhancing drugs than users and ex-users. The results of this study indicate that users attribute advantages to performance-enhancing drugs and are inclined to overlook the risks of using them. Preventive interventions should focus on influencing personal norms and social processes.

Social relationships as a major determinant in the valuation of health states.

PubMed

Frick, Ulrich; Irving, Hyacinth; Rehm, Jürgen

2012-03-01

To empirically determine the impact of the capacity to sustain social relationships on valuing health states. 68 clinical experts conducted a health state valuation exercise in five sites using pairwise comparison, ranking, and person trade-off as elicitation methods. 23,840 pairwise comparisons of a total of 379 health states were analyzed by conditional logistic regression. Social relationships had a clear monotonic association with perceived disability: the more limited the capacity to sustain social relationships, the more disabling the resulting health state valuations. The highest level of limitations with respect to social relationships was associated with slightly lower impact on health state valuations compared to the highest level of limitations in physical functioning. Social relationships showed an independent contribution to health state valuations and should be included in health state measures.

Social determinants of male health: a case study of Leeds, UK.

PubMed

White, Alan; Seims, Amanda; Cameron, Ian; Taylor, Tim

2018-01-19

The social determinants of health have a disproportionate impact on mortality in men. A study into the state of health of the male population in Leeds was undertaken to guide public health commissioning decisions. This paper reports on the data relating to the social lives of men. A cross-sectional study was undertaken, comprising descriptive analysis of data relating to educational attainment, housing, employment (including benefit claimants), marital status and relationships. Data was considered for the whole city and localised at the Middle Super Output Area (MSOA) level and mapped against the Index of Deprivation. Boys' educational attainment was found to be lagging behind girls' from their earliest assessments (Early Years Foundation Stage Profile, 46% vs. 60%, P = 0.00) to GCSEs (53% vs. 63%, P = 0.00), leaving many men with no qualifications. There were 68% more men than women identified as being unemployed, with more men claiming benefits. Men living in social housing are more likely to be housed in high-rise flats. Almost 50% of men aged 16-64 are single, with 2254 lone fathers. There appears to be a lack of sex/gender analysis of current cross city data. In areas of deprivation a complex picture of multiple social problems emerges, with marked gender differences in the social determinants of health, with males seeming to be more negatively affected. There is a need for more focused planning for reaching out and targeting boys and men in the most deprived inner city areas, so that greater efficiency in service delivery can be obtained.

Technological innovations and the rise of social inequalities in health.

PubMed

Weiss, Daniel; Eikemo, Terje Andreas

2017-11-01

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.

Activating the Disadvantaged. Variations in Addressing Youth Transitions across Europe

ERIC Educational Resources Information Center

Pohl, Axel; Walther, Andreas

2007-01-01

The term activation refers to a shift in social policies, through which individuals are given more responsibility for their own social inclusion. This article provides a comparative analysis of the different ways in which EU member states interpret and implement the concept of activation by addressing the transitions of disadvantaged young people…

Beating the Odds: Preparing Graduates to Address Gambling-Related Problems

ERIC Educational Resources Information Center

Engel, Rafael J.; Bechtold, Jody; Kim, Yoonmi; Mulvaney, Elizabeth

2012-01-01

As gambling opportunities proliferate, social workers are likely to see clients with gambling-related problems, but they often lack the expertise to address these concerns. This descriptive study assessed the inclusion of content on gambling-related problems in graduate social work curricula. Responses to an online survey from 86 (43.7%) of the…

Egalitarian policies and social determinants of health in Bolivarian Venezuela.

PubMed

Muntaner, Caries; Benach, Joan; Páez Victor, María; Ng, Edwin; Chung, Haejoo

2013-01-01

In 1999, newly-elected Venezuelan President Hugo Chávez initiated a far-reaching social movement as part of a political project known as the Bolivarian Revolution. Inspired by the democratic ideologies of Simón Bolívar, this movement was committed to reducing intractable inequalities that defined Venezuela's Fourth Republic (1958-1998). Given the ambitious scope of these reforms, Venezuela serves as an instructive example to understand the political context of social inequalities and population health. In this article, we provide a brief overview of the impact of egalitarian policies in Venezuela, stressing: (a) the socialist reforms and social class changes initiated by the Bolivarian Movement; (b) the impact of these reforms and changes on poverty and social determinants of health; (c) the sustainability of economic growth to continue pro-poor policies; and (d) the implications of egalitarian policies for other Latin American countries. The significance and implications of Chávez's achievements are now further underscored given his recent passing, leading one to ask whether political support for Bolivarianism will continue without its revolutionary leader.

[Social determinants of health at distinct levels by gender: education and household in Spain].

PubMed

Gumà, Jordi; Arpino, Bruno; Solé-Auró, Aïda

2018-02-18

To explore from a gender perspective the association with subjective health of the interaction between education and household arrangements within the framework of social determinants of health placed at the micro and mezzo levels. The data comes from the Spanish sample of the European Union Statistics on Income and Living Conditions for 2014. Independent logistic regression models for men and women were run to analyze the association with subjective health of the interaction between education and household arrangements. An additive model was run to assess possible advantages over the interaction approach. The interaction models show a lower or even no significant effect on health of household arrangements usually negatively associated with health among individuals with high education, displaying specific patterns according to sex. Health profiles of women and men are more precisely drawn if both social determinants of health are combined. Among the women, the important role was confirmed of both social determinants of health in understanding their health inequalities. Among the men, mainly those with low educational achievement, the interaction revealed that the household was a more meaningful social determinant of health. This could enable the definition of more efficient public policies to reduce health and gender inequalities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Social determinants and their interference in homicide rates in a city in northeastern Brazil.

PubMed

de Sousa, Geziel dos Santos; Magalhães, Francismeire Brasileiro; Gama, Isabelle da Silva; de Lima, Maria Vilma Neves; de Almeida, Rosa Lívia Freitas; Vieira, Luiza Jane Eyre de Souza; Bezerra Filho, José Gomes

2014-01-01

This paper aims to analyze the possible relationship between social determinants and homicide mortality in Fortaleza (CE), Brazil. To investigate whether the rate of mortality by homicides is related to social determinants, an ecological study with emphasis on spatial analysis was conducted in the city of Fortaleza. Social, economic, demographic and sanitation data, as well as information regarding years of potential life lost, and Human Development Index were collected. The dependent variable was the rate of homicides in the period 2004 to 2006. In order to verify the relationship between the outcome variable and the predictor variables, we performed a multivariate linear regression model. We found associations between social determinants and the rate of mortality by homicides. Variables related to income and education were proven determinants for mortality. The multiple regression model showed that 51% of homicides in Fortaleza neighborhoods are explained by years of potential life lost, proportion of households with poor housing, average years of schooling, per capita income and percentage of household heads with 15 or more years of study. The coefficients for years of potential life lost and households with poor housing were positive. The findings indicate that the mortality by homicide is associated with high levels of poverty and uncontrolled urbanization, which migrates to the peripheries of urban centers.

Deconstructing Superorganisms and Societies to Address Big Questions in Biology.

PubMed

Kennedy, Patrick; Baron, Gemma; Qiu, Bitao; Freitak, Dalial; Helanterä, Heikki; Hunt, Edmund R; Manfredini, Fabio; O'Shea-Wheller, Thomas; Patalano, Solenn; Pull, Christopher D; Sasaki, Takao; Taylor, Daisy; Wyatt, Christopher D R; Sumner, Seirian

2017-11-01

Social insect societies are long-standing models for understanding social behaviour and evolution. Unlike other advanced biological societies (such as the multicellular body), the component parts of social insect societies can be easily deconstructed and manipulated. Recent methodological and theoretical innovations have exploited this trait to address an expanded range of biological questions. We illustrate the broadening range of biological insight coming from social insect biology with four examples. These new frontiers promote open-minded, interdisciplinary exploration of one of the richest and most complex of biological phenomena: sociality. Copyright © 2017 Elsevier Ltd. All rights reserved.

"Healthy People": A 2020 Vision for the Social Determinants Approach

ERIC Educational Resources Information Center

Koh, Howard K.; Piotrowski, Julie J.; Kumanyika, Shiriki; Fielding, Jonathan E.

2011-01-01

For the past three decades, the "Healthy People" initiative has represented an ambitious yet achievable health promotion and disease prevention agenda for the nation. The recently released fourth version--"Healthy People 2020"--builds on the foundations of prior iterations while newly embracing and elevating a comprehensive "social determinants"…

Addressing clients' racism and racial prejudice in individual psychotherapy: Therapeutic considerations.

PubMed

Bartoli, Eleonora; Pyati, Aarti

2009-06-01

Psychotherapists lack clear guidelines regarding how to address clients' racist and prejudicial comments in clinical work. The authors explore the contributions of multicultural, social justice, feminist, and ethical theories to the field of psychotherapy and apply these theories to 2 clinical vignettes in which clients made racially charged statements. These clinical examples highlight the importance of using racial, in addition to traditional, theories to decipher the clinical meanings of racial comments and dynamics in clinical work. The article provides therapeutic conceptualizations regarding how to address clients' racist and prejudicial comments in psychotherapy and elaborates on the complex meanings that might arise from engaging in racially charged discussions with clients depending on the racial composition of the therapeutic dyad. In addition to highlighting how social justice, multicultural, and feminist lenses are necessary to fully understand the meaning of clients' comments, the argument is made that addressing clients' racist and prejudicial comments is at once a clinical and a social justice issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Advancing Sustainability through Urban Green Space: Cultural Ecosystem Services, Equity, and Social Determinants of Health

PubMed Central

Jennings, Viniece; Larson, Lincoln; Yun, Jessica

2016-01-01

Urban green spaces provide an array of benefits, or ecosystem services, that support our physical, psychological, and social health. In many cases, however, these benefits are not equitably distributed across diverse urban populations. In this paper, we explore relationships between cultural ecosystem services provided by urban green space and the social determinants of health outlined in the United States Healthy People 2020 initiative. Specifically, we: (1) explore connections between cultural ecosystem services and social determinants of health; (2) examine cultural ecosystem services as nature-based health amenities to promote social equity; and (3) recommend areas for future research examining links between urban green space and public health within the context of environmental justice. PMID:26861365

Advancing Sustainability through Urban Green Space: Cultural Ecosystem Services, Equity, and Social Determinants of Health.

PubMed

Jennings, Viniece; Larson, Lincoln; Yun, Jessica

2016-02-05

Urban green spaces provide an array of benefits, or ecosystem services, that support our physical, psychological, and social health. In many cases, however, these benefits are not equitably distributed across diverse urban populations. In this paper, we explore relationships between cultural ecosystem services provided by urban green space and the social determinants of health outlined in the United States Healthy People 2020 initiative. Specifically, we: (1) explore connections between cultural ecosystem services and social determinants of health; (2) examine cultural ecosystem services as nature-based health amenities to promote social equity; and (3) recommend areas for future research examining links between urban green space and public health within the context of environmental justice.

Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

PubMed Central

2012-01-01

Introduction In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other

Marketing Animal-Friendly Products: Addressing the Consumer Social Dilemma with Reinforcement Positioning Strategies

PubMed Central

Ingenbleek, Paul T.M.; van Trijp, Hans C.M.; van der Veen, Gerrita

2017-01-01

Simple Summary Modern production systems aimed at improving animal welfare are more costly than traditional systems. Animal-friendly products are therefore typically more expensive than mainstream products, which presents one of the main barriers to consumer animal-friendly product choice. To overcome this barrier, marketing strategies that associate animal welfare with different types of value, such as taste, healthiness or good feeling, may be useful. This article presents a theoretical framework with marketing strategies using various types of value, suitable for animal-friendly products to encourage consumers to buy animal-friendly instead of mainstream products. We also explain why some consumers, such as those with a rational or an intuitive thinking style, may be more sensitive to some strategies over others, giving directions to marketing managers on how to approach different types of consumers. Because the credibility of animal welfare claims is a critical issue in marketing animal-friendly products, we address this issue as well. Specifically, we propose that, to gain consumer trust, companies selling animal-friendly products need to take into account the impact of their overall strategy on the effectiveness of marketing strategies for individual products and that they may need to collaborate with relevant stakeholders, such as media or animal-interest organizations. Abstract This article presents a conceptual framework that aims to encourage consumer animal-friendly product choice by introducing positioning strategies for animal-friendly products. These strategies reinforce the animal welfare with different types of consumption values and can therefore reduce consumers’ social dilemma, which is a major barrier to animal-friendly consumer choices. The article suggests how animal-friendly products can use various types of consumption values (functional, sensory, emotional, social, epistemic and situational) to create an attractive position relative to

Bringing Back the Social History

PubMed Central

Pierce, Mary Clyde; Kaczor, Kim; Thompson, Richard

2014-01-01

The social environment of the child is a key determinant of the child’s current and future health. Factors in the child’s family environment, both protective and harmful, have profound impact on the child’s long-term health, brain development, and mortality. Adverse childhood experiences, and specifically, child maltreatment, are directly linked to increased risk for harm, poor outcomes, ill-health as adults, and even death during childhood or early adulthood. Therefore, it is important to obtain a detailed social history from the first medical visit with the dual goals of identifying strengths to reinforce and weaknesses to address. Screening is paramount in order to foster healthy parenting and help identify areas needing intervention. Occasionally, serious problems are uncovered indicating the child is at significant risk for maltreatment. By addressing these risks openly and directly before serious or permanent harm occurs, child maltreatment and its potentially life-altering consequences (for all) may be prevented. The social history may very well be the best all-around tool available for promoting the child’s future health and well-being. It is a key first step in identifying social needs of the child and family so that they may benefit from intervention. This article focuses on key social history elements known to increase a child’s risk of maltreatment and provides case examples. PMID:25242704

A Systems-Based Conceptual Framework for Assessing the Determinants of a Social License to Operate in the Mining Industry

NASA Astrophysics Data System (ADS)

Prno, Jason; Slocombe, D. Scott

2014-03-01

The concept of a "social license to operate" (SLO) was coined in the 1990s and gained popularity as one way in which "social" considerations can be addressed in mineral development decision making. The need for a SLO implies that developers require the widespread approval of local community members for their projects to avoid exposure to potentially costly conflict and business risks. Only a limited amount of scholarship exists on the topic, and there is a need for research that specifically addresses the complex and changeable nature of SLO outcomes. In response to these challenges, this paper advances a novel, systems-based conceptual framework for assessing SLO determinants and outcomes in the mining industry. Two strands of systems theory are specifically highlighted—complex adaptive systems and resilience—and the roles of context, key system variables, emergence, change, uncertainty, feedbacks, cross-scale effects, multiple stable states, thresholds, and resilience are discussed. The framework was developed from the results of a multi-year research project which involved international mining case study investigations, a comprehensive literature review, and interviews conducted with mining stakeholders and observers. The framework can help guide SLO analysis and management efforts, by encouraging users to account for important contextual and complexity-oriented elements present in SLO settings. We apply the framework to a case study in Alaska, USA before discussing its merits and challenges. We also illustrate knowledge gaps associated with applications of complex adaptive systems and resilience theories to the study of SLO dynamics, and discuss opportunities for future research.

A systems-based conceptual framework for assessing the determinants of a social license to operate in the mining industry.

PubMed

Prno, Jason; Slocombe, D Scott

2014-03-01

The concept of a "social license to operate" (SLO) was coined in the 1990s and gained popularity as one way in which "social" considerations can be addressed in mineral development decision making. The need for a SLO implies that developers require the widespread approval of local community members for their projects to avoid exposure to potentially costly conflict and business risks. Only a limited amount of scholarship exists on the topic, and there is a need for research that specifically addresses the complex and changeable nature of SLO outcomes. In response to these challenges, this paper advances a novel, systems-based conceptual framework for assessing SLO determinants and outcomes in the mining industry. Two strands of systems theory are specifically highlighted-complex adaptive systems and resilience-and the roles of context, key system variables, emergence, change, uncertainty, feedbacks, cross-scale effects, multiple stable states, thresholds, and resilience are discussed. The framework was developed from the results of a multi-year research project which involved international mining case study investigations, a comprehensive literature review, and interviews conducted with mining stakeholders and observers. The framework can help guide SLO analysis and management efforts, by encouraging users to account for important contextual and complexity-oriented elements present in SLO settings. We apply the framework to a case study in Alaska, USA before discussing its merits and challenges. We also illustrate knowledge gaps associated with applications of complex adaptive systems and resilience theories to the study of SLO dynamics, and discuss opportunities for future research.

Social Determinants of Health and Adolescent Pregnancy: An Analysis From the National Longitudinal Study of Adolescent to Adult Health.

PubMed

Maness, Sarah B; Buhi, Eric R; Daley, Ellen M; Baldwin, Julie A; Kromrey, Jeffrey D

2016-06-01

Although rates of adolescent pregnancy are at an all-time low in the United States, racial/ethnic and geographic disparities persist. This research used National Longitudinal Study of Adolescent to Adult Health (Add Health) data to analyze empirical relationships between social determinants of health (SDoH) and adolescent pregnancy. Examining relationships between the SDoH and adolescent pregnancy provides support for funding priorities and interventions that expand on the current focus on individual- and interpersonal-level factors. On the basis of the Healthy People 2020 Social Determinants of Health Framework, the identification of proxy measures for SDoH within the Add Health study allowed for an analysis of relationships to adolescent pregnancy (N = 9,204). Logistic regression examined associations between adolescent pregnancy and each measure of SDoH. Results indicated that 6 of 17 measures of SDoH had an empirical relationship with adolescent pregnancy. Measures negatively associated with adolescent pregnancy included the following: feeling close to others at school, receipt of high school diploma, enrollment in higher education, participation in volunteering or community service, reporting litter or trash in the neighborhood environment as a big problem, and living in a two-parent home. Findings from this study support the need for increased research and intervention focus in SDoH related to areas of education and social and community context. Results of this study provide information for the allocation of resources to best address SDoH that show a link with adolescent pregnancy. Areas of future research can further explore the areas in which SDoH show a relationship with adolescent pregnancy. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Educating for Social Justice: Drawing from Catholic Social Teaching

ERIC Educational Resources Information Center

Valadez, James R.; Mirci, Philip S.

2015-01-01

This article uses a duoethnographic process to develop a model for socially just education based on social justice theory and Catholic social teaching. Three major issues are addressed, including: (a) the definition of socially just education, (b) explaining a vision for establishing socially just schools, and (c) providing a practical guide for…

20 CFR 220.37 - When a child's disability determination is governed by the regulations of the Social Security...

Code of Federal Regulations, 2011 CFR

2011-04-01

... governed by the regulations of the Social Security Administration. 220.37 Section 220.37 Employees... Disability Determinations Governed by the Regulations of the Social Security Administration § 220.37 When a child's disability determination is governed by the regulations of the Social Security Administration...

20 CFR 220.37 - When a child's disability determination is governed by the regulations of the Social Security...

Code of Federal Regulations, 2013 CFR

2013-04-01

... governed by the regulations of the Social Security Administration. 220.37 Section 220.37 Employees... Disability Determinations Governed by the Regulations of the Social Security Administration § 220.37 When a child's disability determination is governed by the regulations of the Social Security Administration...

20 CFR 220.37 - When a child's disability determination is governed by the regulations of the Social Security...

Code of Federal Regulations, 2014 CFR

2014-04-01

... governed by the regulations of the Social Security Administration. 220.37 Section 220.37 Employees... Disability Determinations Governed by the Regulations of the Social Security Administration § 220.37 When a child's disability determination is governed by the regulations of the Social Security Administration...

Why Police Kill Black Males with Impunity: Applying Public Health Critical Race Praxis (PHCRP) to Address the Determinants of Policing Behaviors and "Justifiable" Homicides in the USA.

PubMed

Gilbert, Keon L; Ray, Rashawn

2016-04-01

Widespread awareness of the recent deaths of several black males at the hands of police has revealed an unaddressed public health challenge-determining the root causes of excessive use of force by police applied to black males that may result in "justifiable homicides." The criminalization of black males has a long history in the USA, which has resulted in an increase in policing behaviors by legal authorities and created inequitable life chances for black males. Currently, the discipline of public health has not applied an intersectional approach that investigates the intersection of race and gender to understanding police behaviors that lead to "justifiable homicides" for black males. This article applies the core tenets and processes of Public Health Critical Race Praxis (PHCRP) to develop a framework that can improve research and interventions to address the disparities observed in recent trend analyses of "justifiable homicides." Accordingly, we use PHCRP to offer an alternative framework on the social, legal, and health implications of violence-related incidents. We aim to move the literature in this area forward to help scholars, policymakers, and activists build the capacity of communities to address the excessive use of force by police to reduce mortality rates from "justifiable homicides."

Reducing Oral Health Disparities: A Focus on Social and Cultural Determinants

PubMed Central

Patrick, Donald L; Lee, Rosanna Shuk Yin; Nucci, Michele; Grembowski, David; Jolles, Carol Zane; Milgrom, Peter

2006-01-01

Oral health is essential to the general health and well-being of individuals and the population. Yet significant oral health disparities persist in the U.S. population because of a web of influences that include complex cultural and social processes that affect both oral health and access to effective dental health care. This paper introduces an organizing framework for addressing oral health disparities. We present and discuss how the multiple influences on oral health and oral health disparities operate using this framework. Interventions targeted at different causal pathways bring new directions and implications for research and policy in reducing oral health disparities. PMID:16934121

Social justice and the politics of recognition.

PubMed

Arfken, Michael

2013-09-01

Comments on the original article, "Psychology and social justice: Why we do what we do" by M. J. T. Vasquez (see record 2012-18676-002). Vasquez pointed to numerous initiatives and task forces that the American Psychological Association (APA) has established to address the marginalization and subordination of various groups. There is little doubt that the concerns addressed by these initiatives and task forces are important and play a central role in the development of a just society. Although Vasquez noted that "social realities are important determinants of distress" she failed to appreciate the extent to which our social relations emerge against the background of specific political and economic structures. The cost of this oversight is the perpetuation of a politics of recognition that does little to address the economic inequalities that are a defining feature of unjust societies. Were APA to restrict its attention to psychological distress or access to resources, it would place APA in the service of maintaining rather than transforming the existing structure of society. APA should consider developing initiatives and task forces to investigate the role that capitalism plays in the perpetuation of inequality and exploitation. It may also be time to reflect on why an institution that claims to be dedicated to social justice has had so little to say about one of the dominant features of modern society. © 2013 APA, all rights reserved.

Impact of social determinants on well-being of urban construction workers of Hyderabad.

PubMed

Bala, Sudha; Valsangkar, Sameer; Lakshman Rao, Reshaboyina Lakshmi Narayana; Surya Prabha, Manem Lakshmi

2016-01-01

Hyderabad has witnessed one of the largest labor immigration in recent years and these construction workers are highly vulnerable in terms of health. Social determinants of health (SDH) arise from conditions in which they live and these factors interact with each other to produce direct impact on health. (1) To evaluate the sociodemographic and job characteristics of the construction workers. (2) To assess the impact of social determinants on well-being. A sample size of 135 construction workers working at three sites of HITEC city were interviewed using semi-structured questionnaire. Health perception and the impact on well-being was measured using the Healthy Days Module and Kessler's Psychological Distress Scale. SDH were measured on a 27-item questionnaire with responses on a Likert scale ranging from 0 to 4. Proportions, percentages, P values, and mean scores were obtained. The mean age of the sample was 35.4 ± 11.94 years. Seventeen (12.6%) of the workers reported a high risk score on the Kessler's Psychological Distress Scale. Binary logistic regression analysis was used to identify significant domains of social determinants independently associated with the well being of construction workers and significant among the nine domains of social determinants were addiction score domain with odds of 2.259 and a P value of 0.015 and the distress domain with odds of 1.108 and a P < 0.001. There is a significant impairment of physical and mental health due to various factors including SDH, such as addictive habits and psychological distress, which are amenable to prevention.

Perceptual Incongruity and Social Interaction as Determinants of Infants' Reaction to Novel Persons

ERIC Educational Resources Information Center

Greenberg, David J.; And Others

1975-01-01

A study on the effects of birth order on infants' reactions to novel persons was conducted to test the differing predictions of incongruity theory and social interaction theory. Findings indicated that infants' reactions to novel persons are determined by infants' social interaction within the family during the first year rather than by the number…

Social Justice in Medical Education: Strengths and Challenges of a Student-Driven Social Justice Curriculum

PubMed Central

Andaya, January M; Yamada, Seiji; Maskarinec, Gregory G

2014-01-01

In the current rapidly evolving healthcare environment of the United States, social justice programs in pre-medical and medical education are needed to cultivate socially conscious and health professionals inclined to interdisciplinary collaborations. To address ongoing healthcare inequalities, medical education must help medical students to become physicians skilled not only in the biomedical management of diseases, but also in identifying and addressing social and structural determinants of the patients' daily lives. Using a longitudinal Problem-Based Learning (PBL) methodology, the medical students and faculty advisers at the University of Hawai‘i John A. Burns School of Medicine (JABSOM) developed the Social Justice Curriculum Program (SJCP) to supplement the biomedical curriculum. The SJCP consists of three components: (1) active self-directed learning and didactics, (2) implementation and action, and (3) self-reflection and personal growth. The purpose of introducing a student-driven SJ curriculum is to expose the students to various components of SJ in health and medicine, and maximize engagement by using their own inputs for content and design. It is our hope that the SJCP will serve as a logistic and research-oriented model for future student-driven SJ programs that respond to global health inequalities by cultivating skills and interest in leadership and community service. PMID:25157325

Social justice in medical education: strengths and challenges of a student-driven social justice curriculum.

PubMed

Ambrose, Adrian Jacques H; Andaya, January M; Yamada, Seiji; Maskarinec, Gregory G

2014-08-01

In the current rapidly evolving healthcare environment of the United States, social justice programs in pre-medical and medical education are needed to cultivate socially conscious and health professionals inclined to interdisciplinary collaborations. To address ongoing healthcare inequalities, medical education must help medical students to become physicians skilled not only in the biomedical management of diseases, but also in identifying and addressing social and structural determinants of the patients' daily lives. Using a longitudinal Problem-Based Learning (PBL) methodology, the medical students and faculty advisers at the University of Hawai'i John A. Burns School of Medicine (JABSOM) developed the Social Justice Curriculum Program (SJCP) to supplement the biomedical curriculum. The SJCP consists of three components: (1) active self-directed learning and didactics, (2) implementation and action, and (3) self-reflection and personal growth. The purpose of introducing a student-driven SJ curriculum is to expose the students to various components of SJ in health and medicine, and maximize engagement by using their own inputs for content and design. It is our hope that the SJCP will serve as a logistic and research-oriented model for future student-driven SJ programs that respond to global health inequalities by cultivating skills and interest in leadership and community service.

Autocheck: Addressing the Problem of Rural Transportation.

ERIC Educational Resources Information Center

Payne, Guy A.

This paper describes a project implemented by a social worker from the Glynn County School District in rural Georgia to address transportation problems experienced by students and their families. The project aims to assist families who are unable to keep appointments or attend other important events due to unreliable transportation. A county needs…

Enhancing John Rawls's Theory of Justice to Cover Health and Social Determinants of Health1

PubMed Central

Ekmekci, Perihan Elif; Arda, Berna

2015-01-01

The vast improvements in medical technology reviled the crucial role of social determinants of health for the etiology, prevalence and prognosis of diseases. This changed the content of the right to health concept from a demand of health services, to a claim of having access to all social determinants of health. Thus, the just allocation of scarce resources of health and social determinants of health became an issue of ethical theories. John Rawls developed a theory of justice. His theory suggests that the principles of justice should be determined by individuals in a hypothetic initial position. In the initial position, individuals agree on principles of justice. Rawls puts forth that the institutions of the society should be structured in compliance with these principles to reach a fair social system. Although Rawls did not justify right to health in his theory, the efforts to enlarge the theory to cover right to health flourished quite fast. In this paper first the basic components of Rawls theory is explained. Then the most outstanding approaches to enlarge his theory to cover right to health is introduced and discussed within the discourse of Rawls theory of justice. PMID:27340331

A systematic approach to analyze the social determinants of cardiovascular disease.

PubMed

Martínez-García, Mireya; Salinas-Ortega, Magaly; Estrada-Arriaga, Iván; Hernández-Lemus, Enrique; García-Herrera, Rodrigo; Vallejo, Maite

2018-01-01

Cardiovascular diseases are the leading cause of human mortality worldwide. Among the many factors associated with the etiology, incidence, and evolution of such diseases; social and environmental issues constitute an important and often overlooked component. Understanding to a greater extent the scope to which such social determinants of cardiovascular diseases (SDCVD) occur as well as the connections among them would be useful for public health policy making. Here, we will explore the historical trends and associations among the main SDCVD in the published literature. Our aim will be finding meaningful relations among those that will help us to have an integrated view on this complex phenomenon by providing historical context and a relational framework. To uncover such relations, we used a data mining approach to the current literature, followed by network analysis of the interrelationships discovered. To this end, we systematically mined the PubMed/MEDLINE database for references of published studies on the subject, as outlined by the World Health Organization's framework on social determinants of health. The analyzed structured corpus consisted in circa 1190 articles categorized by means of the Medical Subheadings (MeSH) content-descriptor. The use of data analytics techniques allowed us to find a number of non-trivial connections among SDCVDs. Such relations may be relevant to get a deeper understanding of the social and environmental issues associated with cardiovascular disease and are often overlooked by traditional literature survey approaches, such as systematic reviews and meta-analyses.

A systematic approach to analyze the social determinants of cardiovascular disease

PubMed Central

Martínez-García, Mireya; Salinas-Ortega, Magaly; Estrada-Arriaga, Iván; Hernández-Lemus, Enrique; García-Herrera, Rodrigo

2018-01-01

Cardiovascular diseases are the leading cause of human mortality worldwide. Among the many factors associated with the etiology, incidence, and evolution of such diseases; social and environmental issues constitute an important and often overlooked component. Understanding to a greater extent the scope to which such social determinants of cardiovascular diseases (SDCVD) occur as well as the connections among them would be useful for public health policy making. Here, we will explore the historical trends and associations among the main SDCVD in the published literature. Our aim will be finding meaningful relations among those that will help us to have an integrated view on this complex phenomenon by providing historical context and a relational framework. To uncover such relations, we used a data mining approach to the current literature, followed by network analysis of the interrelationships discovered. To this end, we systematically mined the PubMed/MEDLINE database for references of published studies on the subject, as outlined by the World Health Organization’s framework on social determinants of health. The analyzed structured corpus consisted in circa 1190 articles categorized by means of the Medical Subheadings (MeSH) content-descriptor. The use of data analytics techniques allowed us to find a number of non-trivial connections among SDCVDs. Such relations may be relevant to get a deeper understanding of the social and environmental issues associated with cardiovascular disease and are often overlooked by traditional literature survey approaches, such as systematic reviews and meta-analyses. PMID:29370200

Psycho-social determinants for psychiatric hospitalisation for neurotic disorders in women--a case-control study.

PubMed