Social determinants of Healths universe'

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Social determinants of Healths universe.

• Third part.
• Marcio Ulises Estrada Paneque. MD. PhD.
• Genco Estrada Vinajera. MD.
• Caridad Vinajera Torres. PhD.

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Some questions.

• Why the equity and social justice in health
  constitute ethical guides to build bases and
  suggest public policies?
• Why the frame of the HHRR offers structure for
  the approach of the social determinants in
  health?
• In what extent globalisation has contributed to
  tie its results of health equity and social
  justice in populations?

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SDH frame of reference.

• Different analyses around SDH identifies
  three main boardings, with complementary
  contributions (Solar Irwin, 2007)
• Psycho-social approach
• Social production of the disease-health
• Eco-social approach with multiple reference
  levels.
• All of them look explain health inequities.
  Although dont leave from disease social
  distribution analysis, its interpretation is not
  reduced to biological aspects that are integrated
  to social explanations with different emphases in
  the prospect of population health

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SDH. Psychosocial approach.

• It emphasizes the weight that has personal status
  perception in unequal societies, which leads to
  tension and worse conditions of health.
• In this construction, individual life in inequity
  situation forces to compare status, possessions
  and another condition of life with others,
  generating feelings of devaluation and
  disadvantage, conflicts and deterioration in the
  health. At social level, income hierarchies and
  status debilitate social cohesion.
• Thus are related social perception of inequity,
  psycho-biological mechanisms and situation of
  health

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Social production of health/disease.

• It emphasizes economic and political
  determinants.
• It does not deny psycho-social consequences
  of inequity in the income, but argue the
  necessity of begin from the inequity structural
  causes.
• It explains that the inequity reflects lack of
  resources (groups and individuals) and lack of
  investment in the infrastructure (environmental
  education, services of health, controls, food
  availability, quality of house, environmental
  regulations of occupational health, medical
  controls, transport, etc)

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Ecosocial approach.

• Its multiple reference levels look for interpret
  health inequity like cause and result of a
  dynamic, historical and ecological relation.
• It proposes to study the rule and behaviors of
  population health, disease and well-being
  together like biological expressions of social
  relations.
• More than to add biological and the social
  elements, looks for integrate a complex vision of
  the population health changes.

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Different approaches contributions.

• Allow understand the mechanisms by which the
  determinants influence the health, with
  explanations that are not mutually excluding
• - Social selection, where health determines
  socioeconomic position and not the inverse
  process. Health exerts an important influence in
  the profit of social positions as a result of the
  social mobility, through which the healthy ones
  are in better conditions for ascending than those
  that suffer diseases or incapacities.

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Different approaches contributions.

• Social Position, complements previous mechanism
  and determines health through intermediary
  factors. Health problems have majors
  possibilities of being developed in lower
  socioeconomic groups, mainly in indirect form.
• Perspective of the life course (individual,
  through generations or concerning populations).
  It allows to detect critic periods in the life,
  exposure time to the risk importance and risks
  accumulation throughout the time. Facilitates
  intervention in time in temporal process (early
  childhood, childhood, adolescence and adults.

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Reflection on factors and mechanisms.

• Which characteristics have, in form and
  magnitude, health inequalities and ?
• What contribute to the different perspective or
  approaches for SDH interpretation?
• Which are the differentials or vulnerability
  (that led to health), and its consequences?
• How can extent policies and inter-sectoral
  strategies to drive on the SDH deep causes?

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SDH perspective.

• A strategic frame to act on the SHD adopts a
  concept of social position like central concept
  to interpret health inequities mechanisms, that
  generate power distribution, wealth and risks.
• From this perspective there are
• - Structural determinants, defined by the
  social stratification and its mechanisms of
  maintenance.
• - Intermediaries determinants, regarding
  factors and specific social circumstances.

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Structural SDH approach.

• Consider social stratification like central
  factor in SDH understanding, productor of
  inequality in the power, prestige, income and
  wealth in different socio-economic positions.
• Consider mechanisms that influence in health
  results from social stratification operate
  through social context (assigns to individuals
  and groups different social positions, create
  hierarchies, establish market of work, educative
  system, political institutions and sociocultural
  values)

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Structural SDH approach.

• Consider the differential exposure to health and
  health damages the differential vulnerability in
  health conditions and material resources
  availability according to population groups.
• Consider differentials consequences in health and
  disease conditions for groups with more
  disadvantages.

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Intermediaries SDH approach.

• Structural determinants promote that intermediary
  determinants operate
• Material circumstances quality of house, food
  access and physical environment conditions
• Psycho-social circumstances social tensions
  (stress, violence, coercion, etc, gender and
  ethnic group tensions, and change of the life
  styles.
• Biological and behavioral factors like
  nutrition, physical activity, alcohol and
  tobacco consumption, and genetic factors.

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How it interact?

• Social stratification generates unequal exposure
  to conditions of risk disease and differential
  vulnerability, in conditions of health and
  resources available materials.
• It determines differentials consequences of the
  results of health
• Degree of social cohesion affects the structural
  and intermediaries factors. Magnitude of the
  problem, hits morbidity mortality and affects
  the economic and social growth.

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Changes requirements.

• To reduce the inequities in health entails
• To change power distribution within the society.
• To benefit disadvantaged groups, in several
  levels.
• Action on the SDH is a political process, that
  involves social agencies, community and State in
  a collective action.

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Changes requirements.

• Empowerment of vulnerable groups .
• Surpass depoliticized approaches in State for
  the equity promotion.
• Generate inter-sectoral policies to attack the
  deep causes of the differential vulnerability and
  the risks exposure differential.

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Health systems like SHD.

• Policies that approach health problems with
  preventive and curative actions trough
  improvement of health services effectiveness.
• In order to prevent diseases between people and
  groups with high risk, with individual actions on
  life styles.
• Health systems that tries to improve the equity
  in health.

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Health systems like SDH.

• Health systems is a result of social and
  political processes. It are socially determined
  and a SDH.
• Its organization and values affect people to
  exposure and vulnerability.
• Well designed can solve exposure inequality and
  vulnerability between population groups (equity
  in access, inter-sectoral promotion,
  communitarian participation in the decisions and
  with innovating policies).

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Primary attention (PHC) and SDH.

• Both concepts prioritize equity in health and
  social justice.
• PHC is an approach for Health Systems and society
  with the intention of reaching health equity
  (Health for All).
• SDH offer an analysis of how existence of
  inequities in health include society as a whole.

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PHC and SDH.

• Both insist on health promotion and prevention
  and increasing accessibility to the resources for
  the health and protection of diseases.
• PHC and SDH center in the paper of communities to
  guarantee their health

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PHC and SDH.

• SDH analysis in PHC considers the impact on the
  health of the communitarian factors, like social
  inclusion and exclusion, relative social status
  and communitarian aid and flexibility.
• Actions on the SDH in PHC demand of marginalized
  communities empowerment.

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Inequity facts.

• Even in the developed world the more
  socioeconomic affected groups live less and have
  always a bigger morbidity than the rich one.
• Globally exists differences in the way that
  persons can develop healthy life. Health levels
  are keys to measure that differences

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Requirements for SDH approach application.

• Design a capacity map to clarify necessary
  knowledge, skills and attitudes and to stimulate
  a new thought in the health phenomena
  explanation, disease and the death.
• Three key functions have been identifies for
  which twelve capacities are identified.

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Key purpose.

• To reduce inequities and to advance to inclusive,
  democratic, sustainable and healthful societies
  through a participating work of decision makers,
  civil society and academy.
• Profit of reflection, consensus, learning and
  design, implementation and evaluation of public
  policies directed to the construction of a
  society of men and women more free and healthy.

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Key strategies.

• Articulate different actors involved in decision
  making to construct a common vision, produce
  models and methodologies for the design and
  implementation of public politics with SDH
  approach. Objective Diminish inequities and its
  impact in society welfare.
• Design learning and communication strategies that
  may useful to communities and institutional
  capacities in SDH application.
• Produce useful models and methodologies for the
  design and implementation of the public policies
  with SDH focus.

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