HSS1101E Determinants of Health

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HSS1101E Determinants of Health

• Feb 23 Income Education, part 1

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What Is SES?

• Socioeconomic Status

• Income
• Education
• Social Class

/ Occupation
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Income and Health

• We tend to consider poor countries as having poor
  health, and rich countries as having good health.
  But
• Studies suggest that the distribution of income
  in a given society may be a more important
  determinant of health than the total amount of
  income earned by society members. Large gaps in
  income distribution lead to increases in social
  problems and poorer health among the population
  as a whole.
• Federal, Provincial and Territorial Advisory
  Committee on Population Health, Toward a Healthy
  Future Second Report on the Health of Canadians,
  1999, page ix

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Income and Health

• We widely consider poor people to tend to be of
  lesser health than rich people
• Eg, CMAJ, June 10, 2003 168 (12), Effects of
  low income on infant health
• Households with low incomes in Canada are more
  likely to suffer higher hospital admission rates
  among infants under 5 months of life

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Income and Health

• Another resource
• http//www.phac-aspc.gc.ca/ph-sp/oi-ar/02_income-e
  ng.php
• The income gap between the richest and poorest
  families in Canada is growing
• Strong evidence that the growing gap is mostly
  the result of the rich getting richer, and not
  the poor getting poorer
• However, since services are often targeted to the
  average, the poor are more disserved because
  their distance from the middle is growing.

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Income and Health

• This relationship is confounded by age
• Areas with the highest poverty rates also have
  the highest percentage of seniors
• Same is often true for immigrants, Aboriginals
  and disability status

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Income and Health

• How is this relationship affected by gender?
• For example, women and their children who are
  poor are more likely to be socially isolated,
  which also contributes to ill health

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More on the Influence of Gender

• Additional resource http//www.cwhn.ca/resources/
  women_poverty/summary.html
• Example Manitoba
• the country's third highest rate of poverty
  (18.5) among Canadian provinces, compared to
  16.2 for all of Canada
• 19.9 of Manitoba women aged 18 and over were
  poor in 1999
• In 1999, there were 29,000 more poor women in
  Manitoba than poor men - a difference of 54

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More on Gender

• More than half (51.3) of senior women who live
  alone are poor.   This has remained virtually
  unchanged in the last thirty years.
• Women with disabilities also face a higher risk
  of poverty. In 1997, 27 of women with
  disabilities, aged 16 to 64, lived in poverty.
• Aboriginal women are more likely to live in
  poverty than non-Aboriginal women or Aboriginal
  men
• Recent immigrant women have particularly low
  incomes. In 1995, their average income for all of
  Canada was only 12,000, about 62 of the amount
  earned by Canadian-born women that year

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What Policy Options Are Available?

• increasing the minimum wage
• increasing social assistance rates
• broadening eligibility for Employment Insurance
• reducing the costs of public transportation
• increasing the number of subsidized child care
  spaces
• making child care fully subsidized for women
  living in poverty
• reducing the cost of basic telephone service
• making recreation programs freely available for
  those living in poverty
• providing non-insured health benefits, such as
  dental care and prescription drugs to all those
  living in poverty

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Health and Education

• How are health and education related?

• Those with more education have more knowledge of
  how to be healthy (exercise, dont smoke, eat
  vegetables, etc)
• Those with more education have more knowledge
  about services to keep them healthy (doctors,
  counselors, etc)
• Education leads to better jobs, more income and
  more control over ones life
• Highly educated people tend to associate with
  other highly educated people who traditionally
  have lived heathfully

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Health and Education

• But is it always true?
• Starving students
• Fat professors
• MBAs dropping dead of heart attacks

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Health and Education

• At the population level, one of the best ways to
  increase a communitys long term health and
  wealth is to educate the girls. Why?

• An educated mother tends to share her new life
  skills with her family
• More time spent in school tends to delay
  pregnancy and reduce number of pregnancies
• Fewer children means greater investment in a few
  children, leading to their greater health
• Increased overall quality of nations workforce ,
  leading to increased prosperity

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Lets Look at Maternal Health

• Each year, more than four million babies die
  within four weeks of birth 500,000 women die
  from complications in childbirth. Women in
  developing countries are also 300 times more
  likely to die in childbirth or from pregnancy
  related complications than those in a developed,
  industrialised country.
• In Niger, a woman has a 1 in 7 chance of dying
  from childbirth in Ireland, she has a 1 in
  47,600 chance.
• Whats the difference between Niger and Ireland?

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Maternal Health

• Maternal mortality is as a result of five major
  causes, haemorrhage being the most common one,
  and the others being complications with unsafe
  abortions, infection, obstructive labour and
  hypertension and hypertensive disorders.
• But, these medical problems are closely related
  to the social status of women
• HOW?

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Maternal Health

• Underlying these medical issues are issues having
  to do with nutrition, sanitation, sexual freedom,
  number of pregnancies and age at first pregnancy
• Then theres financing to give birth at a
  hospital, or to seek medical care when sick
• Education is the single greatest tool for
  empowering a woman to control access to her body

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Maternal Health

• a very inadequate health infrastructure and an
  inadequate health care facility are
  essentially a lethal combination
• IPS News (http//ipsnews.net/news.asp?idnews45430
  )
• Niger has one of the highest drop-out rates
  between primary school and secondary school

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How Does This Information Help Us?

• The system pays too much attention to health
  care delivery and to drugs and too little to the
  effects on health and the 'upstream' social and
  economic arrangements.
• Angus Deaton
• The USA spends the most of any country on health
  care, though its worker health is poor
• -gt by spending more on education, maybe the gap
  can be closed?

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Social Class

• An obsession of UK researchers
• Involves status, wealthy, culture, occupation and
  background
• What of a poor son of labourers who is
  nonetheless descended from royalty?
• What of priests?
• What of soldiers?

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From the Readings

• The connection between health and social
  class/status has been explored since at least the
  16th century
• 1572 a law in England was passed to punish
  sturdy beggars and help impotent poor
• 1842 Chadwick writes General Report on the
  Sanitary Conditions of the Labouring Population
  of Great Britain
• Average age of death was 35 for gentry, 15 for
  labourers

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Ageing and Social Class

• From the readings
• Biological age, corrected for obesity, smoking,
  exercise and chronological age, was 7 years
  higher among manual labourers, compared to
  workers of higher social class
• (study used telomere length as proxy for bio age)
• Why?
• Stress effort-reward imbalance, self esteem,
  lack of control over your life

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What Are Causes of Health Inequalities Between
High and Low Class?

• 1. Post hoc ergo propter hoc (chicken or the egg)
• Is it low class that causes poor health, or poor
  health that causes low class?
• Eg, schizophrenic children of wealthy people tend
  to be less wealthy as adults
• Eg, most chronic ailments (COPD, back pain) arise
  later in life, after effects of social class have
  been effected

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What Are Causes of Health Inequalities Between
High and Low Class?

• 2. Material Explanation
• Poor people have less access to resources
  shelter, medicine, sanitary conditions leading
  to poor health
• Eg, Clusters of cases of preventable diseases
  tend to occur in places with fewer resources for
  disease prevention

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What Are Causes of Health Inequalities Between
High and Low Class?

• 3. Cultural Explanation
• Lower social classes prefer less healthy
  lifestyles
• Eat more fatty foods
• Smoke more
• Exercise less often
• Question how much of this is confounded by other
  factors?
• Eg, is the preference for a poor diet the result
  of unhealthy tastes, reduced access to healthy
  foods, or simply a lack of education about what
  constitutes a healthy diet?

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Next Class

• We will look at scales for measuring SES