"What good does it do to treat people's illness, and then to send them back to.."
The determinants of health cover social, environment, individual capacity, personal health practices, and the health care system.
The Determinants of Health
Measuring only health outcomes misses the majority of the population and how they are doing. These health issues are important for whole society and for the world, and it is a mistake to focus only on the bottom 10%.
Wellbeing needs to be a global development outcome. Society development needs to be judged by population health and its fair distribution.
The determinants have been written about extensively by the
What we're most interested in is functional literacy - can people
SES makes a BIG difference; of an age cohort, only 27% of poor kids pass the grade 12 test, while over 70% of rich kids do.
A point-blank question can be helpful:
There are many programs available..
As an important determinant of health, our physical environments have tremendous impact on how we feel and live.
Richness = socioeconomic steroids
"Show me your budget and I'll show you what you value."
The WHO has been active in setting the global agenda, equipping members countries to tackle their population's wellbeing by launching a report in September 2008. The report will cover the conditions in which people are born, grow, live, work, age, the structural drivers of conditions at global, national, and local levels, and monitoring, training, research.
Health Equity: the absence of unfair and avoidable or remiadble differences in health among population or groups defined socially, economically... (Solar and)
participation in society
The policy makers have in their hands the capacity to set levels of poverty through resource distribution. (Fritzell and... )
Tobacco taxes are a way of taking money from the poor and giving it to the rich.
Woolf et al, AJPH 2007
medical advances - 180k deaths averted
educational inequalities, 1.4m deaths averted
Grantha-McGregor et al, 1991
nutrition + stimulation restores growth; neither does on its own.
stress and work
iso-strain: social isolation + strain
Three waves of GH research
1 biomedical disciplines to offer clin
2 health systems, PH interventions
3 sDOH as effected by social and economic policy and upstream political choices
dlp: these resources need to be permeated with:
will prevention save money? debatable. But should it matter? We should prevent disease and illness because health and well-being.
Health systems do matter
major obstacles to third wave: complexity of causal pathways, biological or epidemiolgocial orientation of many clinicians or researchers; many governments are quite cautious
CMA, CPS, CFPC
child and youth challenge
Morris et al, 2007 IJE
minimum income for healthy living - our pensions are insufficient
people drink the same amounts; its vulnerability to it that is linked with death
Kenya - participatory approach to nutrition
problem was social breakdown
Havemann and Pridmore, 2005
60 cents per person per year
one of the biggest problems in health care is very poor customer service.
we need to feel we have control and purpose; we need to love and be loved.
Income correlates with all-cause mortality, with the majority of the impact being unexplained by traditional risk factors such as blood pressure, smoking, etc (Whitehall Study).
This gradient is ubiquitous across wealthy countries, with SES. It cuts across a wide range of disease processes.
This income-health gradient becomes replicated as new conditions emerge - ie post WWII, HIV/AIDS, etc.
This impact appears distinct from biology. How does SES then impact health? Social, emotional, and language development, especially at an early age, are profound.
Sensitive periods in early brain development
get graph from Council from Early Child Development
Nurture is a substantial indicator.
The easiest time to do something is early on.
Problems known to be related to early life include:
Hart and Risley, 1995
Disparities in Early Vocabulary Growth are profiund by 36 months, and appears to be connected to the number of words spoken to them. (30 million word gap).
The words parents use, and the way they are used, are also very important. Disparaging words, or commands, are not great.
The Bill Cosby Show made an effort to model effective household language.
National Long. Study in children and youth:
Can seek the impact of ECD at the level of the population
can seek to understand how biology interacts with development
Biological embedding occurs when experience has a permanent role on human biology.
Need to have a breakdown of experiences and behabviours, neural circuitry, synapses, and molecular biology.
Low SES has an impact on prefrontal cortex, whereby attention is constantly on guard (perhaps a product of chronic disorganized lifestyle). It makes focused attention more difficult. You can train kids to focus better, but at what age is neural circuitry locked in? Is it?
A Capsi. Science. 2004. Serotonin transporter gene potentiates depression, but only in areas of severe abuse. There are now 5-10 very important studies reinforcing gene-environment interactions.
Epigenetics: methylation. This guy has shown methylation can continue not only during fetal development, but also after birth.
Meaney M, Szuf, 2004-2008 - rats who lick their babies more - babies have a better functioning HPA axis (cortisol fine-tuning). Can see methylation of the GR promoter - 'Meaney-Szuf Paradigm' between days 9-16 of rats; not before, not after. And then the mother passes on this behaviour to their babies!
Now doing human genome studies: can find over 1500 loci of differential methylation in children from different SES.
Health Care Without Harm - the Campaign for Environmentally Responsible Health Care
Robin Kearns has done much work on people in place. Some of his publications include: