Social and economic factors which influence the health of people and societies is termed as social determinants of health. The factors are molded by the specific amount of power, money and resources people possess based on policy choices. This determinants influence conditions related to the person’s health outcomes. The factors related to health outcomes include; Education of the individual, early childhood development, ability to acquire and retain employment, type of job one has, food security, easy access to health facilities and the quality offered, status of the habitat, social welfare and discrimination and last but not least the income earned. In this paper I will critically analyze these determinants of health and how they are associated with social determinants of health. I will also describe their respective class theories.
A theory is an effective way of behaviors, event and situations. It has the same meaning as a framework or perspective. Health determinants are conditions that influence a person’s current state of health. These factors are social, socioeconomic, behavioral and psychosocial. Scientists have come up with five general determinants of population health. The determinants are health behaviors for example, drug use, unprotected sex, smoking and alcohol use. The second one is physical environment like congested conditions and housing. The third is health services insurance and accessibility of health care facilities (Venkatapuram, 2013). The fourth is social characteristics for example, gender, income and discrimination. The fifth is genes and biology through gender and age. Other conditions to be considered are culture, suitable childhood development and status in society. In the determinants of population health, genes, health behaviors and biology account for 25 percent while social determinants, which include medical care, social and physical environment take up the remaining of the 75 percent. Social factors influence a person’s behavior as well. They generally refer to a group of factors that affect social patterning of disease, illness and health.
The theories behind social determinants of health include life course analysis, salutogenic model and social capital. Life courses analysis looks at the complex means through which risks in biology interact with social, economic and psychological disciplines in development of illnesses. The perspective identifies a person’s disease status to be linked to his or her past social position. Importance of early childhood development is highlighted as a basic aspect. Birth weight also determines future effect of chronic illnesses to the body. Emphasis is also laid on the interaction amongst individuals and their surroundings throughout their life (Commers, 2002). This theory is essential in determining the successes and failures which contribute to existence of social and health inequalities in society. A person who stays unemployed for a long span of time is likely to live in low quality housing, have a poor diet and look for an unhealthy way to deal with stress like smoking. This is a contrast to someone from a middle class family, who will acquire the right education, get a stable job and on retirement receive pensions therefore his or her life is longitudinal. Therefore, we can conclude that there are socially important stages in life development which can have significant effects on a person. These stages are as follows: Graduating from primary to secondary, school exams, entry to the job market, leaving your maternal home, creating your own residence, establishing parenthood, work security, transfer and loss of a job and leaving the job market.
The salutogenic model focuses on understanding nature of the illness and behaviors that may put you at risk. It states the conditions necessary to establish good health that is origin of salutogenesis and health. The model gives a description of relationships between stressors that exist in life and the health status of the individual or society. Stressors are a must in human existence. Those who are adequately equipped to handle them have strong coherence and retain perfect well-being and health. The model was however recently modified to into salutogenic setting. This new development focuses on analyzing and changing sociocultural conditions that affect health status of individuals. The aim is to work on improving salutary conditions in society to end the illness continuum. This approach, Salutogenesis, supports the population strategy according to McQueen (2007). Salutory factors that affect population include education level, safe living and working conditions and efficient public policies. They bring a positive effect on health outcomes. The last theory is the social capital, which has exhibited high interest from researchers at the International Public Health Institution. Debates have been conducted over it and criticisms stated. One criticism is the lack of clarity it portrays in its meaning. It is described as the constituents of a social organization for example, faith in others, participation in civic activities and reciprocity of norms. All of these features assist in mutual benefit cooperation. Social capital accesses the height of social trust in society.
Social trust considers how people feel safe among each other, the help they give to each other, participation in community groups and social issues. Differences in social capital explain the different expectancy rates of life in different countries. There is a high connection between distribution of income and life expectancy. The critical determining factors of life expectancy are the levels of inequality and poverty. Inequalities in income are related to deficiency in social trust and leads to a number of diseases for example heart diseases, infant mortality amongst others. Research studies, however, contest this fact and state that health inequalities arise from absolute poverty and lack of material and structural basis and this leads to destruction of social fabric, the gap between the rich and the poor. The poor lack resources to maintain a healthy life and as opposed to the rich who have ease of access (Marmot, 2004). Marxism deals with relationships between classes and conflict in society. It uses interpretation of materials in historical development and social transformation using a dialectical view. The dominant group in an area gets to control the resources e.g. the government, rich. The mode of production, dialectical materialism and alienation are concepts discussed by Marxism. If we are to understand how the health system works, we have to look at our material existence in terms of economic production. This existence consists of social classes that oppose each other in a struggle to relate and create a social class that may be challenged with time. A Marxist’s view on health may state that poverty is linked to health, to enhance health outcomes one must improve material conditions, the social causes of illness have been underdeveloped, once individuals lose economic usefulness their health is not served well e.g. old people and many others. It is important to address the role of social determinants of health because since it is a basic approach for us to achieve health equity. This is described as the instance where everyone is able to get full potential of health. Nobody should be in the losing end from attaining full health potential due to his or her social class. This involves the lack of presence of factors that create disparities amongst people because of social groups and social disadvantages or advantages. Contributing factors towards health inequalities are lack of equal access to health amenities, poverty, little or no education, tribalism, racism and stigma as highlighted by McQueen (2007).
A center was founded called the Center for Disease Control and Prevention, which aims at improving peoples’ lives by eradicating health inequalities. Health centers are encouraged to address limiting factors related to health’s social determinants and to ignore behavioral factors. The World Health Organization (WHO) is also looking into this social determinants and it uses three main principles in absolving health inequities all over the world. The first principle is enhancing life conditions that are the way people are born, grow, stay, labor and age. Second principle is handling the unequal distribution of resources, capital and power. These are the important drivers of daily life worldwide. The last principle is to analyze the problems, define an action, increase the range of knowledge, create a workforce dedicated towards training on the determinants of social health and enforce awareness to the public about these social determinants. After the principals were made a conceptual framework was made that distinguishes variables. The framework is aimed at enabling researchers to manage to take suitable action, like creating interventions to promote social determinants of health. The framework’s variables are on factual evidence and scientific study to bring out the right relationships amongst the variable for effective usage of the framework (Commers, 2002). Health determination should be in line with high quality, rigorous and appropriate theories if it is expected to improve and mature. With discussions underway to focus on quality of concepts and theories, it is important for health promoters to enter in substantial debates over the nature of their work to enable people from all over the world to access quality health services. Illness should also be evaluated according to the determinants for efficient treatment processes as stated by Blank (2013).
Social inequality will however remain a key issue in our society for as long as we live. One of the main ways to eradicate health inequalities is to address health behaviors and change them for the better. This can be handled through application of psychological knowledge. The aim then of the theories is to control health specialists to acquire the psychological know-how to improve patients’ health. The psychological knowledge can only be acquired through research and empowering people to analyze the theories to promote behavior change. The main concern should be the health facilities are accessible to all people worldwide.
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