Social Determinants of Health
Discuss about the Development Of A New National Women Health Policy.
Health is the one of the top trendy topics of all time. Whether one is in the grass root level or at international agencies, one would find it discussed there. Health is defined by World Health Organisation as “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2006). It is an important sector as it impacts both the economy and livelihood of the people. One of the reasons that make health such a key issue is that it is affected by a number of factors making it a vulnerable sector. These factors are known as determinants of health. The determinants range from personal, social, economic and environmental factors and they are what distinguish those who are healthy from the unhealthy. Determinants of health fall into the following categories: policymaking, social, health services, personal behaviour and physiological factors (HealthyPeople.gov, n.d) (CDC, 2014).
Out of the five categories listed above, social determinants of health do receive a lot of attention. So what are social determinants of health? These describe the environment where one lives, learns, works and plays. They do affect the general well being of a person and the population as they affect their functioning and health outcomes (HealthyPeople.gov, n.d). Social determinants of health are categorized into education, economic stability, and neighbourhood and built environment, health and health care and social and community context (HealthyPeople.gov, 2010).
Social determinants of health affect health as they do affect the other determinants. The level of education and the economic stability of a population have been associated with better implementation strategies of policies geared towards healthcare as information and resources are available. Social determinants also affect the personal behaviour of a person as it is linked with one’s lifestyle. Aside from this, social determinants of health complement each other whereby one determinant can influence another determinant. For example education correlates with economic stability in that people with higher education levels have better socioeconomic status which brings about better health. These are both protective factors that help in the prevention of diseases and psychological distress.
It is agreed that the social determinants do affect specific populations, but how exactly do they do this? There are three ways in which this happens. These are differences in exposure, vulnerability and consequences (Fusco, Akerman, Drezett, & de Souza e Silva, 2016). Difference in exposure explains why a certain population group will be more affected by health risks than others while difference in vulnerability explains why certain population groups are afflicted with health problems and not others. Lastly, difference in consequences explains the different health outcomes among different population groups (Fusco, Akerman, Drezett, & de Souza e Silva, 2016). This paper shall focus more on economic instability and its effect among the families living under the poverty line in the US.
Economic Instability
Economic stability is a term that talks about the economic level of an individual and population. It brings about the sense of one being able to live comfortable and also someone who lives above the poverty line. Under this factor there are key issues that are considered. These include employment, food insecurity, housing instability and poverty (HealthyPeople.gov, 2010). Economic instability is a key factor as it not only affects the individuals as it dictates their health seeking behaviours through accessibility, availability and affordability of health services. It also affects the government and international agencies through policy planning and implementation.
Employment is an important aspect in a nation as it helps build its economy. Being employed is both a predisposing factor and a protective factor. Having a job is a predisposing factor due to the increased stress that is brought about by the organization, management and relationship with others at the workplace (World Health Organisation, 2003). One’s schedule, roles and responsibilities, relationship with both the management and the colleagues has a great impact on the level of stress one encounters. Job stress is defined as ‘the harmful physical and emotional response that occurs when the requirements of the job do not match the capabilities, resources or needs of the worker‘ (US National Institute for Occupational Safety & Health (NIOSH), 1998). The level of control over one’s job is also an important factor that has been associated with stress and health problems. Those who have less control over their jobs are associated with health problems like lower back pain, heart diseases and increased sickness absence (World Health Organisation, 2003). This has been assessed through the consideration of one’s work demands versus the control. Those with high work demands and low control are more predisposed to health problems as compared to those with high work demands and high control (World Health Organisation, 2003). Aside from the physical health problems stated above, this is also associated with psychological problems like depression, anxiety and burnout (US National Institute for Occupational Safety & Health (NIOSH), 1998). Maladaptive behaviours like smoking and alcohol abuse is also associated with them. These are known to predispose one to non communicable diseases like diabetes, hypertension, cancer etc. In the United States, 40% of the workers are very or extremely stressed due to their job. This has led to them reporting neck pain, back pain, depression, burnout and anxiety as the health problems that they experience due to this stress. This might have been caused by the increase in the number of hours they work and that it is not uncommon for one to have more than one job (US National Institute for Occupational Safety & Health (NIOSH), 1998). Those who live below the poverty line are forced to work more than one job so as to make their earnings. This has led to people working more than 40 hours a week. This figure can go up to 51 or more hours a week and 30 % of those who work these hours are extremely stressed (Statista, 2017). Working more than 50 hours also affects their health outcomes in that they rarely have time to eat a decent meal and have enough rest. This leads to burnout.
Employment
The positive aspect of employment comes about in that it helps to raise the socioeconomic status of a person. Employment is a good factor for good individual and population health (University of Tampere, 2016). Employment and good quality of work brings about food security through the accessibility and affordability of food, stable housing in good and safe neighbourhood, good education, insurance covers and accessibility and affordability of health services. This helps reduce stress that is associated with food insecurity, instable housing and inaccessibility of health services as one gets regular wages and improves social status (University of Tampere, 2016). In the United States, In the United States, it was found that work is associated with better physical and mental wellbeing as it is associated with financial benefits like medical covers, increased household income and accessibility to food, safe housing and healthcare and psychological benefits as it brings about ‘self esteem, self worth, identity and purpose’ (Staudinger, Finkelstein, Calvo, & Sivaramakrishnan, 2016) (Goodman, 2015).
Food insecurity is defined by FAO as “A situation that exists when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life” (Napoli, De Muro, & Mazziotta, 2011). This has been associated with unemployment and poverty whereby people are not able to purchase foods. It has also been highly associated with health problems. Healthy diets and in adequate supply are important for the general well being of a person. Shortage or excess consumption of food can cause malnutrition with shortage causing under nutrition and excess consumption leading to obesity. Obesity came to be after urbanization through better housing and good sanitation and this led to the shift from communicable diseases to non communicable diseases like diabetes, cancer, hypertension etc.
Globally, 815 million people go hungry (Pudar, 2017). This is the reason why food security is receiving a lot of attention. In the United States, approximately 50 million people face food insecurity (Gundersen & Ziliak, 2015). Food insecurity leads to malnourishment. In children, under nutrition poses the risk of underdevelopment leading to impaired cognitive and physical performance and low immunity leading to an increase in infections (Pudar, 2017). Aside from under nutrition, obesity is on the gain especially in adults with a standing of 640.9 million people (Pudar, 2017). The effects of obesity are far reaching. It is one of the main predisposing factors to non communicable diseases such as hypertension, diabetes, cardiovascular diseases etc.
Food Insecurity
Economic and social classes do bring about health disparities. The main difference is the source of nutrients consumed. While the rich consume high energy foods, fats and sugars, the poor consume processed foods which are cheaper as compared to fresh foods. This has led to obesity being associated with the rich and under nutrition being associated with people of low socioeconomic status (World Health Organisation, 2003).
In the United States, the duration of food insecurity is chronic which means that it is present for long periods of time and more frequencies (Seligman, 2016). Food insecurity affects people across the lifespan. Children afflicted by food insecurity are associated with lowered emotional and cognitive development which significantly affects their academic performance. They are also associated with physiological problems like iron deficiency anaemia and mental conditions like depression and anxiety (Seligman, 2016). Food insecurity affects pregnant women to a large extent. Poor feeding may lead to issues with maintaining and delivery of the baby. This is brought about by iron deficiency anaemia, depression and too much weight gain. Children delivered from such mothers are at risk of low birth weight that affects proper development of the child. (Seligman, 2016). Just like other places globally, food security among the adults in the United States is associated with chronic conditions like diabetes, hypertension, cancer and heart diseases (Seligman, 2016).
Housing instability is defined as the inability to pay rent and spending more than half of one’s income housing (Kushel, Gupta, Gee, & Haas, 2006). It is evidenced in multiple moves, living with others, eviction, foreclosure/being behind on mortgage and homelessness (Horowski, Burgard, Seefeldt, & Zelner, 2012). One major factor that brings about housing instability is poverty in that one cannot afford one of the basic needs; shelter. In a study carried out by Kushel, Gupta, Gee, & Haas, 2006, it revealed that the prevalence for housing instability is 26.3% and (4/5) of the respondents live either on or below the poverty line. Housing instability is associated with poor health outcomes due to one postponing seeking health in efforts to find or provide housing. This is reflected by not seeking health when sick and not purchasing medication (Kushel, Gupta, Gee, & Haas, 2006).
Housing instability is associated with unstable security. Most people end up living in environments that lack security and are prone to violence. This leads to violence related injuries and deaths. This is the case in many slums where robbery, murder, rape are prone as compared to gated communities. Aside from this, housing instability is associated with intimate partner violence (Rollins, et al., 2011). In the United States, housing instability is associated with the use of acute care services and an increase reporting to the emergency department. This is believed to be due to the violence and injuries associated with poor housing and unsafe neighbourhoods (Kushel, Gupta, Gee, & Haas, 2006).
Alcohol and drug abuse, anxiety and depression are highly associated with housing instability. The alcohol and drug abuse is believed to be highly correlated with the increase of violence and a major predisposing factor to intimate partner violence. There are increased levels of drug and alcohol abuse among these people as it serves as coping mechanism. Alcohol and drug abuse does predispose them to health problems like cancer, cardiovascular disorders and hypertension. Housing instability causes psychological distress and disorders. Common psychological symptoms are anxiety, depression, and loss of self esteem, self worth, identity and purpose (Horowski, Burgard, Seefeldt, & Zelner, 2012). This predisposes them to stress induced or exacerbated illnesses like hypertension, diabetes, arthritis etc.
Poverty and health are highly interlinked in that poverty does cause poor health outcomes whereas poor health outcomes lead to poverty (Health Poverty Action, n.d). Poverty is defined as inadequate amount of money needed in order to meet the three basic needs; food, shelter and clothing (UNESCO, n.d). Poverty line is the necessary income needed to meet daily basic needs. The international poverty line is set at 1.90$ a day. Globally, approximately 767 million people live under the poverty line (World Bank, 2018). This large figure is what led to the declaration of no poverty as the sustainable development goal one. In the US, 43.1 million people lived under the poverty line (University of California, 2017). One of the major causes of poverty is unemployment. Unemployment is associated with premature death. This is due to the impact it has on health outcomes. It affects both the physical and psychological aspect of a person. Psychologically it leads to high levels of stress, depression, anxiety and drug and alcohol abuse. The drugs and alcohol are a means of coping with the stress levels experienced. These lead to or exacerbate physical problems like diabetes, hypertension, headaches, heart diseases etc (World Health Organisation, 2003).
These health problems come about due to a number of factors. First is the lack of accessibility and affordability of health services and medication. This is brought about by people prioritizing the other basic needs instead of seeking healthcare when sick. It can also manifest itself by people lacking the money to pay for the services and medication making them not seek help at all. Food insecurity is another factor which makes them not able to afford fresh and healthy foods instead they settle for processed foods leading to malnourishment. As discussed earlier, housing instability is a result of poverty. It is highly associated with maladaptive behaviour and violence both intimate and neighbourhood. Poverty is also associated with poor sanitation and overcrowding bringing about spread of communicable diseases like cholera and tuberculosis (Murray, 2006).
From the discussion above, it is clear that economic instability is a major factor for poor health outcomes through work related stress, food insecurity, housing instability and poverty. These issues do bring about an increased prevalence of both psychological and physical problems like depression, anxiety, alcohol and substance abuse, diabetes, hypertension and heart diseases just to name a few. Because of this, it is important for the implementation of strategies that mitigate these problems.
First in order to deal with work related stress, there is need of employers providing better working conditions for their employees by clearly stating their roles, responsibilities, demand and increasing the amount of rewards they receive. This will not only help in reducing stress but will also improve the employees’ productivity. Also there is need of involving employees in making of decisions that do affect them. This will increase their sense of control leading to lowered stress. Another intervention can be the inclusion of stress management strategies such as company fun day and inclusion of mental health practitioners like psychologists who will help fellow colleagues deal with stress (World Health Organisation, 2003).
Regarding food security, there is need of policies that reduce the prices of fresh, healthy foods. This will help people purchase healthy foods as compared to processed foods. There is also need for creation of awareness of healthy eating habits. This information can be geared to the community and also made children friendly (World Health Organisation, 2003). This will help to increase the knowledge of the community. Another intervention that can be started is the use of community gardens. This will help make fresh and healthy foods like vegetables accessible and available at affordable prices.
The government can enact housing subsidies so as to curb housing instability. This will help make houses affordable helping reduce the psychological distress faced by people who cannot afford to pay rent or buy a house. According to Quigley, Raphael, & Smolen, (2001) making houses affordable is the most effective intervention in curbing homelessness. Assistance can be offered to people with rent and mortgage arrears. This has proved to help in the past as only 2-5% of families become homeless as compared to 20% that are evicted without any assistance (Burt & Pearson, 2005). Collaboration between the private and public sector is important in bringing about affordable housing that people can rent or buy.
Poverty is multifaceted issue. It can be solved from different angles. First, the government should provide scholarships to people of low socioeconomic status. This helps them get formal education which brings about better employment opportunities as compared to no education. This will help uplift the families by increasing the household income. More job opportunities should be provided so as to curb unemployment. This will help more people to be absorbed to the labour market. The private and public sector can collaborate and provide skills training like tailoring, carpentry, and construction etc for those who did not receive formal education. This will help them boost their household income and even create employment for others.
Conclusion
Health is a vulnerable sector as it is affected by a number of factors which are policymaking, social, health services, personal behaviour and physiological factors. Among these factors, social determinants of health are considered as they affect both the society and the individual. Economic instability is among the issues under social determinants of health. The impacts of economic instability on health outcomes are seen very clearly among families that live under the poverty line in the US. Some of the impacts increased prevalence of physical problems such as diabetes, hypertension, cardiac diseases and psychological problems like depression, anxiety and alcohol and substance abuse among other. Interventions geared towards work related stress, unemployment, food insecurity and housing instability will help reduce the impact that economic instability on health outcomes. This is requires the collaboration of the private and public sector.
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