The nature of social determinants of health (SDH)
Discuss about the Discrimination of People with Disabilities.
The social determinants of health (SDH) are the conditions that influence the health of individuals or a population. The SDH has gained prominence for the past 15 years with states regarding them as the basic determiner of either deprived or good health. The concept of SDH has since then become a formal health dimensional, and it has extended from the contemplation of nations to the inclusion in the studies and the training programs. This paper will be discussing the concept of SDH. It will explain what SDH is, take one example of SDH (discrimination), and then weigh it against a population (the disabled individuals). In explaining the concept, this paper will deviate from the traditional definition of disability as just the physical impairment. Thus, the paper will adopt the definition held by the World Health Organization’s (WHO) in International Classification of Functioning, Disability and Health (Wrold Health Organization, 2001).
The social determinants of health (SDH) are viewed as an amalgamation of different factors of economic, social, and political, and the interaction of these factors shape a person, the community and the entire population’s health (Muntaner et al., 2015). There is a realm of literature particularly in the last one decade revealing the significant contribution of SDH in shaping the health of individuals albeit medical care (M. Marmot & Bell, 2012). Even though the medical care plays its part in influencing health, it only comes last. That is, medical care comes in to when an individual is already sick, but SDH determines who gets sick or who sustains life injuries (Michael Marmot et al., 2008).
While explaining the nature of SDH, the WHO Global Commission on the Social Determinants of Health (CSDH) summarized their report by stating that SDH is a significant killer of humanity. The commission used a scenario of a girl being born in two different countries. One being a rich country and the other one being a poor country. The report stated that if this girl is born in a rich country like Japan, she may live for more than 83 year 51years (World Health Organization, 2016). If the same girl was born in a poor country like chad, she may only live for up to 51years (World Health Organization, 2016). The rationale created by this report is that governments have to act and provide resolution for these inequalities. Nevertheless, there enough evidence that SDH are not only in poor countries. Research has showed that even rich countries can have some degree of inequalities. For example, people in rich towns seem to have longer life expectancy than those living in poor towns (Michael Marmot, 2015). There is also evidence that social discrimination is a factor that can create inequalities in health where rich towns are provided with good security, improved sanitation, clean water, and quality health services (urban rich vs urban poor) (de Snyder et al., 2011). Another evidence can be found from the work of (Sauvaget et al., 2011) that some cities in the same country can vary in terms of life expectancy. In India, for instance, the work of (Sauvaget et al., 2011) identified that men within richer areas can live longer that those in poorer areas with a variation of 62 years for richer areas and 54 years for poorer areas. In Ausralia, there is a difference of 1.4 times higher of motarity for those in poor cities than those in rich cities (Australian Institute of Health and Welfare, 2014). The latest work of (Michael Marmot, 2017) also identified that the Baltimore and Washington DC have a 20 years shorter life expectancy in poor cities than rich cities.
One example of social determinant of health: Discrimination
Disability is one of the fields that are emerging within the public health. People living with disabilities account for about 15% of the global population. Also, this number includes those with disabilities such as the visual impairments, low back pain, multiple sclerosis, depression, schizophrenia, spinal cord injuries and long term chronic diseases (Wrold Health Organization, 2001). When ageing population is included, this number escalates as ageing people have steady increase in the prevalence of chronic health diseases (Wrold Health Organization, 2001). Therefore, by adopting the WHO definition of disability, the term refers to a single spectrum that encompass psychological, biological, environmental and social aspects (Kostanjsek, 2011). Stigmatization and discrimination are some of the main polupaltions’ determiner of the health and/or other health-related inequalities. Some studies have already analyzed self-reported data and found interpersonal discrimination as one of the detrimental effect in mental health (Pascoe & Richman, 2009; Schmitt, Branscombe, Postmes, & Garcia, 2014).
Global Prevalence of Health Discrimination of the Disabled
Disability-related discrimination is a reality among different nations. For instance, In the UK, despite having firm laws and policies against the discrimination of the disabled, the study of (Lockwood, Henderson, & Thornicroft, 2014) found that a huge gap exist between the law, policies and what actually happens in the practice. This study analyzed the data mainly focusing on mental health in Britain covering 2005-2012. In support of these findings, the study of (Ali et al., 2013) examined how individuals with intellectual disabilities experienced discrimination and discrimination-related barriers while accessing healthcare services. From the respondents, the researchers found that there were instances of negative behaviors and attitudes from the staffs. The study also found other issues like stigmatization, poor communication, lack of eligibility in the services, poor support and limited involvement from the carers. There were also issues with the language and lack of better translation services in the healthcare services. This study concluded that issues of discrimination still needed to be given more attention in England.
Another study by (Du Mont & Forte, 2016) explored whether there is a relation between discrimination and reported health status. Also, the worked aimed to test the prevalence of discrimination experienced by the disabled persons. Of the participants involved in this analysis, the report noted that there is still prevalence of discrimination in Canada, and most of the people with disabilities who said that their health was fair or poor had been subjected to a higher level of discrimination than those who said that their health was good or excellent.
The disabled as a population: an example of discrimination in health
While studying the prevalence of discrimination among the disabled persons in the South Africa, the study of (Vergunst et al., 2017) explored the issue of quality access to healthcare among the disabled person in South African’s rural areas. The study noted that the disabled had more unmet health problems than the non-disabled. In the united states, the study of (Rotarou & Sakellariou, 2017) analysed the cross-sectional data that was composed from a survey conducted in Chile, South America. The study aimed to investigate whether there was difference in the health access from the disabled persons from Chile. The study found that even though there was universal healthcare coverage, those Chileans with disabilities did not have an easy time accessing the health coverage.
Health Discrimination of People with Disabilities in Australia
In Australia, the ratio of the people who have disability is one out of five. Despite the fact that disability is recognized as a situation that can occur either at birth or during someone’s life, the report of (Krnjacki et al., 2018) states that the disabled persons are rarely recognized as important population either within the public health policies or in practice. In addition, despite the high number of the disabled population in the Australia, little is known about their health. The only evidence that exist about disabilities in Australian is an international evidence, and it reports that their health status is worse compared to that of the non-disabled across different areas of health outcomes such as obesity, diabetes, oral health and mental (World Health Organization, 2013). Disability-related discrimination has been identified in various reports and studies in Australia. For instance, the report (National Inquiry into Employment Discrimination Against & Commission, 2016) revealed that there is high rate of discrimination against aged people at work. In connection to the health, this report states that this discrimination proceeds to health either as secondary effects of employment or as direct discrimination.
A few studies have analyzed the prevalence of disability-related actions in Austria. For instance, the study of (Krnjacki et al., 2018) analyzed the rate of discrimination in Austrian disabled population. In particular, the study assessed the correlation between the disability-related discrimination on the overall health, and then analyzed it against the psychological distress. The study used data that was collected from the Australian Bureau of Statistics in the survey that had 2015 data of the disabled, aged, and the carers. The analysis of the study exhibited that about 14% of the disabled population in Australians reported having experienced disability-related discrimination. The study also noted that the discrimination commonly reported by those people who had a particular circumstance such as being unemployed, in lower-status or low income. The study of (Johnstone & Kanitsaki, 2008) identified that older overseas Australians with diverse cultural backgrounds and language experienced considerable level of disparities when seeking healthcare and other social care services. The study of the (Centre of Research Excellence in Disability and Health, 2017) found that 14% of the disabled people, 15- 64 years encountered disability-related discrimination. The highest discrimination was experienced on those with severe restrictions. All these discriminations were also connected to their poor health.
Discrimination against disabled individuals in different countries
Negative Impacts of Discrimination on People with Disabilities
All the SDH consequences are interrelated. The consequences of one determinant may translate to effects of the others. For instance, a discrimination in health would lead to poor health, and the poor health would affect someone’s capabilities at work leading to dismissal. Similarly, discrimination at work may affect someone psychologically which would lead to poor mental health. In addition, discrimination at work may lead to low income and unemployment, which would also incapacitate someone in education and health literacy, food insecurity leading to malnutrition, or injuries due to crimes when someone lives in urban poor areas. While looking at the effects of discriminations, the studies also analyze the effects of perceived discrimination. The rationale behind this focus is that both the perceived and the actual discrimination have the same effects, and both of them could be caused by the same circumstance. In overall the effects of discrimination in health have been identified in causing physical, social, intellectual and emotional effects.
Some of the studies that have studied the impacts of discrimination have found that it worsens the conditions of the disability. Among these studies is the study of (Rogers, Thrasher, Miao, Boscardin, & Smith, 2015) which found that discrimination had worsened condition or developed new disability related conditions after a period of four years. In the study of (Pascoe & Richman, 2009) perceived discrimination was seen to cause various health effects. The meta-analysis provided a comprehensive justification linking perceived discrimination to both physical and mental health consequences. More importantly, perceived discrimination was seen to significantly heighten the patients’ stress responses such as withdrawal and nonparticipation behaviors.
In the study of (Hausmann et al., 2011), perceived discrimination in terms of racism and classism was seen to cause less communication from the patient and less information from the side of the care provider. In overall, perceived classism and racism in healthcare settings was seen to cause negative impact such as uncomfortable tones in patient-provider communication. Discriminattion in form of rasism has also been linked to poor health conditons such as weakened coping capabilities, prenatal problems, issues of subcortical emotional neural circuits, problems of perseverative cognitions e.t.c (Harrell et al., 2011). Poor mental health was also linked to exposure to different forms of discrimination as patients were seen to experience high psychological distress (Ferdinand, Paradies, & Kelaher, 2015). Lastly, the study of (O’Brien, McAbee, Hebl, & Rodgers, 2016) analyzed the effects of perceived interpersonal discrimination on intellectual performance on a sample of students. The study found that perceived interpersonal discrimination caused declined in physical health which also caused a decline in academic performance.
Consequences of social determinants of health and discrimination
Resolutions for Discrimination on People with Disabilities
To comply with human rights legal requirement for dealing with discriminations as SDH, every state must have strategies for ensuring accountability and redress, and these includes monitoring whether the set strategies or policies are complied with by relevant persons in health care and social services. The efforts for ensuring accountability may include strong policies and frameworks for monitoring and evaluation of the programs. Also, the efforts include building and sharing evidence which could be the collected data from the evaluation programs. The major recommendations that can achieve quick elimination of discrimination in the disabled population are discussed below.
Education-Based Intervention
Education-based interventions for anti-stigma and anti-discrimination strategies have been seen by various studies as practical in replacing the myths held about disabilities. These also focus on empowering individuals and challenging prejudice and stigmatizing attitudes (Gronholm, Henderson, Deb, & Thornicroft, 2017). Even though these interventions are commonly applied, the providers should personalize the education depending on the kind of the disability. For instance, mental health disabilities may be provided with education materials that provide information based on mental health that is focusing on enhancing their health literacy. For example, the work of (Jorm, 2012) emphasize on mental health and recovery literacy programmes aimed at increasing knowledge, stimulate coping behaviors and improve attitudes.
Population-Level Interventions
Like education interventions, population focused intervention can be used on reducing discrimination from any type of disability. However, the intervention should focus on specific disability and should not be generalized. Population based interventions are aimed to change the behavior of a large number of people regarding attitudes and beliefs regarding a disability. There are various studies that have tested the efficacy of population-based intervention in addressing discrimination. Among them is the study of (Evans-Lacko et al., 2013). In this study, the authors used a social marketing campaign aimed at social contact to people regardless whether they had mental conditions or not for the purpose of reducing stigmatization and discrimination. The study noted an improvement in the population and people had the intention of changing the behaviors and attitude towards mental disabilities. The conclusion of this study showed that a population-based intervention can be effective in reducing discrimination and stigmatization of the disabled population.
Community-Level Interventions
These interventions are target at community setting with the aim of creating awareness and providing knowledge on discrimination of the disabled. The interventions also aim to encourage the community to protect the rights of the disabled through employments, safety, proper housing, food security and other SDH. One study undertaken by (Stuart et al., 2014) explore the effects of the Canadian commission community level project on Anti-Stigma Initiative. The initiative incorporated grassroot-community development philosophies, clearly defined target groups, and used contact-focused education as the main way of organization. On analysis, the study was able to achieve partnership among the different community groups which were the main focus on the ant-stigma project.
Family and Individual Based Interventions
The interventions focusing on family or individual are more suitable for the cases of early childhood developments, parenting, adolescent, senior adults and other vulnerable population that is affected by the health discriminations. According to (Nayar, Stangl, De Zalduondo, & Brady, 2014), a child’s can be greatly affected by stigmatization and discrimination which is connected to his or her social status and health. Where development is influenced by such SDH, the child’s growth would be diverted to feature the conditions. In analyzing this rationale, the study of (Ali, Hassiotis, Strydom, & King, 2012) found that self-stigma in an individual with intellectual disabilities within a family had significant negative effects on the person’s psychological wellbeing.
Health Sector Reforms
The landmark ruling of (Olmstead v. L.C, 1999) affirmed that the state should provide people with disabilities an opportunity to pursue a life within an integrated setting where all their needs are met. This rationale has also been cited by various jurisdiction in the world and international organizations fighting for the rights of the disabled persons. It is also a WHO and human rights provisions from the Human Rights Commission that eliminating stigma and discrimination of the disabled and of any other person should be a provision with the states regulations. The main purpose of these reforms is to provide a resolution for the stigma and discrimination mainly experienced at the public institutions. Also, the reforms aims to improve affordability and access to healthcare and social services. In Australia, there reforms are monitored by the provisions of the Disability Discrimination Act 1992 (DDA) which now makes it mandatory that no organization whether public or private can discriminate people in areas of health, employment, services, education, buying renting and accessing public places just because they are disabled (Australian Human Rights Commission, 2015).
Conclusion
The aim of this paper was to discuss the issue of SDH. As SDH is a broad concept, the paper chose to focus on one area of discrimination against the disabled persons. While looking at the disability, this paper used the term holding the meaning used by the WHO commission which includes any form of a person’s impairment whether physical or non-physical. In this dimension, the disabilities were taken to include impaired old age, mental, intellectual, long term disease conditions, etc. After taking this approach, the paper looked at the effects of these conditions by reflecting the international prevalence, and then cantering the discussion on the data available from Australia.
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