social epidemiology
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Social epidemiology . Definition. B ranch of epidemiology that studies the social distribution and social determinants of health ( Berkman and Kawachi 2000). A ll epidemiology is social epidemiology (Kaufman and Cooper 1999) with the analysis of the social determinants of Health . - PowerPoint PPT PresentationTRANSCRIPT
Social epidemiology
Branch of epidemiology that studies the social distribution and
social determinants of health (Berkman and Kawachi 2000).
All epidemiology is social epidemiology (Kaufman and Cooper 1999) with the analysis of the social determinants of Health .
Builds and expands by posing new research questions, utilising
new research methods and influencing government policy agenda.
Definition
I1674 john Graunut : who was dying during outbreaks .
1763 Loius rene villerme : social class & work condition as the crucial determinants of health & diseases.
1800 physician & other argued that bad air & emanation from decaying matter cause outbreak of illness , observing that death were commonly clustered among poor .
1830 john snow who methodically covered the street of London collecting statistics documenting the location of outbreak. Snow identified that contaminated water from communal pumps is the source of cholera
History:
1844 Freidrich Engels : the horrible working condition &
identified the relationship between these condition & disease.
1860 Germ theory identifies single causal agent such as Salmonella Typhi as the cause of disease.
By the 1950 -60 : clinician & epidemiologist monitoring these condition to understand the chronic disease caused by combination of biological social behaviour patterns.
History cond….
1960- the health impact of social condition & social class as the key
determinants of morbidity & mortality .
By the end of 20th century the concept of social causation of disease gained traction
DIFFERENCE BETWEEN MODERN &
SOCIAL EPIDEMIOLOGY
MODERN EPIDEMIOLOGY Biological paradigm
All diseases are biological phenomena can be described in fully biological paradigm.
Disease is reflection of individual risk factor
SOCIAL EPIDEMIOLOGY Bio psychosocial paradigm
Biology of organism is determined in multilevel interactive environment
Disease are assumed to be product of mutual interaction among social factor,individual factor & biological factor
is to conceptualize, operationalize and test the associations between aspects of the social environment (families, workplaces, residential neighbourhoods, the political economy) and population health
The range of problems studied by social epidemiologist : whether neighbourhood contexts , or workplace organization, or income inequality and social cohesion affect the health
Goals of Social epidemiology
What are the social determinants of health?
"The poor health of the poor, the social gradient in health within countries, and the health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples lives –their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, –and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a natural phenomenon….Together, the structural determinants and conditions of daily life constitute the social determinants of health."
(WHO Commission on Social Determinants of Health, 2008)
What are the social determinants of health?
Pathway underlying Social determinant Marmot & Wilkinson
Why emphasize social determinants?
Have a direct impact on health.
Predict the greatest proportion of health status inequity.
Social determinants of health structure health behaviours.
Interact with each other to produce health.
Under 5 mortality (per 1000 live births) by wealth group
Mortality over 25 years according to level in the occupational
hierarchy: Whitehall (Marmot & shipley , BMJ 1996)
40-64 65-69 70-890
10
20
30
40
50
60
70
80
Admin Prof/Exec clercial others
Infant mortality in Brazil by race and mother's education, 1990
In social epidemiology the three main theoretical framework for
explaining disease distribution are
(1) Psychosocial
(2) Social production of disesase /political economy of health
(3) Ecosocial & other emerging multi level frameworks
Theories of Social Epidemiology in the 21st century Ecosocial prospective
The commissioner overreaching recommendation:
1. 1. Improve daily living condition 2. 2. Tackle the inequitable distribution of power money &
resources
3. Measure & understand , assesses the impact of action
Commission on social determinant of health: closing the gap in generation
What must be done
Commit & implement a comprehensive approach to early life building on existing child survival programms & extending intervention in early life to include social emotional & language /cognitive development
Expand the provision & scope of education to include the principal of early child development (physical social emotional & language).
Improve daily living condition 1.1 Equity from start
What must be done Place health & health equity at the heart of urban governance &
planning
Promote health equity between rural & urban areas through sustained investment in rural development
Ensure that economic & social policy responses to climate change & other environmental degradation take into account health equity.
1.2 Healthy places healthy people
What must be done Make full & fair employment & decent work a central goal of national
& international social & economic policy.
Achieving health equity requires safe ,secure & fairly paid work year round work opportunities & healthy work balance for all
Improve the working condition for all worker to reduce their exposure to material hazard , work related stress & health damaging behaviour
1.3 Fair employment decent work
What must be done Establish & strengthen universal comprehensive social protection
policies that supports a level of Income sufficient for healthy living.
Ensure social protection to those normally excluded .
1.4 Social protection across life course
What must be done Build health care system based on principles of equity , disease
prevention & health promotion
Ensure that health care system financing is equitable .
Build & strengthen the health workforce & expand capabilities to act on the social determinant of health
1.5 Universal health care
2.1 Health equity in all policy system programmes
what must be done
Place responsibility for action on health & health equity at the highest level of goverance & ensure its coherent consideration across all policies.
Adopt a social determinant framework across the policy & programmatic function of the ministry of health & strengthen in supporting a social determinants approach across government.
2. Tackle the inequitable distribution of power money & resources the structural drivers of the conditions of daily life
globally, nationally, and locally
What must be done Strengthen public finance for action on the social determinants of
health.
Increase international finance for heath equity & coordinate increased finance through social determinants of health action framework.
Fairly allocate government resources for action on the social determinant of health
2.2 Fair financing
Address gender biases in the structures of society –in laws & their
inforcement in the way organisation are run & intervention designed.
Develop finance policies & programme that closes gaps in education & skills & that support female economic participation.
Increase investment in sexual & reproductive health services & programme building to universal coverage & right.
2.3 Gender equity What must be done
Empower all group of society through fair representation in decision
making & how society operates particularly in relation to its effect on health equity .
Enable civil society to organise & act in a manner that promotes & realize the political & social right affecting health equity
2.4 Political empowerment- inclusion of voiceWhat must be done
Make health equity global development goal & adopt a social
determinant of health framework to strengthen multilateral action for development .
Strengthen WHO leadership in global action on the social determinant of health institutionalizing social determinants of health as a guideline principle across WHO department
2.5 Good global governanceWhat must be done
3.1 The Social Determinants of Health: Monitoring, Research, and Training Ensure that routine monitoring systems for health equity and the social
determinants of health are in place, locally, nationally, and internationally. Invest in generating and sharing new evidence on the ways in which social
determinants influence population health and health equity and on the effectiveness of measures to reduce health inequities through action on social determinants.
Provide training on the social determinants of health to policy actors,
stakeholders, and practitioners and invest in raising public awareness
3. Measure and Understand the Problem and Assess the Impact of Action
Examples of action
Sweden
–National health policy with a focus on decreasing health inequity based on population interventions defined with a social determinants approach .
Cuba
–Intersectoral approach to child health between health and education sectors resulting in strong interaction between health staff in polyclinics and other sectors, along with emphasis on early child development with almost all children (99.8%) attending early child services.
Cuba has very low child mortality across all groups and high educational attainment despite significant economic difficulties
Examples action
New Zealand
–Whole-of-government national policy to reduce inequities led by health sector with primary health care reform, now showing reduction in major health inequity (between health status of indigenous and non-indigenous New Zealanders)
Thailand –Implementation of universal health care coverage without fee-for-service,
using a capitation based system with a primary health care approachBrazil
–Implementation of Family Health Programme to improve coverage of health care using a health team approach, building in intersectoral action, which is already showing impressive improvements in infant mortality
Indira Aawas yojna MNREGA Public distribution system Rajiv gandhi swasthya guarantee yojna ICDS VHNSC Vridha Pension Yojna
Government of India
Social Determinants of Health and Primary Health Care
Advance holistic view of health, with primary value of health equity The Declaration of Alma implicitly referred to the social determinants Primary health care starts with the health sector and reaches out to
other sectors Social determinants discourse sees health sector as one of the social
determinants –Report of the Commission and the upcoming World Health Report
thus complement each other, and the Commission's findings will inform WHO's revitalisation of primary health care
Progress can be achieved in short time periods
The social determinants of health: Health behaviours Material, economic and political determinants of health: Life course Social biology Ecological prospective General susceptibility of disease Social support Social disorganisation Work stress Depression & affective disorder
How society affect health: area of research
Chanola Tarani, Marmot Micheal :social epidemiology , Dept of
Epidemiology & public health , University college London Kriger Nancy International journal of epidemiology 2001:30: 668-667 Commission on social determinant of health 2008: final Report World
Health Organisation Candace Miller , Chapter 2 , social epidemiology Jones & Bartlett
Publisher Equity, Social Determinant & Public Health Programme: World Health
Organisation 2010 Eric Blas , Social Determinants Approach to Public Health , from concept
to practice
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