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Microsoft PowerPoint - Lisa Wood Social determinants of health

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Microsoft PowerPoint - Lisa Wood Social determinants of health

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									     Social determinants of
  what does it mean in practice for
  Healthway funded research and

Lisa Wood, School of Population Health, UWA
What is meant by ‘social determinants
            of health’?
Poorer people live shorter lives and are more
often ill than the rich. This disparity has drawn
attention to the remarkable sensitivity of health
to the social environment.
[Social Determinants of Health, The Solid Facts, WHO 2003]

Increasing recognition internationally and in
Australia of the significant impact that social,
economic, lifestyle and some environmental
factors have on health, and on the vast
differences in health between the most and least
advantaged groups in the community
    Defining ‘social determinants
              of health’

Social and economic (and sometimes
 environmental) conditions that affect
 people’s health
But what are they? - The top ten*
1.   The social gradient
-    What you do
-    How much you earn     Accumulated evidence
     Who you are
     Where you live
                           linking these to:
2.  Stress                 Physical diseases
3. Early life              mental health
4. Social exclusion        Mortality
5. Working conditions
6. Unemployment
7. Social support
8. Addiction
9. Healthy food
10. Transport policy
‘Properties’ of social determinants
 Can exist at multiple levels:
  individual eg my family is socially isolated
  local community eg our neighbourhood is poor
  societal eg unemployment is at an all time high

 Be cumulative:
 often ‘this goes with that’ for those most disadvantaged
 eg healthy foods ↓ and addictions ↑ amongst unemployed

 Be causal (direct & indirect) or protective
 eg low social support is predictive of mental health problems, while
 good social support networks are protective

 And possibly work both ways:
 Health   social or socio-economic circumstances     health
 eg an overweight child excluded socially by peers
    But are social determinants the
    business of Health Promotion?
 “t’was a dangerous cliff, as they
 freely confessed, though to walk
 near its crest was so pleasant.
 But over its terrible edge there
 had slipped, a Duke and full
 many a peasant.
 The people said something
 would have to be done, but
 their projects did not at all tally.
 Some said ‘put a fence around
 the edge of the cliff’, some ‘an
 ambulance down in the                   Said just one to his plea,
                                         ‘it’s a marvel to me that
 valley’………                              you’d give so much greater
                                         attention, to repairing
From the Parable of the Dangerous Cliff, results than to curing the
         Joseph Malins (1895)            cause, you had much better
                                         aim at prevention……
Why Healthway’s interest in social
    determinants of health?
Recommended by Priorities Review (2003)
Endorsed by stakeholder consultations
underpinning current Strategic Plan
Critical to improving health for some of
Healthway’s priority target groups
Aligns with an ↑ partnerships focus
Cannot be ignored if genuinely seeking to
improve and promote health
     Recognising the ‘need’ but not
           knowing how….
“ although there is often evidence on the scientific
   justification for action and for some specific
   interventions ,there is generally little evidence
   about the cost-effectiveness of public health and
   preventative policies or their practical
   implementation… there is so little evidence
   about what works among disadvantaged
   groups to tackle some of the key
   determinants of health inequalities”

Wanlass, D. Securing Good Health for the Whole Population.
  Report to UK government 2004
For Healthway, what does an increased
emphasis on social determinants mean…

1.   in terms of potential funding of
     research/health projects that focus
     on social determinants?
2.   for research/projects in other
     priority areas?
3.   for how we go about Healthway
     funded research/programs?
1. Implications for research/health projects
    that focus on social determinants….
   In this context, a social determinants
     focus could be:
     Behaviour oriented
     Environments oriented
     Psycho-socially oriented
     Priority target group oriented
     mechanisms oriented
     Evaluation oriented
1.1 behaviour oriented

 skills that counter
 influences of social

  For example:
  Parenting skills
  life-skills for children
  Mental health promotion
 1.2 Environments oriented

  Access to healthy lifestyle
  options (increase access
  and/or reduce barriers)

For example:
  Access to healthy food
  Availability & affordability of
  recreational opportunities
  Urban environments that facilitate
1.3 psycho-socially oriented
  addressing factors
  that are predictive
  or protective of
  poor social
  determinant related
  health outcomes

For example:
   social isolation
   locus of control
1.4 priority/target group oriented
  developing or tailoring
  programs for more at
  risk population groups
  eg Indigenous people,
  lower SES

For example:
  smoking in pregnancy
  among Indigenous women
  physical activity participation
  for disadvantaged kids
  recreational opportunities for
  youth in remote/rural towns
1.5 mechanism oriented
  understanding the underlying
  mechanisms by which social
  determinants influence health
  behaviours, identifying those
  that can be influenced and how
  public health can intervene
  along pathways of influence

For example:
  how do social determinant factors
  contribute to smoking or poor diet
  and which ones are amenable to change?
1.6 evaluation oriented
  impact on health and
  wellbeing of broader
  community social policy &
  programs directed at social

For example:
opportunity for natural experiments of
  health impacts of;
  work for dole programs
  neighbourhood renewal projects
  parenting programs implemented in
  lower SES areas
2. Implications for research/projects in
     other Healthway priority areas
Priority    Taking into account social determinants
tobacco     Do disadvantaged groups respond in the same way
            to cessation messages?
            is social support a greater barrier to quitting for
Physical    What are the impediments to being active in a
activity    remote town or if you are poor?
            How and with whom can these be overcome?
Nutrition   Is healthy food equally available to all?
            What incentives or strategies might encourage lower
            SES families to alter their diet?
Mental      Which social determinants affect stressors/coping?
health      Who will benefit most from parenting interventions?
3. Implications for how we go about
Healthway funded research/programs
Emphasis on partnering sectors outside of health

Role may sometimes be as a partner/contributor as
opposed to primary funder

thinking outside the square: not just about adapting
what has worked for mainstream issues/populations
to those less fortunate

Taking social determinants into account in reducing
barriers/increasing facilitators for behaviour change

Assessing the impact – are messages, strategies,
opportunities getting to priority groups and effective
Some summary do’s and don’ts
Don’t need:
 To keep proving that inequalities exist
 To go off on well meaning tangents

Do need:
    Knowledge of what works
 Engagement with non-health sectors
 Policy oriented research
 Intervention oriented research
 ‘genuine’ outcome evaluation – benefits and
 unintended ‘negatives’
And in the end…..
 Whether Healthway health promotion
 research, projects or sponsorships, social
 determinants of health is really about:

 Acknowledging differences in health and life
 looking at health and its influences
  doing some of the things we do differently
 for different people, with different partners,
 different strategies, different expectations
 and different measures of ‘success’
And ultimately it’s about…..

   trying to make a difference

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