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Book part
Publication date: 4 September 2013

Anne M. Hewitt

Recent national policy adoptions of the social determinants of health approach present enormous challenges to practitioners designing health promotion programs aimed at…

Abstract

Purpose

Recent national policy adoptions of the social determinants of health approach present enormous challenges to practitioners designing health promotion programs aimed at eliminating health disparities. This chapter provides a framework for understanding the social determinant rationale embedded in Healthy People 2020 and introduces the concept of place as an important consideration.

Methodology/Approach

This chapter presents a conceptual explanation of social determinant thinking and describes the potential impact for traditional health promotion activities that target the at-risk populations.

Findings

Two major resources, the Health Impact Assessment Toolkit and the HHS Disparities Action Plan, have emerged as frameworks for developing a health in all policies approach that will enable health practitioners to enhance their social determinant interventions.

Research limitations/implications

Current social determinant approaches and models need to be strategically tailored to interventions aiming to reduce health disparities. Additional research focusing on how these approaches are integrated within the existing health promotion program frameworks is required.

Practical implications

Very few health practitioners have had the opportunity to integrate a social determinant approach that emphasizes the concept of place and explores the consequences of using a health in all policies approach. This chapter serves as a practical introduction and outlines the major challenges.

Originality/value of paper

The tipping point for the inclusion of social determinants of health in addressing health disparities occurred with the publication of Healthy People 2020. As this innovation begins to diffuse throughout the country, health practitioners will benefit by reviews and applications of the new rationale and model.

Details

Social Determinants, Health Disparities and Linkages to Health and Health Care
Type: Book
ISBN: 978-1-78190-588-3

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Article
Publication date: 12 March 2018

Lynn A. Stewart, Amanda Nolan, Jennie Thompson and Jenelle Power

International studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical disorders relative to the general population…

Abstract

Purpose

International studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical disorders relative to the general population. Although social determinants of health have been found to affect the mental health of a population, less information is available regarding the impact of social determinants on physical health, especially among offenders. The purpose of this paper is to examine the relationship between social determinants and the physical health status of federal Canadian offenders.

Design/methodology/approach

The study included all men admitted to federal institutions between 1 April 2012 and 30 September 2012 (n=2,273) who consented to the intake health assessment. Logistic regression analyses were used to explore whether age group, Aboriginal ancestry, and each of the individual social determinants significantly predicted a variety of health conditions.

Findings

The majority of men reported having a physical health condition and had experienced social determinants associated with adverse health outcomes, especially men of Aboriginal ancestry. Two social determinants factors in particular were consistently related to the health of offenders, a history of childhood abuse, and the use of social assistance.

Research limitations/implications

The study is limited to the use of self-report data. Additionally, the measures of social determinants of health were indicators taken from assessments that provided only rough estimates of the constructs rather than from established measures.

Originality/value

A better understanding of how these factors affect offenders can inform strategies to address correctional health issues and reduce the impact of chronic conditions through targeted correctional education and intervention programmes.

Details

International Journal of Prisoner Health, vol. 14 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Abstract

Purpose

This chapter analyses and discusses local government health promotion in Norway.

Approach/methodology

Institutional theory indicates that political and administrative jurisdictions are path dependent in their policy formation and implementation. By using data from different sources this assumption is analysed and discussed according to health promotion in Norwegian municipalities. The main methodology is cross tabulations, bivariate correlations and regression is carried out to supplement analyses.

Findings

Municipalities are path dependent in their health promotion policies. They acknowledge and prioritize health behaviour independent of experienced socio-economic challenges, municipal capacity as size and income, and local government political profile. Competence devoted to health promotion can create changes in policies.

Limitation/policy implications

The rhetoric on determinants and social determinants in particular is new in Norway. Rhetoric on, and interventions, that highlight the social determinants of health need to be coordinated.

Originality

The chapter presents new knowledge on Norwegian local government health promotion and how this is implemented in relation to the challenges experienced.

Details

Technology, Communication, Disparities and Government Options in Health and Health Care Services
Type: Book
ISBN: 978-1-78350-645-3

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Article
Publication date: 16 December 2019

Juan Smart and Alejandra Letelier

The purpose of this paper is to do a systematic assessment and testing of identified human rights norms alongside social determinant approaches in relation to identified…

Abstract

Purpose

The purpose of this paper is to do a systematic assessment and testing of identified human rights norms alongside social determinant approaches in relation to identified health issues of concern in four Latin American countries (Argentina, Chile, Paraguay and Uruguay) to show how social determinants and human rights frameworks improve population health.

Design/methodology/approach

To do so, in the first part the authors analyze the inequalities both between and within each of the selected countries in terms of health status and health determinants of the population. Then, in the second section, the authors analyze the level of recognition, institutionalisation and accountability of the right to health in each country.

Findings

From the data used in this paper it is possible to conclude that the four analysed countries have improved their results in terms of health status, health care and health behaviours. This improvement coincides with the recognition, institutionalisation and creation of accountability mechanisms of human rights principles and standards in terms of health and that a human rights approach to health and its relation with other social determinants have extended universal health coverage and health systems in the four analysed countries.

Originality/value

Despite of the importance of the relation between human rights and social determinants of health, there are few human right scholars working on the issues of social determinants of health and human rights. Most of the literature of health and human rights has been focussed specific relations between specific rights and the right to health, but less human right scholar working on social determinants of health. On the other hand, just a few epidemiologists and people working on social medicine have actually started to use a universal human rights frame and discourse. In fact, according to Vnkatapuram, Bell and Marmot: “while health and human rights advocates have from the start taken a global perspective, social medicine and social epidemiology have been slower to catch up”.

Details

International Journal of Human Rights in Healthcare, vol. 13 no. 1
Type: Research Article
ISSN: 2056-4902

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Book part
Publication date: 30 December 2004

Nancy Blythe and Cecilia Benoit

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the…

Abstract

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

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Article
Publication date: 1 June 2007

Bridget Candy, Vicky Cattell, Charlotte Clark and Stephen Stansfeld

Those most socially disadvantaged are at a greater risk of common mental disorder (CMD). The need to evaluate the health impact of social policy interventions that aim to…

Abstract

Those most socially disadvantaged are at a greater risk of common mental disorder (CMD). The need to evaluate the health impact of social policy interventions that aim to reduce social inequalities between the disadvantaged and the better off is well recognised. This paper reports findings from a review to explore evidence on the health impact of UK policy interventions that aim to tackle the key social determinants of CMD. These were previously identified from the literature as cumulative socioeconomic deprivation, unemployment, psychosocial work characteristics, and poor social relationships. We identified some evidence of a positive impact on CMD of urban regeneration schemes, but evidence was sparse on interventions relating to the other determinants. The ability of research to inform policy designed to improve the lives of the disadvantaged could be assisted by a broader definition of what counts as evidence. This may include wider use of qualitative methodologies and a more deliberate focus on social processes known to be implicated in mental health.

Details

Journal of Public Mental Health, vol. 6 no. 2
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 15 June 2021

Lilcelia A. Williams

Intersectionality theory is a social justice theory customarily employed to address inequities which arise in the academic or legal arenas as it relates to race and…

Abstract

Purpose

Intersectionality theory is a social justice theory customarily employed to address inequities which arise in the academic or legal arenas as it relates to race and gender. The application of intersectionality theory extends beyond the convergence of multiple social identities. It provides an invaluable framework to examine the convergence of social identities, the social determinants of health and a global pandemic in communities of historically marginalized and underrepresented persons. The purpose of this paper is to examine how the coronavirus pandemic has exacerbated the disparities experienced by African American and Latinx persons using the principles of intersectionality theory as the schema.

Design/methodology/approach

A literature review was performed on the scholarly articles examining the disproportionate incidence and mortality rates of African Americans and Latinx persons in America.

Findings

The current literature confirms that the disparities which existed prior to the onset of the coronavirus pandemic have been magnified by systemic oppression and racism of historically marginalized and underrepresented persons in America. The coronavirus pandemic has spotlighted the disparities in sustainable employment and access to health care for African American and Latinx persons.

Originality/value

Employing a social justice theoretical framework of intersectionality provides an opportunity to examine the lived experiences of African American and Latinx persons without race/ethnicity being the primary focal point. Future research will illustrate the urgent need for public health policy reform to eradicate the disparities experienced by African American and Latinx populations.

Details

Equality, Diversity and Inclusion: An International Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2040-7149

Keywords

Content available
Book part
Publication date: 6 May 2019

Kinga Zdunek, Mitch Blair and Denise Alexander

The Models of Child Health Appraised (MOCHA) project recognises that child health policy is determined to a great extent by national culture; thus, exploring and…

Abstract

The Models of Child Health Appraised (MOCHA) project recognises that child health policy is determined to a great extent by national culture; thus, exploring and understanding the cultural influences on national policies are essential to fully appraise the models of primary care. Cultures are created by the population who adopt national rituals, beliefs and code systems and are unique to each country. To understand the effects of culture on public policy, and the resulting primary care services, we explored the socio-cultural background of four components of policy-making: content, actors, contexts and processes. Responses from the MOCHA Country Agents about recent key national concerns and debates about child health and policy were analysed to identify the key factors as determinants of policy. These included awareness, contextual change, freedom, history, lifestyle, religion, societal activation and tolerance. To understand the influence of these factors on policy, we identified important internal and external structural determinants, which we grouped into those identified within the structure of health care policy (internal), and those which are only indirectly correlated with the policy environment (external). An important child-focused cultural determinant of policy is the national attitude to child abuse. We focused on the role of primary care in preventing and identifying abuse of children and young people, and treating its consequences, which can last a lifetime.

Details

Issues and Opportunities in Primary Health Care for Children in Europe
Type: Book
ISBN: 978-1-78973-354-9

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Article
Publication date: 25 November 2014

Asongu Simplice

Owing to lack of relevant data on health human resource (HHR) migration, the empirical dimension of the health-worker crisis debate has remained void despite abundant…

Abstract

Purpose

Owing to lack of relevant data on health human resource (HHR) migration, the empirical dimension of the health-worker crisis debate has remained void despite abundant theoretical literature. A health worker crisis is growing in the world. Shortages in health professionals are reaching staggering levels in many parts of the globe. The paper aims to discuss these issues.

Design/methodology/approach

A quantile regression approach is used to examine the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an investigation of the determinants when existing emigrations levels matter. The author assesses the determinants of emigration in the health sector through-out the conditional distribution of HHR emigration.

Findings

The findings have been presented in two main strands: when existing emigration levels are low and when existing emigration levels are high. In the former case (when existing emigration levels are low), wealth-effects have the following implications. First, while economic prosperity is a good tool against nurse brain drain in middle income countries (MICs), health expenditure is a good instrument against physician brain drain in low income countries (LICs). Second, whereas positive demographic change fuels the problem in LICs, it mitigates the issue in their MIC counterparts. Third, savings, government-effectiveness, foreign-aid and inflationary pressures only accentuate the problem for both income groups. Fourth, corruption-control becomes a vital tool for emigration-control in both income-brackets. Fifth, while trade openness mitigates physician emigration in LICs, financial openness has the opposite effect on nurse emigration. In the latter case (when existing immigration levels are high), the following conclusions have been drawn. First, While economic prosperity fights nurse emigration only in LICs, savings is a tool against physician emigration only in their MIC counterparts. Second, health expenditure and inflationary pressures are relevant tools in the battle against physician resource flight. Third, whereas, government effectiveness is an important policy measure for mitigating emigration in LICs, human development plays a similar role in MICs. Fourth, democracy, press-freedom, foreign-aid and financial openness fuel emigration in either income strata. Fifth, population growth and trade openness are important tools in the fight against brain-drain. Sixth, the HIV infection rate is a deterrent only to nurse emigration.

Originality/value

This paper complements existing literature by empirically investigating the World Health Organization hypothetical determinants of health-worker migration in the context of globalization when income-levels matter. In plainer terms, the work explores how the wealth of exporting countries play-out in the determinants of HHR emigration.

Details

International Journal of Social Economics, vol. 41 no. 12
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 13 July 2015

Asongu Simplice

How do economic prosperity, health expenditure, savings, price-stability, demographic change, democracy, corruption control, press freedom, government effectiveness, human…

Abstract

Purpose

How do economic prosperity, health expenditure, savings, price-stability, demographic change, democracy, corruption control, press freedom, government effectiveness, human development, foreign aid, physical security, trade openness and financial liberalization play-out in the fight against health-worker crisis when existing emigration levels matter? Despite the acute concern of health-worker crisis in Africa owing to emigration, lack of relevant data has made the subject matter empirically void over the last decades. The paper aims to discuss these issues.

Design/methodology/approach

A quantile regression approach is used to assess the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an assessment of the determinants when existing emigrations levels matter.

Findings

Findings provide a broad range of tools for the fight against health-worker brain-drain. As a policy implication, blanket emigration-control policies are unlikely to succeed equally across countries with different levels of emigration. Thus to be effective, immigration policies should be contingent on the prevailing levels of the crisis and tailored differently across countries with the best and worst records on fighting health-worker emigration.

Originality/value

This paper has examined the theoretical postulations of a World Health Organization report on determinants of health-worker migration.

Details

International Journal of Social Economics, vol. 42 no. 7
Type: Research Article
ISSN: 0306-8293

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