Determinants of Health Paper

March 6, 2022

Determinants of Health Paper

Determinants of Health Paper

Determinants of Health Paper

Although inequalities in income and education underlie many health  disparities, the poor are sometimes held responsible for their health  status. For instance, Dr. Ichiro Kawachi, a Harvard University professor  and social epidemiologist, reports that the ability to avoid negative  health behaviors like smoking and eating unhealthy foods depends on  access to “income, education, and the social determinants of health.” On  the basis of your knowledge of the health of the poor, answer the  following questions:

  • Should the poor be held responsible for their health disparities? Why or why not?
  • What are some common stereotypes of the poor? How do these  stereotypes contribute to the poor being held responsible for their  health status?
  • What conditions in your community promote or hinder healthy choices?
  • In addition to the above, consider the input that research on women  has lagged behind research on men. Many health treatments that address  health risks for women are based on research conducted on men. With  reference to your understanding of the healthcare system, mention the  factors that determine whether the health treatments based on research  on men will be successful with women.

A large and compelling body of evidence has accumulated, particularly during the last two decades, that reveals a powerful role for social factors—apart from medical care—in shaping health across a wide range of health indicators, settings, and populations.1–16 This evidence does not deny that medical care influences health; rather, it indicates that medical care is not the only influence on health and suggests that the effects of medical care may be more limited than commonly thought, particularly in determining who becomes sick or injured in the first place.4,6,7,17,18 The relationships between social factors and health, however, are not simple, and there are active controversies regarding the strength of the evidence supporting a causal role of some social factors. Meanwhile, researchers increasingly are calling into question the appropriateness of traditional criteria for assessing the evidence.17,19–22

The limits of medical care are illustrated by the work of the Scottish physician, Thomas McKeown, who studied death records for England and Wales from the mid-19th century through the early 1960s. He found that mortality from multiple causes had fallen

Determinants of Health Paper

Determinants of Health Paper

precipitously and steadily decades before the availability of modern medical-care modalities such as antibiotics and intensive care units. McKeown attributed the dramatic increases in life expectancy since the 19th century primarily to improved living conditions, including nutrition, sanitation, and clean water.23 While advances in medical care also may have contributed,23–26 most authors believe that nonmedical factors, including conditions within the purview of traditional public health, were probably more important;24 public health nursing, including its role in advocacy, may have played an important role in improved living standards.27 Another example of the limits of medical care is the widening of mortality disparities between social classes in the United Kingdom in the decades following the creation of the National Health Service in 1948, which made medical care universally accessible.28 Using more recent data, Martinson found that although health overall was better in the United Kingdom than in the United States, which lacks universal coverage, disparities in health by income were similar in the two countries.29 Large inequalities in health according to social class have been documented repeatedly across different European countries, again despite more universal access to medical care.30–32

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Another often-cited example of the limits of medical care is the fact that, although spending on medical care in the U.S. is far higher than in any other nation, the U.S. has consistently ranked at or near the bottom among affluent nations on key measures of health, such as life expectancy and infant mortality; furthermore, the country’s relative ranking has fallen over time.33,34 A recent report from the National Research Council and Institute of Medicine has documented that the U.S. health disadvantage in both morbidity and mortality applies across most health indicators and all age groups except those older than 75 years of age; it applies to affluent as well as poor Americans, and to non-Latino white people when examined separately.35 Other U.S. examples include the observation that, while expansions of Medicaid maternity care around 1990 resulted in increased receipt of prenatal care by African American women,36,37 racial disparities in the key birth outcomes of low birthweight and preterm delivery were not reduced.38 Although important for maternal health, traditional clinical prenatal care generally has not been shown to improve outcomes in newborns

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Posted in nursing by Clarissa