This document discusses social determinants of health and health inequalities. It will include an interactive game to illustrate social determinants and how unequal social conditions can influence health. Differences in health status and access to health resources between populations can lead to health inequalities, some of which may be considered unfair or avoidable. Addressing social factors like poverty, living and working conditions, rather than just healthcare access, can help reduce health inequities.

1. Social Determinants of Health
• We are going to discuss health inequalities
(first 30 minutes)
• We are going to play a game (The Last
Straw) on social determinants of health
• This will be an Interactive Class

2. “The world is not an inn but a hospital”

3. Health Inequality and Inequity
• Health inequality = differences in health
status or
• Differences in the distribution of health
determinants between different
population groups.

9. Differences in health status
• Gross inequality exists across the
world
• Gross inequality in health achievement
exists within New Zealand
• Is this inequality unFAIR?

10. Fairness is not the same as Equality
• The difference between Equity and
Fairness is Important in Health Care
• Inequalities in health are undesirable to
the extent that they are Unfair or Unjust
• Unjust or Unfair or Avoidable
inequaities are inequities

11. Somecauses ofill healthmay be
avoidable

12. Unnecessary, avoidable, unjust, unfair situations
resulting in health inequalities also lead to
inequity in health

13. How does one tell if a population is
thriving?
• Measure consumption patterns?
• Measure average income?
• Measure economic wellbeing with
measures such as GNP?

15. A better answer is to measure health
status.
If health of a population suffers it is an
indicator that the set of social
arrangements needs to change.

16. Social conditions powerfully
influence both the onset and
response to treatment of the major
killer infectious diseases

17. How Do We Explain?

18. Rawlsian Framework:
Socioeconomic disparities
in health status reflect
underlying inequities in
distribution of primary
goods

19. Causes of the causes
• Access to material resources is socially
determined
• Material deprivation can account for
high DALY in some countries but
• Poverty reduction is not a matter of just
providing clean water or better medical
care.

20. Spillover effects
• Inequalities Affect everyone
• Interventions to reduce social inequalities
will have other benefits, benefits other
than or more than just health
• Sanitary Reforms of 19th Century
• Conditions that lead to marked health
disparities are detrimental to Everyone
• When Inequalities in health are reduced,
everyone benefits

21. Achievement of Equity, Removal of
health inequity

22. Utilitarian
principle:
maximize health
gain for all,
increase average
health for all

23. Why health inequalities must be
reduced?
• Public health programmes that are
aimed to reduce health inequalities can
be cost effective
• Reducing social inequalities in health is
an issue of social justice.

24. Should we strive to achieve a more
even share of good health, beyond
improving the average health status
of the population?

25. What is meant by closing the
inequity
• Health/Disability in Rich <———>
disability in poor, after reduction,
health/disability in rich <—> that in poor,
this sort of an intervention is labelled as
targetting to reduce health inequality
• It is possible to reduce inequality in health
without bringing down the overall health
of the population
• Money Spent on Reducing health
inequalities lead to larger health gains
than money spent on other kinds of health
interventions

26. What happens if the social situation is such that a
person may take a wrong step out of his free will
but there are situations in the society that makes it
easy for him to take a wrong step? Who is
responsible?

27. When one is “responsible” for an unhealthy
decision that then leads to ill health, and in turn
health inequality, can that inequality be labelled as
“unfair”?

28. Strategies to reduce inequalities in health
across the world (Marmot, 2001)
• Address and Relieve poverty
• Develop health systems and
• Improve the circumstances in which
people live and work
• Structural and environmental interventions
affect the population more evenly than
educational programmes aimed at
behaviour change

29. Address social determinants of health