The Social Determinants of Health
The social determinants of health (SDOH) are key social factors that affect our health.
Much of the profound inequity in health outcomes, both within and
between countries,
is socially mediated and determined. This inequality arises from
peoples' social conditions and experiences - where they
live and work, social relations, institutional settings, early life
experiences, educational opportunities, privilege, wealth and status,
etc. These social factors, or social determinants of health, are
responsible for the majority of the global burden of disease and
of health inequalities within and between
countries.
Studies from the 1980's demonstrated that health improves across all
socio-economic status ranges regardless of where along the spectrum an
individual resides. In other words, the wealthier you are, the
better health you have compared to anyone lower on the socio-economic
ladder.
At the same time, there remains a correlation between social class
and infant mortality rates, and life expectancy
and inequalities in the use of medical services. In
other words, poorer health experience of lower occupational
groups applied at all stages of life.
In effect, what is observed is that individuals at the bottom of the
hierarchy have a higher risk of heart attacks - the lower you
were in the hierarchy, the higher the risk. More astonishingly,
the same applied to all the major causes of death -
cardiovascular disease, gastrointestinal disease, renal disease,
stroke, accidental violent deaths, cancers that were not related
to smoking as well as cancers that were related to smoking.
One might believe that more high pressure jobs with higher incomes and
responsibilities would cause greater stress and poorer health.
What these studies found across countries and between countries,
was quite the opposite.
"Sir Michael Marmot says that our health and longevity
is influenced to a high degree by our social standing. Status it
seems, is more important than genetics, or even smoking - and
yeah, even money. Your position in the hierarchy very much
relates to how much control you have over your life and your
opportunities for full social engagement."
As a relative issue, SDOH underscore the importance of relative
socio-economic status and capabilities within a particular social
setting.
Now the irony - capitalism is structured inequality.
Hunter-gatherers on the other hand (along with many of their
descendants we see in Aboriginal populations today in their traditional
forms), tirelessly sought to ensure egalitarianism, even when those
actions would lead to less optimal outcomes for the individual.
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