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Skip to 0 minutes and 7 seconds OLUWASEUN AKINYEMI: Now let’s start with the social determinants of health. Let’s start with the example of epidemiology characteristics of wild polio cases in Pakistan between 2006 and 2007. As of September 13, 2007, there were 53 cases. A lot of these cases– 79% of them– were from poor families. 92% of the cases’ fathers and 96% of the cases’ mothers had no formal education. Majority of them live in multiple family dwellings, and a good chunk of them– more than 60%– of the cases were from rural areas, and about a third of the cases were from urban slum. I’d like you to consider why these cases distributed this week. Do you think this is coincidence?

Skip to 1 minute and 2 seconds What, in your opinion, do you think put these people at risk societies. I mean, a lot of health is defined as the conditions in which people are born, grow, live, work, and age and shaped by the distribution of money, power, and resources at the global, national, and local level. It is mostly responsible for health inequities that feed the unfair and avoidable differences in health status seen within the national and international communities. There are a few other examples that illustrate the effect of social determinants of health.

Skip to 1 minute and 41 seconds That is the availability of resources to meet daily needs, access to educational, economic, and job opportunities; access to health care services; quality of education and job training; availability of community-based resources to support community; community living; and opportunities for recreation and leisure. So other examples include public safety, social support, social norms and attitude. That is discrimination, racism, and distrust of government; exposures to crime, violence, and social disorder; socioeconomic conditions; residential segregation; and access to media and emerging technologies. Now let’s talk about how social determinants of health effects polio. I’d like you to consider this question on your screen. What puts children at risk of contact with the polio virus? And what are the social determinants behind these factors?

Skip to 2 minutes and 44 seconds OK, you might have thought about contaminated water sources, living in a house or animal without improved sanitation. These improve the risk of fecal or transmission of the polio virus in the label. There are many other right answers. Social determinants of health behind these factors may include level of education, the labeled, the children are living, or other social factors, including the experiences they had in the past. Still talking about social determinants of polio, we also know that children that are most likely not to be reached with routine immunization are the ones that need the polio vaccine the most. Well, I’m just talking about campaigns, both even routine immunization. So this seems to be a paradox.

Skip to 3 minutes and 36 seconds those who need the vaccines are the people that are less likely to get them. So I’d like you to reflect on other social determinants behind these factors. That is the picture we just painted where those who are likely to need vaccine the most are less likely to get them. Please take a moment to reflect on the social determinants behind these factors. Just like I said earlier, the children are most at risk of contracting polio also often the most less likely to be reached with routine immunizations, and this is where the equity issues come in. And this is true for not only for polio, but for most vaccine-preventable diseases in many countries across the world.

Skip to 4 minutes and 28 seconds Now we proceed to talk to about socially disadvantaged population in health programs, and how the social disadvantage may affect their access to health. Some of the social anxiety and population that I’ve been described include the poor, those who live less than $2 a day. Women in many societies– women are still disadvantaged in terms of access to employment in terms of access to education and even to health services. Migrants or refugees– due to conflict and insecurity, we know that the world is going through currently through a refugee or migrant crisis and members of other disenfranchised racial, ethnic, and religious groups.

Skip to 5 minutes and 12 seconds And I’d like you to think about other groups that may fall into this class or social disadvantage population to reduce health inequities require action to reduce socioeconomic and others’ inequalities. There are other factors that influence what is outweighed by the overwhelming impacts of socioeconomic factors, the material sociopolitical, cultural condition that shape our lives and behaviors. That’s according to Mammoth and colleagues. I’d like you to think about other disadvantaged groups, especially your context– maybe the homeless or any other groups you might think about. I think about all these people disenfranchised from getting access to health care.

Skip to 6 minutes and 1 second This framework of social determinants of health illustrates how socioeconomic and political contexts, social position, as well as the health care system influence the distribution of health and well-being. From this framework, you may see that the socioeconomic and political context include governance, policy, cultural/societal norms whereas these be directly or indirectly affect the social position, which includes education, occupation, income, gender, ethnicity, or race. And these also will affect availability of material circumstances, social cohesion cycles, social factors, behaviors, biological factors, which as an influence on the health care system, and these also as a direct influence on distribution of health and well-being.

Social Determinants of Health

Oluwaseun Akinyemi, MD, MPH, FWACP, FRSPH, PhD
College of Medicine, University of Ibadan & University College Hospital, Nigeria

Dr. Akinyemi states, “a lot of health is defined by the conditions in which people are born, grow, live, work, and age, and is shaped by the distribution of money, power, and resources at the global, national, and local levels.”

At the 6-minute mark of the video and on slide 7 of the downloadable slide deck, the diagram illustrates how improved access to health care improves the distribution of health and well-being throughout society, which in turn impacts one’s social position, and the socioeconomic and political standing of individuals. Why is the diagram drawn this way? In what way does improved health care impact the social position, socioeconomic, and political standing?

Post at least two ideas in the discussion forum.

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