Social Determinants of Health

by Alex nairn July 23, 2020

The purpose of this report is to describe the role of the social determinants of health (SDH1) in Cardiovascular disease (CVD) and the health inequalities in today’s society in Australia. Key factors this report will cover include; the social and economic environment, the physical environment and individual characteristics and how they impact CVD within the Australian society.

THE SOCIAL AND ECONOMIC ENVIRONMENT:

Income/socioeconomic status (SES) and education are SDH which create inequities within our society. This may cause groups of people to be more susceptible to poor health and diseases such as CVD. The income and SES of a person are often closely associated with a person’s health, as displayed by the social gradient2. A person of a high SES would have a lower chance of developing or dying from CVD overall, due to the greater opportunities and access to health care services and goods and services to prevent it.

For example, ‘20% of Australians in the lowest socioeconomic areas in 2014-15 were 1.6 times as likely as the highest 20% to have at least two chronic health conditions, such as CVD’ (2). This demonstrates the social gradient and how much more vulnerable people of a lower SES are to developing CVD.

Similarly, to income/SES, the education of a person is also linked with their health. Low education is often associated with poorer health as well as increased levels of stress and lower self-confidence. A person’s education is also often associated with their SES, where the higher the status the higher the level of education. Education can help equip people with adequate housing, income, employment, and the ability to deal with ill health afford health care services. This is why often people of a higher education are less likely to develop or die from CVD, as they have the knowledge to help prevent it or the wealth and opportunities to manage it.

PHYSICAL ENVIRONMENT:

The physical environment, health service access and social support networks are all SDH which impact health inequities within society. The environment of which a person lives creates large inequities to the health of Australians within our society. A positive physical environment may include fresh air and water, healthy and safe housing, workplaces and communities, as well as access to health care3. A person that has easy access to necessities such as these, is more likely to be healthier than a person that doesn't. As well as this, a person with strong support networks from family, friends, and the community, is likely to be healthier, both physically and mentally than those that don’t.

Inequities to a person’s health, can be displayed by the different physical environment’s we live in. For example; Aboriginals, and Torres Strait Islanders who live in remote areas in Australia have the highest rate of hospitalisation and death, caused by CVD. This may be due to many of the social determinants of health, including limited access to health care, a poor physical environment to live in or deprived social networks.

INDIVIDUAL CHARACTERISTICS AND BEHAVIOURS

A person’s individual characteristics such as their gender and culture/ethnicity are also SDH which create inequities to the health of our society. However, these determinants are often out of our control and something we are born with.

Traditionally, men and women may suffer from different diseases at different ages. For example, men are at higher risk of CVD throughout their lives, whereas a women’s chance of developing CVD equals with men after menopause. In Australia in 2017 CVD was responsible for 13% of deaths of men and 10% of deaths of women. This shows a slightly higher rate of deaths in men than women. In saying this though, CVD has been shown to be one of the highest causes of death in women as ‘women tend to develop symptoms at a much later stage of the illness than men’(16) and their symptoms are often more vague than the symptoms in men. This therefore shows gender plays a role in the development of CVD, however, both men and women are still susceptible to developing it.

People of different ethnic backgrounds and cultures also often have health inequities and varied likelihoods to developing different diseases or illnesses. For example, Aboriginal and Torres Strait islander’s in Australia are at more risk of developing CVD, which is often due to lifestyle factors. ‘Compared with non-indigenous Australians, Aboriginals and Torres Strait islander people were 70% more likely to die from circulatory disease’(4). This shows evidently that different ethnicities have varied chances of developing different diseases, showing inequities to our health within Australia.

CONCLUSION:

Social determinants of health create inequities to our health within our society, including factors such as our SES / income, education, physical environment, access to health care services, social support networks, gender and ethnicity / culture. These factors all play different roles in our development of CVD within Australia, varying our chance of development, suffering or death by the disease.

APPENDIX:

1 The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.

(About social determinants of health. (2017, September 25). Retrieved from https://www.who.int/social_determinants/sdh_definition/en/)

2 The greater the income and SES, the greater an individual’s health. This is because, a person of greater wealth and of higher SES will most likely have greater access to goods and services including food, housing, additional health care options and other health benefits.

3The relationship between a person’s health and the quality of their housing can be described as a gradient, where the better the environment a person lives is, the better their health, the poorer the environment, the worse their health.

REFERENCES:

1. Prevention of cardiovascular disease, diabetes and chronic kidney disease: Targeting risk factors, Table of contents. (n.d.). Retrieved April 16, 2019, from https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/prevention-cardiovascular-diabetes-chronic-kidney/contents/table-of-contents

2. Mortality inequalities in Australia 2009–11, Table of contents. (n.d.). Retrieved from https://www.aihw.gov.au/reports/social-determinants/mortality-inequalities-in-australia-2009-11/contents/table-of-contents

3. About social determinants of health. (2017, September 25). Retrieved from https://www.who.int/social_determinants/sdh_definition/en/

4. The Heart Foundation. (n.d.). Cardiovascular risk profile of Aboriginal and Torres Strait Islander peoples. Retrieved from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-risk-profile-of-aboriginal-and-torres-strait-islander-peoples

5. The determinants of health. (2010, December 01). Retrieved from https://www.who.int/hia/evidence/doh/en/index1.html

6. Australia's health 2016, Chapter 4 Determinants of health. (n.d.). Retrieved April 26, 2019, from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/determinants

7. The Heart Foundation. (n.d.). Cardiovascular disease fact sheet. Retrieved April 25, 2019, from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-disease-fact-sheet

8. The Heart Foundation. (n.d.). Heart disease in Australia. Retrieved April 25, 2019, from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia

9. Social Determinants of Health. (n.d.). Retrieved April 25, 2019, from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

10. Australia's health 2016, Chapter 4 Determinants of health. (n.d.). Retrieved April 25, 2019, from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/determinants

11. Kumar, S. (2017, January 05). Cardiovascular Disease and Its Determinants: Public Health Issue. Retrieved from http://www.imedpub.com/articles/cardiovascular-disease-and-its-determinants-public-health-issue.php?aid=18223

12. Lang, T., MD, PhD, Lepage, B., MD, Schieber, A., MD, Lamy, S., & Kelly-Irving, M., PhD. (n.d.). Social Determinants of Cardiovascular Diseases(No 2 ed., Vol. Vol. 33, 601-622, Rep.). Retrieved April 25, 2019, from https://link.springer.com/content/pdf/10.1007/BF03391652.pdf

13. Kreatsoulas, C., & Anand, S. S. (2010). The impact of social determinants on cardiovascular disease. Retrieved April 25, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949987/

14. Australia's health 2016, Chapter 4 Determinants of health. (n.d.). Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/determinants

15. About social determinants of health. (2017, September 25). Retrieved from https://www.who.int/social_determinants/sdh_definition/en/

16. Women and Heart Disease. (n.d.). Retrieved April 25, 2019, from https://www.heartresearch.com.au/heart-disease/women-and-heart-disease/