Day 1 Session 2

Question 1

What are social determinants?

Answer 1

‘Supra-individual’ factors that influence the health of individual populations.

Question 2

What are some examples of social determinants?

Answer 2

• social (eg status)
• economic (eg income)
• cultural (eg Norms)
• political (eg war)
• global (eg 3rd world debt)

Question 3

What are the relationships between social determinants & health?
- Example: life expectancy

Answer 3

• Massive gap between high & low income countries
• Over time these increases are not proportional
• Modifiable

Question 4

What is health inequality?

Answer 4

Measurable differences in health experience and health outcomes between different population groups
- According to SES, geographical area, age, disability ect.

Question 5

What is health inequity?

Answer 5

• Differences in the opportunities of different population groups which result in unequal life chances, access to health services, nutritious food, housing ect.
• Absence of socially unjust or unfair health disparities (health inequalities)
• Doesn’t require everyone to be equal but to have the same possibilities
• social justice & fairness

Question 6

What are the best interventions to do with the gradient?

Answer 6

Interventions need to encompass the whole gradient

- seen in under 5 mortality (Marmot & Lancet, 2007)

Question 7

Is:
Younger & older Australian mortality rates
- 15-24 year old women: 26/100,000 per year
- 65-84 year old women: 2100/100,000 per year

Answer 7

• Inequality

Same gander, country & availability to the same services

Question 8

What is the relation of inequity to inequality?

Answer 8

All equities are inequalities

Question 9

What do we mean by the social gradient in health?

Answer 9

• It runs from the top to the bottom of the socioeconomic spectrum
• Seen in low, middle and high income countries
• Means that health inequities affect everyone
• Risk factors are socio-economically set standards

Question 10

What type of cancer does not follow this negative gradient?

Answer 10

Breast Cancer

Question 11

What are the three recommendations by the WHO commission on the Social Determinants of Health?

Answer 11

1 Improve daily living
2 Tackle the inequitable distribution of power, money and resources
3 Measure & understand the problem and assess the impact of action

Question 12

Why is early life important? And what ages does this include?

Answer 12

Sets the scene for the rest of life

- prenatal to 8 years of age

Question 13

What are 5 methods for improving daily living conditions?

Answer 13

1 Early Life
2 Where people live
3 Fair employment and decent work 
4 Social protection policies 
5 Universal Health care

Question 14

What are the 6 approaches to tackling the inequitable distribution of power, money and resources?

Answer 14

• Health equity (in all policies, systems and programs)
• Fair financing
• Market responsibility
• Gender equity
• Political empowerment
• Good global Governance

Question 15

Tackling the inequitable distribution of power, money and resources: explain Health equity in all policies, systems & programs.

Answer 15

1.Health equity in all policies, systems and programs
Place responsibility for action on health and health equity at the highest level of government, and ensure its coherent consideration across all policies
Adopt a social determinants framework across the policy and programmatic functions of the ministry of health and strengthen its stewardship role in supporting a social determinants approach across government.

Question 16

Tackling the inequitable distribution of power, money and resources: explain fair finance.

Answer 16

2.Fair financing
Strengthen public finance for action on the social determinants of health (e.g. progressive taxation).
Increase international finance for health equity, and coordinate increased finance through a social determinants of health action framework. (e.g. honour existing commitments for global aid)
Allocate government resources for action on the social determinants of health.

Question 17

Tackling the inequitable distribution of power, money and resources: explain marketing responsibility.

Answer 17

3. Market responsibility
   Institutionalize consideration of health and health equity impact in national and international economic agreements and policy-making (e.g. electricity pricing).
   Reinforce the primary role of the state in the provision of basic services essential to health (such as water/sanitation) and the regulation of goods and services with a major impact on health (such as tobacco, alcohol, and food).

Question 18

Tackling the inequitable distribution of power, money and resources: explain gender equity.

Answer 18

4. Gender equity
   Address gender biases in the structures of society – in laws and their enforcement, in the way organizations are run and interventions designed, and the way in which a country’s economic performance is measured. (e.g. legislation re discrimination on basis of sex)
   Develop and finance policies and programmes that close gaps in education and skills, and that support female economic participation. (e.g. family friendly policies)
   Increase investment in sexual and reproductive health services and programmes, building to universal coverage and rights

Question 19

Tackling the inequitable distribution of power, money and resources: explain political empowerment & inclusion.

Answer 19

5. Political empowerment and inclusion
   Empower all groups in society through fair representation in decision-making about how society operates
   Enable civil society to organize and act in a manner that promotes and realizes the political and social rights affecting health equity.

Question 20

Tackling the inequitable distribution of power, money and resources: good global governance.

Answer 20

6. Good global governance
   Make health equity a global development goal, and adopt a social determinants of health framework to strengthen multilateral action on development.
   Strengthen WHO leadership in global action on the social determinants of health, institutionalizing social determinants of health as a guiding principle across WHO departments and country programmes.

Question 21

What is a targeted approach?

Answer 21

Address the health gap between the poorest and most disadvantaged in society

• but health inequities may remain as they haven’t addressed the gradient (heart of the problem)

Question 22

What is a universal approach?

Answer 22

Focus on improving the health of all, reducing the social gradient

• but some initiatives may only be taken up with those with the most resources to do so and thus widen the health inequities

Question 23

What is a place based approach? & their success?

Answer 23

• approach for that specific place
• Mixed evidence of effectiveness
• Need good community group support