Module 4 Section 3

Question 1

The first recommendation in the Closing the Gap in a Generation report

Answer 1

improve daily living conditions

Question 2

5 areas that need to be addressed to improve daily living conditions

Answer 2

• Equity from the Start
• Healthy Places Healthy People
• Fair Employment and Decent Work
• Social Protection Across the Lifecourse
• Universal Healthcare

Question 3

quote by the Ottawa Charter, 1986

Answer 3

“Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love.”

Question 4

housing and home environment

Answer 4

• Housing is a key social determinant of health. It can be further understood by exploring its three main dimensions.
• These include the physical and structural elements, the social meanings attached to a house, and the spatial location of a house.

Question 5

physical dimension

Answer 5

• The physical condition of a house should meet all of an individual’s basic survival needs. This includes having clean water and sanitation, electricity, plumbing, heating, proper ventilation, and a safe infrastructure.
• Poor housing conditions are associated with high rates of communicable diseases, injuries, violence, poor nutrition, and mental health problems.

Question 6

social dimension

Answer 6

• The social dimension of housing involves aspects such as affordability and home ownership, which contribute to a person’s sense of belonging and control over their home.
• Moreover, the domestic environment is also central to this dimension, where a personal sense of safety and stability and lack of overcrowding lead to the health and well-being of a household.

Question 7

spatial dimension

Answer 7

• The spatial dimension of housing refers to the location of a house in relation to other things in its environment. This includes the distance to schools, healthcare services, recreation areas, and grocery stores.
• The proximity to industrial waste and other environmental contaminants is also important to consider.

Question 8

displacement and shelter challenges (syrian refugee in lebanon video)

Answer 8

• Ahmad and over 500,000 Syrian refugees have fled to Lebanon.
• Refugees face severe housing shortages:
• Many sold possessions to escape Syria but cannot afford rent.
• Families live in unfinished buildings, garages, or overcrowded rooms (sometimes 2–3 families per room).
• Others are forced into tented settlements.

Question 9

impact on health (syrian refugee in lebanon video)

Answer 9

1. Winter health risks:
   - Over 50% of patients developed respiratory infections.
   - Refugees burned plastic and scraps for heating.
   - Overcrowded, poorly ventilated housing spread contagious diseases.
   - Lack of hygiene led to skin infections.
2. Summer challenges:
   - Very limited access to water and sanitation.
   - Some shelters have just 1 toilet for 60 people.
   - High risk of communicable diseases.
   - Poor nutrition—families can often only afford rice.

Question 10

MSF (Médecins Sans Frontières) Response (syrian refugee in lebanon video)

Answer 10

• MSF expanded services in response to growing needs:
  
  • Free medical care in Bekaa Valley, Tripoli, and Sidon.
  • Mental health support for both refugees and vulnerable Lebanese.
• Health issues addressed include both physical illness and war-related trauma compounded by refugee conditions.

Question 11

Mental Health and Social Strain (syrian refugee in lebanon video)

Answer 11

• Refugees lost homes, work, and stability—arriving in very poor conditions.
• Now live in economically disadvantaged areas of Lebanon.
• Refugees face extreme frustration and pressure, making integration difficult.
• Rising risk of major depression due to inability to cope with displacement and uncertainty.

Question 12

living conditions on indigenous reserves

Answer 12

• You may recall from earlier in the course that many Indigenous Peoples living on reserve have many health outcomes that fair worse than the general Canadian population. As discussed, many of these outcomes are a result of poor living conditions. One example of these below standard living conditions are long-term drinking water advisories.
• As of December 2020, there were a total of 59 long-term drinking water advisories in 41 communities; many of which are on Indigenous reservations. One such community, the Neskantaga First Nation, has been under a long-term drinking water advisory for over 25 years

Question 13

Long-term drinking water advisories

Answer 13

• A drinking water advisory states that the water is not safe to drink as is.
• The advisory becomes long-term when it has been in place for more than a year.
• Neskantaga First Nation: An Oji-Cree First Nation band government in northern Ontario, situated along the shore of Attawapiskat Lake in the District of Kenora

Question 14

early childhood development and health

Answer 14

• Adequate living conditions are particularly important to ensure healthy early childhood development. In the first six years of life, a number of instrumental developmental changes occur that allow children to reach their full potential. In particular, the healthy development of the brain allows for progression of linguistic, cognitive, and psychosocial development.
• At least 200 million children globally are not achieving their full development potential due to poor living conditions in early life.

Question 15

equity from the start

Answer 15

• To close the gap in health inequities in the population, it is vital to understand how those early childhood development years are critical to the health of an individual, and further set the stage for health outcomes of the population. Equity from the start means that every child is given the same opportunities and access to services such as education, food and nutrition, health care, and that they grow up in safe and healthy environments.
• A comprehensive, upstream approach to the protection and promotion of the well-being of children prevents larger inequalities in population health.

Question 16

the jamaican study

Answer 16

The Jamaican Study was a longitudinal study that looked into the relationship between ensuring the healthy development of children, both physical and psychosocial, and a child’s later development in life.

Question 17

the jamaican study - context

Answer 17

• Early childhood (first 8 years) is critical for psychosocial and neurological development.
• Interventions during this period have a long-term impact on health and life outcomes.

Question 18

the jamaican study design

Answer 18

• Conducted over 24 months with children who were stunted (not growing or developing as expected).
• Four groups were compared:

1. Control group – no intervention (open circle line on chart).
2. Nutrition group – given high-nutrition supplementation.
3. Psychosocial stimulation group – received developmental stimulation.
4. Combined group – received both nutrition and psychosocial stimulation.

Question 19

jamaican study - key findings

Answer 19

• Children in the combined group (nutrition + stimulation) showed the highest mean development scores.
• Both nutrition and stimulation individually improved outcomes compared to the control, but together they had the strongest effect.

Question 20

jamaican study - implications

Answer 20

• Confirms that early childhood development is a powerful determinant of future health and well-being.
• Interventions during this critical period can reduce global health disparities by improving development in disadvantaged children

Question 21

employment and working conditions

Answer 21

The employment and working conditions of individuals can have profound effects on health and health equity. When individuals work in healthy conditions, they gain financial security, social status, personal development, social relations, self-esteem, and protection from physical and psychosocial illness.

Working Condition
- Adverse working conditions tend to be clustered in lower-status occupations. They are associated with poor physical and psychosocial health and stress, which has been shown to increase risk of coronary heart disease (C H D) by 50%.
- Some examples of adverse working conditions include a physically or psychologically demanding job, low job autonomy, inflexible working hours, and an effort-reward imbalance.

Job Security
- Definition: The probability that an individual will keep their job
- In addition to working conditions, job security is a S D H. Unemployment can have a profound negative effect on physical and mental health through financial insecurity, material deprivation, a lack of opportunities for personal development, and increased stress.

Question 22

CASE: MIGRANT WORK AND EARLY CHILDHOOD HEALTH & DEVELOPMENT

Answer 22

• Early childhood health and development is crucial in preventing future illnesses and diseases. Read about a case that describes issues related to both the work environment and childhood health and safety.
• As you read, think about some of the major health and development problems associated with children being on unsupervised construction sites
• The construction industry is the second largest employer in India, employing almost 30 million workers. Migrant construction workers in India cannot afford to pay for childcare for their children. As a result, 3 million children can be found unsupervised on construction sites across India.

Question 23

NEIGHBOURHOOD AND NATURAL ENVIRONMENT

Answer 23

• In the Closing the Gap in a Generation report, the second goal for “Improving Living Conditions” was “Healthy Places Healthy People”. In addition to the home environment, discussed before, this also involves improving the larger built-in environment where people live, which has a large impact on physical and mental health.
• Related to this is the W H O’s Healthy Cities program, which is a long-term international development initiative that aims to create an environment that supports health and a good quality of life

Question 24

VIDEO: THE HEALTHY CITIES, HEALTHY COMMUNITIES MOVEMENT

Answer 24

• With a growth of urbanization, people living in cities usually have better access to opportunities and healthcare.
• However, city life leads to sedentary lifestyles, pollution, and crowded living conditions, which can negatively impact population health

Question 25

Cities and Health

Answer 25

- Over half of the world’s population lives in cities, and this number is growing. - Cities can support better health through access to health services, education, and jobs. - However, they also expose people to risks: - Crowded housing - Sedentary lifestyles - Processed food consumption - Pollution and traffic accidents

Question 26

Health Risks in Cities

Answer 26

- 8 out of 10 cities globally fail to meet WHO air quality guidelines. - Around 3 million people die each year from air pollution-related diseases such as: - Heart attacks - Stroke - Lung cancer - Respiratory diseases

Question 27

Healthy Cities Concept

Answer 27

- Healthy cities = healthy people. - Sick populations undermine prosperity, while healthy communities help cities thrive. - Local leaders (like mayors) have power to implement changes that affect millions.

Question 28

Solutions for Healthier Cities

Answer 28

Solutions are often simple, affordable, but need political will: - Bike paths, car-free zones, green parks - Reliable public transport - Responsible waste management Examples: - Copenhagen, Denmark – extensive bike and transit networks; ~1/3 of travel by walking/biking. - Curitiba, Brazil – model for sustainable transport, green spaces, and waste management.

Question 29

Reducing Inequalities

Answer 29

- Both rich and poor concentrate in cities. - Progress requires closing gaps between communities. - Everyone must have access to: - Affordable healthcare - Safe and attractive public spaces - Healthy food - Reliable public transport

Question 30

Healthy Cities and Urban Health - conclusion

Answer 30

- The WHO Healthy Cities Network supports knowledge-sharing and political commitment. - Building cities of the future means nurturing health for all

Question 31

crowding

Answer 31

- With an increase in urbanization comes an increase in population density. If the volume of stores and access to services does not keep up with this increased population demand, then the increased population must compete for the limited daily resources. Such resources include grocery stores, healthcare services, community centres, etc. In order to keep up with demand, urban centres get more investment, while rural communities, including many Indigenous communities, end up suffering from underinvestment and lack of access to essential services. - Urbanization also leads to city level crowding, because a greater population must live in the same geographical area. With limited space, the cost of housing increases, which can then lead to crowding at the family level. For example, due to cost, sometimes multiple generations are forced to live in small living quarters and unsuitable conditions.

Question 32

Violence & Injuries

Answer 32

- With increased urbanization and crowding, there tends to be an increase in disparities in the standards of living amongst citizens, which may lead to conflicts over resources. - As well, urban cities tend to have areas with higher crime rates, which create insecurity for much of the population. - Often women, migrants, and refugees bear the brunt of this lack of security, with significant impacts on their livelihoods, health, and access to basic services. - Higher levels of violence and this lack of security have both economic and social impacts on the entire population.

Question 33

disease

Answer 33

- In urban centres that experience crowding and urbanization, there is an increased risk of the spread of communicable diseases due to a large population living in a close proximity. Research has shown that urbanization accounts for significant changes in dietary patterns and physical activity levels, which increase the risk of obesity in children, and increase both injuries and non-communicable diseases in the urban-poor. - Additionally, there is increasing evidence that the design of a city strongly impacts the walkability and access to services. For instance, if there are sidewalks and safe neighbourhoods, individuals are more likely to take active forms of transportation. Conversely, if there are more fast food restaurants than grocery stores, it is easier for individuals to pick up less healthy fast food

Question 34

Pollution & Climate Change

Answer 34

- Although climate change affects the entire world, the impact is disproportional, with those living in low SDI countries which have poor health infrastructure, people living on small islands, and those living in mega cities, mountain ranges, or the polar regions being more vulnerable to climate change.. In 2008, decreased air quality as a result of pollution contributed to 1.4% of all deaths. Urbanization has also led to increases in greenhouse gas emissions, which is the main cause of climate change. Climate change is also a major health issue as it impacts air and water quality, sanitation, sufficient food production, and secure shelter, all of which are needed for a healthy quality of life. - Although climate change affects the entire world, the impact is disproportional, with low S D I countries which have poor health infrastructure, people living on small islands, those living in mega cities, mountainous regions, and the polar regions being more vulnerable to climate change. The W H O reported that climate change is expected to cause approximately 250 000 additional deaths per year between 2030 and 2050, with the main causes of death being heat exposure in elderly individuals, childhood malnutrition, diarrhoea, and malaria

Question 35

Gentrification

Answer 35

- Gentrification is the process through which low-value neighborhoods experience an influx of affluent residents and business, transforming the neighborhoods to high-value areas. - Gentrification tends to occur once the other impacts of urbanization have happened. - Although gentrification may sound like good way to ‘clean up’ a city, there are some major consequences. - Gentrification drives up rent an property values, leading to the forced displacement of low-income individuals, and changes in the racial and ethnic composition of a neighborhood. - If individuals are not displaced, then often they can no longer afford the daily basics, such as healthy food. - These social and economic changes are associated with a loss of community identity and social bonds.

Question 36

Urbanization definition

Answer 36

The gradual increase in the proportion of people living in urban areas.

Question 37

Underinvestment definition

Answer 37

Many Indigenous communities in Canada face barriers to investment. These barriers include a legal and regulatory environment that is unfavourable for economic development, barriers to control over lands and resources, underinvestment in housing and infrastructure, low rates of financial literacy, higher costs of doing business, a lack of support for business growth, and a complex government funding regime

Question 38

Urban-poor definition

Answer 38

People who live in urban areas who do small jobs like farming, potting, and dyeing. These people do not earn a proper income, have extremely limited access to essential services such as water, sanitation, electricity, and healthcare.

Question 39

GOVERNMENTS AND SOCIAL POLICIES

Answer 39

The Closing the Gap in a Generation report identified two areas of improvement that lie within the policy level of global and population health. These two areas are: 1. Social Protection Across the Lifecourse 2. Universal Healthcare These two areas focus on the broader, structural forces that play a significant role in determining the health of the population.

Question 40

SOCIAL PROTECTION ACROSS THE LIFECOURSE

Answer 40

- Only 29% of the world’s population have a form of social security to protect them against emergencies such as illness, disability, or loss of income and work. - The W H O has identified that a universal comprehensive social protection policy is needed, because greater social security has been associated with better population health. Implementing a universal social protection policy is critical for improving health in poor countries as most of the population works in the informal sector or domestically

Question 41

What is UHC?

Answer 41

- Universal Health Coverage ensures everyone receives the health services they need without financial hardship. - It balances quality, access, and cost containment. - Misconceptions: some believe it’s too costly or reduces services, but evidence shows it improves outcomes at lower overall costs when managed well.

Question 42

UHC Challenges

Answer 42

Global trends increasing costs: - Aging populations. - Rise of non-communicable diseases (diabetes, heart disease, cancers). - Expensive new treatments. Need to manage expectations—UHC guarantees basic care for all, not unlimited coverage.

Question 43

UHC global momentum

Answer 43

- 2012: UN General Assembly adopted a resolution supporting UHC as part of sustainable development. - Few countries have fully achieved UHC, but many are making progress.

Question 44

UHC country examples

Answer 44

1. China - Expanded health insurance dramatically. - Rural coverage rose from 10% → 97% in just a few years. 2. Oman - Challenge: small but widely dispersed population. - Established 200+ primary health care centers so all villages are within 30 minutes of care. - Focuses on prevention and early diagnosis to cut costs. 3. Mexico - Introduced People’s Insurance: a comprehensive health package. - Covers primary care, vaccinations, childbirth, and now long-term treatments (e.g., diabetes, cancer). - Reduced treatment dropouts due to high costs. 4. Turkey - Coverage expanded to 98% of the population. - Improved maternal and child health programs. - Maternal mortality nearly halved, 97% of children vaccinated. 5. Thailand - Began UHC 10 years ago. - Expanded services to cover expensive treatments (e.g., dialysis). - Example: home-based dialysis devices reduce clinic visits and costs. 6. Rwanda - 55% of health budget managed locally with strict accountability. - Government covers insurance for the poorest 25%. - Coverage rose from 7% → 97% in a decade. - Life expectancy up by 10 years; child mortality cut in half; malaria deaths down by two-thirds.

Question 45

UHC takeaways

Answer 45

- No one-size-fits-all model—strategies depend on each country’s history, resources, and needs. - Primary health care is the foundation: prevention and early diagnosis reduce costs and save lives. - UHC is essential for longer, healthier lives and for making health systems sustainable.

Question 46

RACIAL INEQUALITY IN HEALTHCARE

Answer 46

Canada prides itself as a diverse and immigration-friendly country. In 2016, 22.3% of Canadian citizens self-identified as a visible minority. Unfortunately, visible minorities in Canada experience healthcare inequities, which can be attributed to a lack of minority healthcare workers, meaning the current Canadian healthcare system lacks the ability to deliver culturally sensitive care. The language, cultural, and spiritual differences between physicians and patients is a huge barrier to healthcare for many racialized minorities in Canada, including immigrants and Indigenous Peoples.

Question 47

Some Canadian Racial Health Disparities Statistics

Answer 47

- Between 2010 and 2013, 14.2% of Black Canadians over the age of 18 reported their health to be fair or poor, compared to 11.3% of White Canadians. - For First Nations individuals, the infant mortality rate is twice as high as that for the rest of the Canadian population. - Immigrant men are at an increased risk of work related injuries that require medical attention in their first 5 years in Canada

Question 48

ABC project overview

Answer 48

- The ABC Project was an early childhood intervention conducted 30 years ago in North Carolina, targeting disadvantaged children. - The intervention provided enriched preschool and access to healthcare. - Evaluated using randomized trials with a treatment group and a control group, ensuring high-quality research standards. - Participants have been followed for at least 35 years, with medical exams conducted on both groups in their mid-30s.

Question 49

ABC project key findings

Answer 49

1. Metabolic Syndrome - 1 in 4 males in the control group developed metabolic syndrome (a condition involving obesity and hypertension). - Metabolic syndrome is linked to heart disease, stroke, and diabetes. - 0% of men in the treatment group experienced metabolic syndrome. 2. Health Indicators (Blood Pressure) - Systolic and diastolic blood pressure were substantially lower in the treatment group compared to the control group. - There were also significant differences in pre-hypertension levels for females.

Question 50

ABC project implications

Answer 50

- The study emphasizes the importance of early health and education interventions in shaping later health outcomes. - Early childhood interventions not only improve health but also reduce the burden on the healthcare system. - These interventions have the potential to boost the economy by promoting healthier, more productive individuals in the long term.