An introduction to the social determinants of health

What makes us Healthy? An An introduction to the social determinants of health | The Health Foundation

This report explores how a person’s opportunity for health is influenced by factors outside the health and social care system.

It also shows that many people don’t have the same opportunities to be as healthy as others. It contains suggestions for further reading and highlights how action can create improvements in the health of the whole population, for the lasting benefit of individuals, society and the economy.

Full document available here

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Cancer survival trends

Little evidence for any direct impact of national cancer policies on short-term survival in England and no evidence for a reduction in socioeconomic inequalities in cancer survival. Findings emphasise that socioeconomic inequalities in survival remain a major public health problem. |  London School of Hygiene & Tropical Medicine | British Medical Journal

New research from the London School of Hygiene and Tropical Medicine found that despite overall improvements in cancer survival, the gap in survival between the most affluent and most deprived groups of patients remains unchanged for most cancers.

Survival trends were examined for 21 cancers in men and 20 cancers in women.

For each cancer, the chances of survival at one year after diagnosis were estimated separately for men and women in five levels of socio-economic deprivation, from the most affluent to the most deprived, and in each of the three calendar periods.

Researchers focused on one-year survival because most of the inequalities in cancer survival in England arise shortly after diagnosis. The survival estimates were corrected for the risk of dying from other causes of death. Estimates were also adjusted for differences in the age profile of cancer patients between men and women, and over time.

The “deprivation gap” in survival between the most affluent and most deprived groups of patients remained unchanged for most cancers. There was a clear and persistent pattern of lower survival among more deprived patients. It narrowed slightly for some cancers, where one-year survival was already more than 65% in 1996, such as cervical cancer and skin melanoma in men. By contrast, the deprivation gap in survival widened between the late 1990s and 2013 for brain tumours in men and lung cancer in women.

Full story at London School of Hygiene and Tropical Medicine

Link to the research: Aimilia Exarchakou et al.  (2018). Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ.

2008 recession led to increase in obesity, diabetes and mental health issues

The 2008 recession resulted in changes to individuals’ health behaviour, with a significant increase in the likelihood of obesity, diabetes and mental health problems | Social Science & Medicine | Story via ScienceDaily.

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Researchers from City University London and King’s College London looked at data from the Health Survey for England (HSE), a cross-sectional survey taken yearly from a representative sample of about 9,000 English households. They specifically used data on respondents above 16 years of age for the period 2001-2013. In addition to socio-economic characteristics, the HSE includes information on a wide range of health lifestyles and health conditions.

The results of the study suggest that the start of the recession was associated with worse dietary habits and increased BMI and obesity. It was also associated with a shift away from risky behaviours, as a decrease in smoking and alcohol consumption was seen. In addition, there was an increase in the use of medicines and a higher likelihood of suffering diabetes and mental health problems, all of which were generally experienced more acutely by those with less education and by women.

Researchers discovered that the probability of being obese and severely obese increased by 4.1 and 2.4 percentage points respectively. Similarly, the probability of having diabetes was 1.5 percentage points higher after 2008, with the prevalence of mental health problems increasing by 4 percentage points.

Full story at ScienceDaily

Full reference: Mireia Jofre-Bonet, Victoria Serra-Sastre, Sotiris Vandoros |  The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England | Social Science & Medicine, 2018.

Deprivation strongly linked to mortality

Report from the Office for National Statistics reveals “sizeable and highly significant” absolute and relative inequalities in avoidable mortality between those living in the most and least deprived areas.

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Main points

  • Avoidable, amenable and preventable mortality is strongly related to area deprivation in England and in Wales.
  • In England in 2015 there were 16,686 deaths from avoidable causes in the most deprived areas whereas there were less than half that number (7,247 deaths) in the least deprived areas.
  • In the most deprived areas of Wales there were 1,054 deaths from avoidable causes in 2015, compared with 509 deaths in the least deprived areas.
  • Absolute and relative inequalities in avoidable mortality between those living in the most and least deprived areas were sizeable and highly significant, but the excess was larger for males than females in all cases.
  • The largest relative inequality in avoidable mortality was for deaths from respiratory diseases which were 4.8 times (males) and 7.7 times (females) more likely in the most deprived populations compared with the least deprived.
  • The largest absolute difference in avoidable mortality between the most and least deprived deciles was from cardiovascular disease and cancer.

Full report: Measuring Socioeconomic inequalities in avoidable mortality in England and Wales: 2015

Psychosocial pathways and health outcomes

Overview of current evidence about the relationships between social determinants, psychosocial factors and health outcomes. | Public Health England

This report highlights the current evidence that exists about the relationships between social determinants, psychosocial factors and health outcomes.

It also provides a conceptual framework that focuses on the psychosocial pathways between factors associated with social, economic and environmental conditions, psychological and psychobiological processes, health behaviours and mental and physical health outcomes.

Preventing depression in low-income mothers

It is well-established that women in low-income households have an increased risk of developing mental health problems, in particular depression | The Mental Elf

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Studies have found that these women are around twice as likely to develop the disorder compared with those from higher-income households (Hobfoll et al, 1995). Low-income women are also less likely to seek and receive appropriate treatment, in part because of the associated costs (Lennon et al, 2001).

For women who are mothers, this is especially consequential: parental depression has been linked with developmental, emotional and mental health problems in children (McDaniel et al., 2013). In the United States this has been highlighted as a public health concern, and it is increasingly being recognised that community-based services offer valuable opportunities to reach those for whom help is less accessible.

Head Start is a US government-funded service aimed at families at or below the federal poverty level with young children under five. They use a case-management structure to establish a healthy family environment in order to look after the child’s development and wellbeing. Depression affects almost half of the mothers at Head Start. A recent study by Silverstein et al. (2017) examines the efficacy of embedding a depression prevention strategy in the Head Start program.

How Early do Social Determinants of Health Begin to Operate?

From a life course perspective, important insights about how social determinants of health operate can be gained by analyzing the various forms that social climate can take in different life periods | Journal of Pediatric Nursing

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Highlights:

  • Perceptions of power imbalance and exclusion affect children’s self-rated health as early as elementary school.
  • Social exclusion in school is associated with lower odds of “excellent or very good” or “good” self-rated health.
  • Rejection from peers is a more important determinant of children’s self-rated health than is physical aggression.

Full reference: Zhang, A. et al. (2017) How Early do Social Determinants of Health Begin to Operate? Results From the Fragile Families and Child Wellbeing Study. Journal of Pediatric Nursing. Published online: 10th July 2017