Social determinants of health are non-medical aspects impacting health outcomes (Devoe et al. 2016). These are conditions in which individuals are born, work, grow, live in, and observe a wide set of systems and forces shaping factors in one’s daily life. The designed forces can include developmental agendas, policies, and social norms. The social components of health equity are multifaceted and complex, involving a wide range of stakeholders in the healthcare sector. Healthy life expectancies have enhanced, but persistently wide gaps remain between those with the worst and best health and wellbeing. The essay will demonstrate the social determinants of health regarding Andrew’s case. The potential hindrances to health equity would be observed. It would also discuss strategies of healthcare promotion for inculcation and execution of better practices.
“Social determinants of health” are conditions or environments in which an individual is born and brought up, affecting a wide range of functioning, health, quality of risks and outcomes (Moore et al. 2015). These determinants can affect health equity positively and negatively. Social protection, education, unemployment, food insecurity, housing and neighbourhood, social inclusion, conflict, access to health services are social determinants.
It also contributes to a wide range of health inequities and disparities. Andrew has been diagnosed with Acquired Brain Injury following the unfortunate incident of a bike accident, which has left a deep impact on his lifestyle, cognitive functioning and associations. For instance, if people do not have direct access to grocery stores for its absence in neighbourhood areas, it is highly likely they would not have good nutritional intake or practices supporting the same. Andrew had the habit of growing the vegetables from his garden but would often waste them and turn it into compost. It can be portrayed how the surrounding culture, neighbourhood and access to local stores impacted his food intake. The promotion of healthier choices does not necessarily eliminate other health disparities. Andrew always contemplated positively reviving his vegetable beds but mostly resorted to shop-bought vegetables. He feels miserable to throw away products that can be of vital significance. His alcohol consumption was also increasing, as observed by his neighbour and friend Jim.
The neighbourhood of a person has a great impact on a person’s wellbeing and health (Jetten et al. 2017). Andrew’s lifestyle has changed since he got divorced and retired. He is financially stable but has a low-income level and lives in seclusion. Due to his trouble with memory retention, he has to be assisted by Jim, even when he wants to go to the grocery shop. However, the monotony in his life is visible. He cannot ride bikes anymore after the incurred brain injury.
In the societal and community context, familial relationships, interactions and bonds, and communication with community members and co-workers greatly influence people’s health and wellbeing of people (Gallagher et al. 2015). People deserve to get social support in times of need. People are prone to face challenges that are not under their control, such as unsafe neighbourhoods, trouble affording things and discrimination. Andrew mainly engages in playing instruments while in isolation. Due to his memory disorder, he often refrains from meeting people due to their discomfort communicating with him. The social exclusion has a profound effect on his mind. He rarely socialises with people as he meets Jim once a week and a few friends once a month. Andrew has impaired memory and has difficulty retaining things, making him a poor conversationalist. He must struggle when people are impatient to talk to him and can rarely emote.
Health Equity is the absence of avoidable, remediable or unfair health differences among populations (Bergen et al. 2019). Health equity ensures everyone has a chance of achieving the best health. Certain factors are not in a person’s direct control, while challenges can be imposed to improve health (Farrer et al. 2015). A person’s access to good health practices can become limited due to social or environmental hindrances. Key enablers or major barriers to health equity are independent in nature. For instance, strong fostering relationships build trust and are supported through processes aiding communication. It contributes to a clear vision and transparency. Various enablers or barriers to health equity are shared vision, relationships between partners, resources, leadership, process and structure. Successful relationships are characterised by mutual respect and trust, including all participants, unambiguous communication, transparently articulated vision, and clarity of responsibilities and roles.
Overcoming health obstacles can make individuals gain health equity. It cannot be brought about by oneself. Adaptive modifications are required in the community, governments, and healthcare organisations (Corburn, 2017). The concept suggests that people should get opportunities based on their requirements. If someone cannot afford healthcare, that can be made free for him, whereas another wealthy individual might have to pay for the same care. Hence, health equity utilises individualised care to be available to people for bringing them to an equal level.
Lower-income populations experience worse conditions of health than rich populations. Trends of health inequity are unjust, unfair and avoidable. Many health differences are caused by social norms, policies, decision-making procedures, and societal structures. As the inequities are socially determined, it prevents poor populations from rising in society and utilising their maximum potential (Golden et al. 2015). Collaboration can occur at varying levels through coordination of services in a given area, induced partnerships, building awareness of social problems, and mobilising community and community advocacy. Challenges in fostering relationships often exhibit variance in understanding amongst partners. They face issues in analysing inherent problems as a clear vision is not maintained. The influence of an inspiring and coherent vision can be practical and concrete. Collaborations should use vision statements as tools for deciding future directions. It is also imperative that budgetary rules and difficulties can isolate groups instead of bringing them together to function in unison. Resources are an important aspect of promoting health equity as that would determine the utilisation of services by financially stable or unstable (Heiman and Artiga 2015). Under powerful sectors or smaller agencies might be disadvantaged to access required resources. Structure refers to legislations, policies, institutions and mechanisms determining the work processes. It addresses the population’s health by promoting an architectural framework housing multiple sectors. Efficiently designed structures can facilitate service integration and strengthen communication between partners. Structural barriers identified for health equity include restricted access to nutritious food, convenient transportation, housing and environmental quality (Weiler et al. 2015). These tend to disrupt the provision of high-quality care within communities if they take a negative direction. Identifying barriers can strengthen community bonds and improve lives. Healthcare providers should be supported in their core mission of providing care while alleviating barriers through strategic partnerships and diversity management.
Pursuing health equity requires striving for a high standard of health for individuals while giving specific attention to the requirements of people at greatest risk of having poor health, based on different social conditions (Hosseinpoor et al. 2015). Andrew has been facing the barrier of social isolation due to his impaired mind. He rarely interacts with people and prefers staying in seclusion for fear of being indirectly disrespected by his peers. He is aversive towards cooking for himself despite living alone, which invariably causes nutritional deficits. A health promotion activity can involve the improvement of his daily living conditions. This can modify the circumstances through mediating effective interactions. He lives in a distant location, and his house should be shifted to the regional centre. The absence of neighbours might be fatal for the elderly. Andrew would require immediate assistance in times of need. He would be helpless in an emergent situation as he rarely meets his only friends or neighbours. His nutritional intake can be recorded and monitored by a healthcare practitioner. The structural drivers of promoting good health conditions can only be derived after assessing the situation, problems and impact of necessary actions. Andrew’s case should handle the inequitable distribution of resources, money, and power. The process can be mediated by the appointment of a healthcare provider, who would regularly assess his needs, resolve his queries, set daily goals and plans, and aid his nutrition or medicine intake.
Andrew’s neighbour Jim can also make him understand the implications of having unmodulated amounts of alcohol at an old age and the associated repercussions. He should support him in collaborative efforts, spend more quality time with his friend and try to reflect on his inherent troubles and anxiety. After receiving a changed locality, Andrew would be expected to try and recuperate from his past experiences and engage in community activities. He can be encouraged to participate in his hobbies and interests more often and have an effectively functioning social life, where his woes would be shared. Peers should not highlight his memory impairment to make him gain confidence in engaging more with people.
Conclusion
An understanding of various social factors gives invaluable insight to improve an individual’s health status. Reduction of health inequities is ethically and morally imperative. Overall, lifestyle and living conditions can affect psychological functioning and influence behaviours like diet quality, physical activity and alcohol abuse, as in the case of Andrew. The contributing factors of health inequity should be recognised and eliminated. Various health promotion activities have been discussed to enhance Andrew’s mental and physical health while eradicating barriers to health equity.
References
Bergen, N., Ruckert, A., Kulkarni, M.A., Abebe, L., Morankar, S. and Labonté, R., 2019. Subnational health management and the advancement of health equity: a case study of Ethiopia. Global health research and policy, 4(1), pp.1-13.
Corburn, J., 2017. Urban place and health equity: critical issues and practices. International journal of environmental research and public health, 14(2), p.117.
DeVoe, J.E., Bazemore, A.W., Cottrell, E.K., Likumahuwa-Ackman, S., Grandmont, J., Spach, N. and Gold, R., 2016. Perspectives in primary care: a conceptual framework and path for integrating social determinants of health into primary care practice. The Annals of Family Medicine, 14(2), pp.104-108.
Farrer, L., Marinetti, C., Cavaco, Y.K. and Costongs, C., 2015. Advocacy for health equity: a synthesis review. The Milbank Quarterly, 93(2), pp.392-437.
Gallagher, M., Muldoon, O.T. and Pettigrew, J., 2015. An integrative review of social and occupational factors influencing health and wellbeing. Frontiers in psychology, p.1281.
Golden, S.D., McLeroy, K.R., Green, L.W., Earp, J.A.L. and Lieberman, L.D., 2015. Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Education & Behavior, 42(1_suppl), pp.8S-14S.
Heiman, H.J. and Artiga, S., 2015. Beyond health care: the role of social determinants in promoting health and health equity (Vol. 4). November.
Hosseinpoor, A.R., Bergen, N. and Schlotheuber, A., 2015. Promoting health equity: WHO health inequality monitoring at global and national levels. Global health action, 8(1), p.29034.
Jetten, J., Haslam, S.A., Cruwys, T., Greenaway, K.H., Haslam, C. and Steffens, N.K., 2017. Advancing the social identity approach to health and wellbeing: Progressing the social cure research agenda. European journal of social psychology, 47(7), pp.789-802.
Moore, T.G., McDonald, M., Carlon, L. and O’Rourke, K., 2015. Early childhood development and the social determinants of health inequities. Health promotion international, 30(suppl_2), pp.ii102-ii115.
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