E-Mail Alert

Add your e-mail address to receive forthcoming issues of this journal:

Journal Browser

Journal Browser

Special Issue "Social and Economical Determinants of Health"

Quicklinks

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 October 2012)

Special Issue Editor

Guest Editor
Dr. Arjumand Siddiqi

Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 566, Toronto, ON M5T 3M7, Canada
Interests: social determinants of health/health disparities; societal conditions, particularly policy; conceptual/methodological issues in social research

Special Issue Information

Dear Colleagues,

The contribution of our social and economic circumstances to our lived experiences and thus, to our health, has been well established.  In every society and for most health outcomes, incremental changes in socioeconomic status are associated with incremental changes in health status; a phenomenon which has come to be known as the socioeconomic gradient in health.  On the other hand, the extent and particular characteristics of the gradient seem to differ across time and place.  Together, these findings have provided powerful motivation to understand the context which leads both to the durable aspects of the effect of socioeconomic circumstances on health, and to the elements of context which may play a role in the observed variation in the gradient.  In turn, this has led to a proliferation of studies, from the role of localities (such as neighborhoods) to the national and global environments.  Our insights, however, are still limited.  Much more work is needed to understand the link between socioeconomic circumstances, context, and health.  At the same time, over the past few decades, we have begun to gain much more sophisticated understandings of how socioeconomic circumstances 'get under the skin' to influence brain and biological development.  Studies of stress response pathways, brain development, allostatic load and epigenesis have shown that socioeconomic circumstances can become 'biologically embedded' in ways that can influence health across the life course.  But the role of context and the nature of biological embedding are far from understood.  Are there current contexts - such as contemporary economic trends - which provide new insights?  Are there contexts which have remained underexplored? How are socioeconomic circumstances connected to biological mechanisms in different settings and for different aspects of health? We seek research that addresses these and other relevant questions in rigorous and novel ways and, in so doing, furthers scientific understandings.

Dr. Arjumand Siddiqi
Guest Editor

Keywords

  • social determinants of health
  • socioeconomic status
  • biological mechanisms
  • society

Published Papers (17 papers)

View options order results:
result details:
Displaying articles 1-17
Export citation of selected articles as:

Research

Jump to: Review

Open AccessArticle Global Trade, Local Impacts: Lessons from California on Health Impacts and Environmental Justice Concerns for Residents Living near Freight Rail Yards
Int. J. Environ. Res. Public Health 2014, 11(2), 1914-1941; doi:10.3390/ijerph110201914
Received: 18 September 2013 / Revised: 19 November 2013 / Accepted: 18 December 2013 / Published: 10 February 2014
Cited by 6 | PDF Full-text (1019 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Global trade has increased nearly 100-fold since 1950, according to the World Trade Organization. Today, major changes in trade are occurring with the advent of mega-ships that can transport thousands more containers than cargo ships now in use. Because global trade is [...] Read more.
Global trade has increased nearly 100-fold since 1950, according to the World Trade Organization. Today, major changes in trade are occurring with the advent of mega-ships that can transport thousands more containers than cargo ships now in use. Because global trade is expected to increase dramatically, the railroad industry—in the U.S. alone—has invested more than $5 billion a year over the past decade to expand rail yards and enhance rail routes to transport goods from ports to retail destinations. This article describes cancer risks for residents living in close proximity to rail yards with emissions of diesel particulate matter pollution from locomotives, trucks and yard equipment. The article examines the demographics (income, race/ethnicity) of populations living in the highest estimated cancer risk zones near 18 major rail yards in California, concluding that the majority are over-represented by either lower-income or minority residents (or both). The authors also describe a review of the news media and environmental impact reports to determine if rail yards are still being constructed or expanded in close proximity to homes and schools or in working class/working poor communities of color. The paper suggests policy efforts that might provide more public health protection and result in more “environmentally just” siting of rail yards. The authors conclude that diesel pollution from rail yards, which creates significant diesel cancer risks for those living near the facilities, is an often overlooked public health, health disparities and environmental justice issue in the U.S. The conclusions are relevant to other countries where international trade is increasing and large new intermodal rail facilities are being considered. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Figures

Open AccessArticle Education as a Social Determinant of Health: Issues Facing Indigenous and Visible Minority Students in Postsecondary Education in Western Canada
Int. J. Environ. Res. Public Health 2013, 10(9), 3908-3929; doi:10.3390/ijerph10093908
Received: 1 June 2013 / Revised: 11 July 2013 / Accepted: 19 August 2013 / Published: 28 August 2013
PDF Full-text (228 KB) | HTML Full-text | XML Full-text
Abstract
The level of educational attainment is increasingly being recognized as an important social determinant of health. While higher educational attainment can play a significant role in shaping employment opportunities, it can also increase the capacity for better decision making regarding one’s health, [...] Read more.
The level of educational attainment is increasingly being recognized as an important social determinant of health. While higher educational attainment can play a significant role in shaping employment opportunities, it can also increase the capacity for better decision making regarding one’s health, and provide scope for increasing social and personal resources that are vital for physical and mental health. In today’s highly globalized knowledge based society postsecondary education (PSE) is fast becoming a minimum requirement for securing employment that can afford young adults the economic, social and personal resources needed for better health. Canada ranks high among OECD countries in terms of advanced education, with 66% of Canadians having completed some form of postsecondary education. Yet youth from low income indigenous and visible minority (LIIVM) backgrounds continue to be poorly represented at PSE levels. The current study aimed to understand the reasons for this poor representation by examining the experiences of LIIVM students enrolled in a postsecondary program. Findings show that the challenges they faced during the course of their study had an adverse impact on their health and that improving representation of these students in PSE will require changes at many levels. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle The Contribution of Neighbourhood Material and Social Deprivation to Survival: A 22-Year Follow-up of More than 500,000 Canadians
Int. J. Environ. Res. Public Health 2013, 10(4), 1378-1391; doi:10.3390/ijerph10041378
Received: 25 January 2013 / Revised: 25 March 2013 / Accepted: 25 March 2013 / Published: 2 April 2013
Cited by 10 | PDF Full-text (330 KB) | HTML Full-text | XML Full-text
Abstract
Background: We examined the incremental influence on survival of neighbourhood material and social deprivation while accounting for individual level socioeconomic status in a large population-based cohort of Canadians. Methods: More than 500,000 adults were followed for 22 years between 1982 [...] Read more.
Background: We examined the incremental influence on survival of neighbourhood material and social deprivation while accounting for individual level socioeconomic status in a large population-based cohort of Canadians. Methods: More than 500,000 adults were followed for 22 years between 1982 and 2004. Tax records provided information on sex, income, marital status and postal code while a linkage was used to determine vital status. Cox models were used to estimate hazard ratios (HR) for quintiles of neighbourhood material and social deprivation. Results: There were 180,000 deaths over the follow-up period. In unadjusted analyses, those living in the most materially deprived neighbourhoods had elevated risks of mortality (HRmales 1.37, 95% CI: 1.33–1.41; HRfemales 1.20, 95% CI: 1.16–1.24) when compared with those living in the least deprived neighbourhoods. Mortality risk was also elevated for those living in socially deprived neighbourhoods (HRmales 1.15, CI: 1.12–1.18; HRfemales 1.15, CI: 1.12–1.19). Mortality risk associated with material deprivation remained elevated in models that adjusted for individual factors (HRmales 1.20, CI: 1.17–1.24; HRfemales 1.16, CI: 1.13–1.20) and this was also the case for social deprivation (HRmales 1.12, CI: 1.09–1.15; HRfemales 1.09, CI: 1.05–1.12). Immigrant neighbourhoods were protective of mortality risk for both sexes. Being poor and living in the most socially advantageous neighbourhoods translated into a survival gap of 10% over those in the most socially deprived neighbourhoods. The gap for material neighbourhood deprivation was 7%. Conclusions: Living in socially and materially deprived Canadian neighbourhoods was associated with elevated mortality risk while we noted a “healthy immigrant neighbourhood effect”. For those with low family incomes, living in socially and materially deprived areas negatively affected survival beyond their individual circumstances. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Welfare State Regimes, Gender, and Depression: A Multilevel Analysis of Middle and High Income Countries
Int. J. Environ. Res. Public Health 2013, 10(4), 1324-1341; doi:10.3390/ijerph10041324
Received: 17 February 2013 / Revised: 15 March 2013 / Accepted: 18 March 2013 / Published: 28 March 2013
Cited by 4 | PDF Full-text (407 KB) | HTML Full-text | XML Full-text
Abstract
Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model [...] Read more.
Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model found that the odds of experiencing a brief depressive episode in the last 12 months was significantly higher for Southern/Ex- dictatorship countries than for Southeast Asian (odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.05–0.27) and Eastern European (OR = 0.36, 95% CI 0.22–0.58) regimes after controlling for gender, age, education, marital status, and economic development. In adjusted interaction models, compared to Southern/Ex-dictatorship males (reference category), the odds ratios of depression were significantly lower among Southeast Asian males (OR = 0.16, 95% CI 0.08–0.34) and females (OR = 0.23, 95% CI 0.10–0.53) and Eastern European males (OR = 0.41, 95% CI 0.26–0.63) and significantly higher among females in Liberal (OR = 2.00, 95% CI 1.14–3.49) and Southern (OR = 2.42, 95% CI 1.86–3.15) regimes. Our results highlight the importance of incorporating middle-income countries into comparative welfare regime research and testing for interactions between welfare regimes and gender on mental health. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Early Childhood Caries and Body Mass Index in Young Children from Low Income Families
Int. J. Environ. Res. Public Health 2013, 10(3), 867-878; doi:10.3390/ijerph10030867
Received: 1 September 2012 / Revised: 25 February 2013 / Accepted: 25 February 2013 / Published: 5 March 2013
Cited by 7 | PDF Full-text (266 KB) | HTML Full-text | XML Full-text
Abstract
The relationship between early childhood caries (ECC) and obesity is controversial. This cross-sectional survey investigated this association in children from low-income families in Goiania, Goias, Brazil and considered the role of several social determinants. A questionnaire examining the characteristics of the children [...] Read more.
The relationship between early childhood caries (ECC) and obesity is controversial. This cross-sectional survey investigated this association in children from low-income families in Goiania, Goias, Brazil and considered the role of several social determinants. A questionnaire examining the characteristics of the children and their families was administered to the primary caregiver during home visits. In addition, children (approximately 6 years of age) had their height, weight, and tooth condition assessed. The primary ECC outcome was categorized as one of the following: caries experience (decayed, missing, filled tooth: “dmft” index > 0), active ECC (decayed teeth > 0), or active severe ECC (decayed teeth ≥ 6). Descriptive, bivariate and logistic regression analyses were conducted. The participants in the current study consisted of 269 caregiver-child dyads, 88.5% of whom were included in the Family Health Program. Caregivers were mostly mothers (67.7%), were 35.3 ± 10.0 years old on average and had 9.8 ± 3.1 years of formal education. The mean family income was 2.3 ± 1.5 times greater than the Brazilian minimum wage. On average, the children in the current study were 68.7 ± 3.8 months old. Of these, 51.7% were boys, 23.4% were overweight or obese, 45.0% had active ECC, and 17.1% had severe ECC. The average body mass index (BMI) of the children was 15.9 ± 2.2, and their dmft index was 2.5 ± 3.2. BMI was not associated with any of the three categories of dental caries (p > 0.05). In contrast, higher family incomes were significantly associated with the lack of caries experience in children (OR 1.22, 95%CI 1.01–1.50), but the mother’s level of education was not significantly associated with ECC. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle The Impact of Socio-Economic Status on Self-Rated Health: Study of 29 Countries Using European Social Surveys (2002–2008)
Int. J. Environ. Res. Public Health 2013, 10(3), 747-761; doi:10.3390/ijerph10030747
Received: 3 January 2013 / Revised: 8 February 2013 / Accepted: 20 February 2013 / Published: 25 February 2013
Cited by 13 | PDF Full-text (513 KB) | HTML Full-text | XML Full-text
Abstract
Studies show that the association between socio-economic status (SES) and self-rated health (SRH) varies in different countries, however there are not many country-comparisons that examine this relationship over time. The objective of the present study is to determine the effect of three [...] Read more.
Studies show that the association between socio-economic status (SES) and self-rated health (SRH) varies in different countries, however there are not many country-comparisons that examine this relationship over time. The objective of the present study is to determine the effect of three SES measures on SRH in 29 countries according to findings in European Social Surveys (2002–2008), in order to study how socio-economic inequalities can vary our subjective state of health. In line with previous studies, income inequalities seem to be greater not only in Anglo-Saxon and Scandinavian countries, but especially in Eastern European countries. The impact of education is greater in Southern countries, and this effect is similar in Eastern and Scandinavian countries, although occupational status does not produce significant differences in southern countries. This study shows the general relevance of socio-educational factors on SRH. Individual economic conditions are obviously a basic factor contributing to a good state of health, but education could be even more relevant to preserve it. In this sense, policies should not only aim at reducing income inequalities, but should also further the education of people who are in risk of social exclusion. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle The Effect of Social Trust on Citizens’ Health Risk Perception in the Context of a Petrochemical Industrial Complex
Int. J. Environ. Res. Public Health 2013, 10(1), 399-416; doi:10.3390/ijerph10010399
Received: 15 November 2012 / Revised: 21 December 2012 / Accepted: 8 January 2013 / Published: 21 January 2013
Cited by 8 | PDF Full-text (370 KB) | HTML Full-text | XML Full-text
Abstract
Perceived risk of environmental threats often translates into psychological stress with a wide range of effects on health and well-being. Petrochemical industrial complexes constitute one of the sites that can cause considerable pollution and health problems. The uncertainty around emissions results in [...] Read more.
Perceived risk of environmental threats often translates into psychological stress with a wide range of effects on health and well-being. Petrochemical industrial complexes constitute one of the sites that can cause considerable pollution and health problems. The uncertainty around emissions results in a perception of risk for citizens residing in neighboring areas, which translates into anxiety and physiological stress. In this context, social trust is a key factor in managing the perceived risk. In the case of industrial risks, it is essential to distinguish between trust in the companies that make up the industry, and trust in public institutions. In the context of a petrochemical industrial complex located in the port of Castellón (Spain), this paper primarily discusses how trust — both in the companies located in the petrochemical complex and in the public institutions — affects citizens’ health risk perception. The research findings confirm that while the trust in companies negatively affects citizens’ health risk perception, trust in public institutions does not exert a direct and significant effect. Analysis also revealed that trust in public institutions and health risk perception are essentially linked indirectly (through trust in companies). Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Figures

Open AccessArticle Assessing the Impact of Socioeconomic Variables on Small Area Variations in Suicide Outcomes in England
Int. J. Environ. Res. Public Health 2013, 10(1), 158-177; doi:10.3390/ijerph10010158
Received: 23 October 2012 / Revised: 14 December 2012 / Accepted: 20 December 2012 / Published: 27 December 2012
Cited by 11 | PDF Full-text (3969 KB) | HTML Full-text | XML Full-text
Abstract
Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random [...] Read more.
Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle The Impact of Relative Poverty on Norwegian Adolescents’ Subjective Health: A Causal Analysis with Propensity Score Matching
Int. J. Environ. Res. Public Health 2012, 9(12), 4715-4731; doi:10.3390/ijerph9124715
Received: 20 October 2012 / Revised: 6 December 2012 / Accepted: 10 December 2012 / Published: 18 December 2012
Cited by 4 | PDF Full-text (217 KB) | HTML Full-text | XML Full-text
Abstract
Studies have revealed that relative poverty is associated with ill health, but the interpretations of this correlation vary. This article asks whether relative poverty among Norwegian adolescents is causally related to poor subjective health, i.e., self-reported somatic and mental symptoms. Data [...] Read more.
Studies have revealed that relative poverty is associated with ill health, but the interpretations of this correlation vary. This article asks whether relative poverty among Norwegian adolescents is causally related to poor subjective health, i.e., self-reported somatic and mental symptoms. Data consist of interview responses from a sample of adolescents (N = 510) and their parents, combined with register data on the family’s economic situation. Relatively poor adolescents had significantly worse subjective health than non-poor adolescents. Relatively poor adolescents also experienced many other social disadvantages, such as parental unemployment and parental ill health. Comparisons between the relatively poor and the non-poor adolescents, using propensity score matching, indicated a negative impact of relative poverty on the subjective health among those adolescents who lived in families with relatively few economic resources. The results suggest that there is a causal component in the association between relative poverty and the symptom burden of disadvantaged adolescents. Relative poverty is only one of many determinants of adolescents’ subjective health, but its role should be acknowledged when policies for promoting adolescent health are designed. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Uneven Magnitude of Disparities in Cancer Risks from Air Toxics
Int. J. Environ. Res. Public Health 2012, 9(12), 4365-4385; doi:10.3390/ijerph9124365
Received: 30 July 2012 / Revised: 22 November 2012 / Accepted: 26 November 2012 / Published: 3 December 2012
Cited by 7 | PDF Full-text (1380 KB) | HTML Full-text | XML Full-text
Abstract
This study examines race- and income-based disparities in cancer risks from air toxics in Cancer Alley, LA, USA. Risk estimates were obtained from the 2005 National Air Toxics Assessment and socioeconomic and race data from the 2005 American Community Survey, both at [...] Read more.
This study examines race- and income-based disparities in cancer risks from air toxics in Cancer Alley, LA, USA. Risk estimates were obtained from the 2005 National Air Toxics Assessment and socioeconomic and race data from the 2005 American Community Survey, both at the census tract level. Disparities were assessed using spatially weighted ordinary least squares (OLS) regression and quantile regression (QR) for five major air toxics, each with cancer risk greater than 10−6. Spatial OLS results showed that disparities in cancer risks were significant: People in low-income tracts bore a cumulative risk 12% more than those in high-income tracts (p < 0.05), and those in black-dominant areas 16% more than in white-dominant areas (p < 0.01). Formaldehyde and benzene were the two largest contributors to the disparities. Contributions from emission sources to disparities varied by compound. Spatial QR analyses showed that magnitude of disparity became larger at the high end of exposure range, indicating worsened disparity in the poorest and most highly concentrated black areas. Cancer risk of air toxics not only disproportionately affects socioeconomically disadvantaged and racial minority communities, but there is a gradient effect within these groups with poorer and higher minority concentrated segments being more affected than their counterparts. Risk reduction strategies should target emission sources, risk driver chemicals, and especially the disadvantaged neighborhoods. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Figures

Open AccessCommunication The Association between Cardiovascular Disease Risk and Parental Educational Level in Portuguese Children
Int. J. Environ. Res. Public Health 2012, 9(12), 4311-4320; doi:10.3390/ijerph9124311
Received: 4 September 2012 / Revised: 19 November 2012 / Accepted: 20 November 2012 / Published: 27 November 2012
Cited by 5 | PDF Full-text (194 KB) | HTML Full-text | XML Full-text
Abstract
The aim of this study was to examine any differences in cardiovascular disease (CVD) risk in Portuguese children split by parental educational level. A cross-sectional school-based study was conducted in 2011 on 359 Portuguese children (202 girls and 157 boys) aged 10 [...] Read more.
The aim of this study was to examine any differences in cardiovascular disease (CVD) risk in Portuguese children split by parental educational level. A cross-sectional school-based study was conducted in 2011 on 359 Portuguese children (202 girls and 157 boys) aged 10 to 17 years (mean age ± SD = 13.9 ± 1.98 years). Height and body mass were assessed to determine body mass index (BMI). Parental education level (PEL) was used as a surrogate for socioeconomic status (SES). Capillary blood sampling was used to determine: Total Cholesterol (TC), Triglycerides (TG), Fasting Glucos (GLUC), High and Low Density Lipoprotein (HDL/LDL). These measurements were combined with measures of systolic blood pressure and cardiorespiratory fitness as z-scores. CVD risk was constructed by summing the z-scores. Analysis of covariance, controlling for BMI, indicated that CVD risk was significantly different across PEL groups (p = 0.01), with CVD risk score being significantly lower in low (p = 0.04) and middle (p = 0.008) PEL groups, compared to high PEL. Moreover, the covariate, BMI was also significant (p = 0.0001, β = 0.023), evidencing a significant positive association between BMI and CVD risk, with higher BMI associated with greater CVD risk. In Portuguese children, significantly greater CVD risk was found for children of high PEL, while higher BMI was associated with greater CVD risk. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Educational Inequalities in Women’s Depressive Symptoms: The Mediating Role of Perceived Neighbourhood Characteristics
Int. J. Environ. Res. Public Health 2012, 9(12), 4241-4253; doi:10.3390/ijerph9124241
Received: 14 August 2012 / Revised: 13 November 2012 / Accepted: 15 November 2012 / Published: 22 November 2012
Cited by 1 | PDF Full-text (183 KB) | HTML Full-text | XML Full-text
Abstract
Socio-economically disadvantaged (e.g., less educated) women are at a greater risk of depression compared to less disadvantaged women. However, little is known regarding the factors that may explain socioeconomic inequalities in risk of depression. This study aimed to investigate the contribution of [...] Read more.
Socio-economically disadvantaged (e.g., less educated) women are at a greater risk of depression compared to less disadvantaged women. However, little is known regarding the factors that may explain socioeconomic inequalities in risk of depression. This study aimed to investigate the contribution of perceived neighbourhood factors in mediating the relationship between education and women’s risk of depression. Cross-sectional data were provided by 4,065 women (aged 18–45). Women self-reported their education level, depressive symptoms (CES-D 10), as well as four neighbourhood factors (i.e., interpersonal trust, social cohesion, neighbourhood safety, and aesthetics). Single and multiple mediating analyses were conducted. Clustering by neighbourhood of residence was adjusted by using a robust estimator of variance. Multiple mediating analyses revealed that interpersonal trust was the only neighbourhood characteristic found to partly explain the educational inequalities in women’s depressive symptoms. Social cohesion, neighbourhood aesthetics and safety were not found to mediate this relationship. Acknowledging the cross-sectional nature of this study, findings suggest that strategies to promote interpersonal trust within socioeconomically disadvantaged neighbourhoods may help to reduce the educational inequalities in risk of depression amongst women. Further longitudinal and intervention studies are needed to confirm these findings. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Narratives and Images Used by Public Communication Campaigns Addressing Social Determinants of Health and Health Disparities
Int. J. Environ. Res. Public Health 2012, 9(12), 4254-4277; doi:10.3390/ijerph9124254
Received: 16 August 2012 / Revised: 9 November 2012 / Accepted: 13 November 2012 / Published: 22 November 2012
Cited by 2 | PDF Full-text (255 KB) | HTML Full-text | XML Full-text
Abstract
Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These [...] Read more.
Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation’s Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one’s home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother’s education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya
Int. J. Environ. Res. Public Health 2012, 9(10), 3588-3598; doi:10.3390/ijerph9103588
Received: 16 August 2012 / Revised: 18 September 2012 / Accepted: 26 September 2012 / Published: 12 October 2012
Cited by 1 | PDF Full-text (173 KB) | HTML Full-text | XML Full-text
Abstract
A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of [...] Read more.
A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Social, Psychological, and Environmental-Structural Factors Associated with Tobacco Experimentation among Adolescents in Shanghai, China
Int. J. Environ. Res. Public Health 2012, 9(10), 3421-3436; doi:10.3390/ijerph9103421
Received: 10 July 2012 / Revised: 13 August 2012 / Accepted: 17 September 2012 / Published: 26 September 2012
Cited by 6 | PDF Full-text (151 KB) | HTML Full-text | XML Full-text
Abstract
Objective: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. Methods: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global [...] Read more.
Objective: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. Methods: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. Results: Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49–10.39); one or both parents smoking (AOR 1.57; CI: 1.39–1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37–1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28–1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10–1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84–13.66) more so than among boys (AOR 7.79; CI: 5.97–9.94) and media tobacco exposure had no association with tobacco experimentation among female students. Conclusions: Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Open AccessArticle Linear and Non-Linear Associations of Gonorrhea Diagnosis Rates with Social Determinants of Health
Int. J. Environ. Res. Public Health 2012, 9(9), 3149-3165; doi:10.3390/ijerph9093149
Received: 25 July 2012 / Revised: 6 August 2012 / Accepted: 23 August 2012 / Published: 3 September 2012
Cited by 4 | PDF Full-text (317 KB) | HTML Full-text | XML Full-text
Abstract
Identifying how social determinants of health (SDH) influence the burden of disease in communities and populations is critically important to determine how to target public health interventions and move toward health equity. A holistic approach to disease prevention involves understanding the combined [...] Read more.
Identifying how social determinants of health (SDH) influence the burden of disease in communities and populations is critically important to determine how to target public health interventions and move toward health equity. A holistic approach to disease prevention involves understanding the combined effects of individual, social, health system, and environmental determinants on geographic area-based disease burden. Using 2006–2008 gonorrhea surveillance data from the National Notifiable Sexually Transmitted Disease Surveillance and SDH variables from the American Community Survey, we calculated the diagnosis rate for each geographic area and analyzed the associations between those rates and the SDH and demographic variables. The estimated product moment correlation (PMC) between gonorrhea rate and SDH variables ranged from 0.11 to 0.83. Proportions of the population that were black, of minority race/ethnicity, and unmarried, were each strongly correlated with gonorrhea diagnosis rates. The population density, female proportion, and proportion below the poverty level were moderately correlated with gonorrhea diagnosis rate. To better understand relationships among SDH, demographic variables, and gonorrhea diagnosis rates, more geographic area-based estimates of additional variables are required. With the availability of more SDH variables and methods that distinguish linear from non-linear associations, geographic area-based analysis of disease incidence and SDH can add value to public health prevention and control programs. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)

Review

Jump to: Research

Open AccessReview The Social Determinants of Infant Mortality and Birth Outcomes in Western Developed Nations: A Cross-Country Systematic Review
Int. J. Environ. Res. Public Health 2013, 10(6), 2296-2335; doi:10.3390/ijerph10062296
Received: 3 February 2013 / Revised: 26 April 2013 / Accepted: 16 May 2013 / Published: 5 June 2013
Cited by 22 | PDF Full-text (387 KB) | HTML Full-text | XML Full-text
Abstract
Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within [...] Read more.
Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world. Full article
(This article belongs to the Special Issue Social and Economical Determinants of Health)
Figures

Journal Contact

MDPI AG
IJERPH Editorial Office
St. Alban-Anlage 66, 4052 Basel, Switzerland
ijerph@mdpi.com
Tel. +41 61 683 77 34
Fax: +41 61 302 89 18
Editorial Board
Contact Details Submit to IJERPH
Back to Top