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Wood, David L. "Social Determinants of Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5168.
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Muir, Jonathan A. "Societal Shocks as Social Determinants of Health." The Ohio State University, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=osu1615597384677722.
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Jaishankar, Gayatri. "Social Determinants of Health Screening." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/8873.
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Wood, David L. "New Models of Health and Social Determinants of Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5180.
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Farrants, Linda Kristin Ostlund. "Recommodification of the social determinants of health." Thesis, Durham University, 2016. http://etheses.dur.ac.uk/11375/.
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Background Decommodification is the extent to which living standard is independent of market position. In recent decades, some states have embarked on a process of recommodification, restricting the alternatives to participating in the market. This study has investigated how recommodification of unemployment healthcare and pensions are correlated with health inequalities. Methods Using Health Survey for England and the Swedish Living Conditions Survey, this study computes the magnitude of health inequalities in Sweden and England and correlates the magnitude of inequalities with measures of recommodification. In stage 1, the odds ratio of Not good health/having visited a doctor was computed using logistic regression for each year, using the employed and the high educated as the reference categories. In stage 2, the log (odds ratios) of poor health or doctor visits computed in stage 1 were correlated with the net replacement rate/price of primary care using linear regression. Results Health inequalities between the employed and the unemployed were significantly higher in both England and Sweden in 2011 than in 1991, a period during which unemployment benefit was recommodified in both countries. The association between health inequality and net replacement rate was much stronger in Sweden. Health inequalities increased slightly among English pensioners, while those of the Swedish sample remained steady. This is not what we would expect from the development of recommodification in the two countries: Sweden recommodified while England did not. 3 For groups with similar needs, the higher educated are more likely to seek healthcare. There were no trends in inequality in access to healthcare in Sweden. Conclusion This study has shown that recommodification is associated with health inequalities, especially in Sweden, and that inequalities in replacement rates are associated with health. However, the links between recommodification and health are context-dependent.
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Franklin, Wanda J. "Social Determinants of Health in Appalachian Populations." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8369.
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Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.
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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse.
The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.
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Denton, Kacie Hoyle, and Claire Gleadhill. "Social Determinants of Health in Belize Free Clinic." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/205.
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Abstract: Social Determinants of Health in Belize Free Clinic
Introduction: To determine the most appropriate ways to serve patients in rural Belize through medical mission work, it is important to assess social determinants of health (SDOH). It has long been agreed that a variety of factors affect health, including environment, community and social context, access to healthcare, stress, income, mental health, education, and transportation. Many people in Roaring Creek, Belize, a village with a population of approximately 2,000, use Body and Soul Ministries, a nonprofit that invites medical teams from all over to deliver medical care, as their primary source of healthcare. During one of these trips, a medical team from East Tennessee State University (ETSU) provided medical care and employed the TeamCare survey, already used in several clinics in east Tennessee to assess the SDOH needs of the patient population in Roaring Creek. The purpose of this study was to use a survey that assesses several SDOH to determine better ways to address health needs in the community of Roaring Creek as well as connect patients with resources to meet those needs.
Methods: A team of ETSU medical students, a resident, and five physicians served in a free clinic in Roaring Creek, Belize in October 2017. The team saw approximately 500 patients. Some patients were randomly selected to take the TeamCare survey to assess for six SDOH, including literacy, financial needs, drug use, abuse, transportation, and mental health. Based on the results of the survey, patients were connected with their local community health worker to assist in locating resources for patients. Using SPSS, results from the survey were arranged for frequencies and measures of central tendency.
Results: Overall, a total of 106 patients responded to the TeamCare survey. Based on the survey results, 83.2% of patients responded “yes” to at least one question regarding needs related to SDOH. In fact, 7.9% of patients answered “yes” to five questions. Of note, 53.5% of patients responded positively for financial need, 46.5% positive for mental health needs, 37.6% positive for environmental alcohol or drug abuse, and 32.7% positive for transportation needs. More women stated positively for physical or verbal abuse compared to men (-1.48, p=0.001).
Discussion and Conclusion:
Roaring Creek, Belize is a rural community that illustrates how SDOH can impact health outcomes. There has been a recent effort for clinicians to address SDOH, especially in rural areas, but perhaps not enough globally. One way this can be done is by surveying for SDOH at clinic visits and then linking patients with relevant community resources. However, resources are not always readily available in Roaring Creek, Belize. Many patients are positive for SDOH, but with an overall lack of resources, it is important to do more research to determine how global health efforts can best serve these populations. Perhaps the best way for SDOH needs to be addressed is for Body and Soul to collaborate with community health workers and mission teams to establish ongoing programs and longstanding resources for the community.
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Shirely, Kaitlyn, Margaret Smith, Kacie Denton, Blair Brandt, Ivy A. Click, and Joseph Gravel. "Social Determinants of Health in Rural Tennessee Clinics." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6383.
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Omotoso, Kehinde Oluwaseun. "Assessing changes in the social determinants of health and health inequality." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/65505.
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This thesis broadly investigates the relative changes in socio-economic related health inequalities over the second decade of post-apartheid South Africa. This period is characterised by di erent policies and reforms, aimed at reducing socio-economic inequalities that pervaded all aspects of life before 1994. By extension, these policies and reforms have also been applied to the health care system. Speci cally, policy interventions such as scal redistribution directed at key sectors, abolition of user fees for primary health care, and the ongoing discussions related to universal health coverage through yet-to-be-implemented national health insurance have targeted reductions in socio-economic related health inequality. However, evidence from the academic and policy-oriented literature suggests that not much has changed. Health inequality which is strongly linked to inequalities in its social determinants, persist, despite notable policies targeting socio-economic factors. Moreover, existing literature has not identi ed drivers of change, and, therefore, presents a narrow perspective of health inequality. Hence, it is important to analyse changes in social determinants of health and health inequality over the current post-apartheid period. This thesis uses data from the nationally representative General Household Surveys (GHS), which started in 2002. After scrutinising the data for consistency and comparability across the years, the thesis pro les trends in health outcomes across a spectrum of socio-demographic factors, using the GHS data covering the years 2004 - 2014. The health variables considered are ill-health status, medical aid coverage, and preference for public or private health care. As there are few obvious patterns in the raw health variables' time series, the analysis, which is descriptive in nature, relies upon both parametric and non-parametric techniques to smooth the time series in order to outline a few general trends. It is found that medical aid coverage and the general population's preference for public health care decreased by 0.2% and 0.1%, per year, respectively, while reports of ill-health status increased by 0.4%, annually. Moreover, the probability that an individual, who is covered by a medical aid scheme, would utilize public health care decreased by about 44%. Having established changes in the health indicators, the thesis further explores some key socio-economic drivers of these changes. Speci cally, the thesis uses information collected on social determinants of health (SDH), and a variety of health indicators in the 2004 and 2014 GHS data, to explain how changes in the SDH have impacted health inequalities over that decade. Using the Oaxaca-Blinder decomposition of change in a concentration index, the thesis nds that rising inequalities in ill-health are largely explained by changes in the composition of those residing in urban areas and in relatively richer provinces. Meanwhile, rising inequality in medical aid coverage and the utilisation of private health care are attributable to changes in educational attainment and racial composition. On the other hand, changing elasticities in SDH, rather than increasing inequalities, are found to explain a widening preference for private health care in the event of illness. Finally, the thesis investigates socio-economic factors driving health inequality at a fairly disaggregated level, by examining the relative contributions of SDH to changes in gendered health di erentials between 2005 and 2014. Using di erences-in-decompositions, the thesis nds that the gender gap in health narrowed by approximately 2% between 2005 and 2014, and the narrowing of that gap can be attributed to changes in educational attainment and social grant receipt. Speci cally, the relative increase in social grant receipt by females explains approximately 28% of the reduction, while the relative increase in the receipt of formal education by females explains about 1.11%.Thesis (PhD)--University of Pretoria, 2017.
Economics
PhD
Unrestricted
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Vitale, Caitlin McManus. "TheRole of the Social Determinants of Health in Rural Health Equity:." Thesis, Boston College, 2020. http://hdl.handle.net/2345/bc-ir:109012.
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Thesis advisor: Karen S. LyonsBackground: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts
Thesis (PhD) — Boston College, 2020
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Thomas, William. ""The social determinants of Aboriginal Health: A literature review"." School of Native Human Services, 2003. http://142.51.24.159/dspace/handle/10219/416.
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The Assembly of First Nations has identified "the need to develop an integrated, holistic,
inter-departmental and inter organizational organism to address the inequities and gaps in
health and social service delivery to First Nations" (AFN, 2002). However, there is much work to
be done in efforts to reach this goal, as there are many factors that one must
take into consideration when examining Aboriginal health from a holistic perspective. For
example, it has been reported that in British Columbia (BC) that 20% of Aboriginal people
are below the provincial average based on income, employment, and educational attainment and
housing (Kendell and Hull, 2002).
In addition to national reports, the BC Ministry of Health advocates that there is the need to
look at the broad spectrum of health and social determinants to come up with solutions that
will improve the health and well being of Aboriginal people. These determinants are comprised
of health, gender, biology, culture, coping skills, social environments, social support
networks, income and social status, employment and working conditions, education, child
development and physical environments. The determinants are interdependent, cannot be examined
individually and a holistic approach needs to be utilized when dealing with
Aboriginal health issues. It is important for non-aboriginals to observe the difference
in fundamental viewpoints of Aboriginal people in their relationship with the natural
surroundings, other races, flora and fauna (Driben and Simpson, 2000). The lack of control over
one's life plays an important factor in their well-being.
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Stoddard, Pamela Jane. "Social and structural determinants of health among Mexican adults." Diss., Restricted to subscribing institutions, 2009. http://proquest.umi.com/pqdweb?did=1997523901&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Hawkins, DeAnna Hawkins. "Educating the Current and Future Nursing Workforce on Principles of Health Equity: A Standardized Social Determinants of Health Screening Tool and Education Module." Xavier University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1525611349608889.
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Nuno, Velia Leybas. "Determinants of Early Adolescent Girls' Health." Diss., The University of Arizona, 2012. http://hdl.handle.net/10150/265813.
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Adolescence is a period of development when health-related behaviors can become rooted and subsequently contributes to leading causes of adult morbidity and mortality. The dissertation is based on three studies. The first is a cohort study (n=577) of sixth grade students followed for 2.5 years to assess changes in smoking susceptibility measured by intention to smoke. The second study applies a pre-post design to evaluate the outcomes of a 13-week after-school program and three-day, in-residence University camp on personal and familial factors among 37 sixth grade girls, most of whom were Mexican American. The third study is a cross-sectional study of depression among 80 sixth grade girls, the majority of whom were Mexican American. A survey measured depression severity and familial and individual factors that influence depression. Results showed smoking intention increased nearly six-fold from sixth grade to eighth grade (OR=5.8, 95% CI: 1.19, 3.05). The intervention study resulted in changes from pre to post test in familial and personal factors. The prevalence of depression was 50% among participants in the third study, 38% of girls reported moderate to severe levels. In sum, the greater prevalence of smoking intention over time suggests a norm of acceptance occurring as students' progress through middle school. Protective factors from such attitudes differ by gender and are influenced by the relationships surrounding the adolescent. Similarly, relationships were protective in the study of depression. The father's relationship with his daughter guards against depression as does positive peer relationships. These relationships can be strengthened through interventions as was suggested in the intervention study. Study findings emphasize the protective influence familial and peer relationships have on the developing adolescent.
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Krishna, Aditi. "Social and Intergenerational Determinants of Children’s Physical and Cognitive Development." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:23205171.
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Identifying the key determinants of poor developmental outcomes is critical in improving the lives of millions of children who suffer from poor physical growth and cognitive deficits. Much research suggests that early life conditions, particularly those experienced within the household, critically influence children’s development across the life course. In this dissertation exercise, I explore how three dimensions of early experiences – prenatal conditions, parental education, and household socioeconomic conditions – influence children’s physical and cognitive development. Chapter 1 finds that the influences of low birth weight, often touted as a key determinant of later health, wane over time with increasing importance of postnatal factors. Chapter 2 also counters accepted evidence that maternal education matters more for children’s physical development by finding that both parents’ education matters equally in both infancy and childhood with no mechanisms distinguishing maternal and paternal education. Chapter 3 supports the evidence that household socioeconomic status matters for children’s cognitive development and finds that household assets are the critical determinant of cognitive status. Findings from each of these chapters will not only contribute new scientific evidence but will also help inform policies and programs to improve children’s health and well-being.
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Evans, Clare Rosenfeld. "Innovative Approaches to Investigating Social Determinants of Health - Social Networks, Environmental Effects and Intersectionality." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:23205168.
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Contexts are important social determinants of individual health trajectories and population level patterns of health disparities. This dissertation examines three types of contexts—social networks, physical environments, and social positions—using innovative quantitative approaches. Chapter 1 examines the intersectional social positions created by interlocking social identities—race/ethnicity, sex, income, education, and age—and their relationship to health disparities in the obesity epidemic. We outline an innovative analytic approach to evaluating intersectionality using multilevel models. After adjustment for the contributions of the main effects, a large intersectional effect remains. While clear social patterning emerges, interactions are not necessarily patterned according to ‘multiple jeopardy’ and ‘multiplicative benefit’ as might have been expected. These findings reveal the complex social patterning of the obesity epidemic, and challenge us to consider possible refinements to intersectionality theory.
Chapter 2 evaluates whether U.S. adolescent social networks are segregated by family income level. Network segregation or integration may affect adolescent health trajectories through a variety of pathways, yet the extent to which networks are socioeconomically segregated is poorly understood. We approach the evaluation of income segregation through a novel lens by explicitly considering three scales of analysis within social networks: the network community level, the dyadic level, and a level in between. We find evidence of income segregation at all three levels, though this segregation is neither extreme nor universal. Family income appears to be a socially salient factor in the structure of adolescent social networks.
In Chapter 3, three contexts of relevance to the adolescent obesity epidemic—schools, neighborhoods, and social networks—are examined simultaneously. Using a novel combination of social network community detection and cross-classified multilevel modeling, we compare the contributions of each of these contexts to the total variation in adolescent body mass index. After adjusting for relevant covariates, we find that the school-level and neighborhood-level contributions to the variance are modest compared with the network community-level. These results are robust to multiple sensitivity tests. This study highlights the salience of adolescent social networks and indicates that they may be a promising context to address in the design of health promotion programs.
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Foppiano, Palacios Carlo. "THE IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON HOSPITAL READMISSIONS." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/381898.
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Urban BioethicsM.A.
The current fragmented delivery of health care has contributed to unplanned hospital readmissions as a leading problem in the United States. Reducing readmissions to urban teaching hospitals is difficult. Many patients living in urban communities face social, economic, language, and transportation barriers to maintaining their health. Both the patient and the medical center experience the burden of readmission and are challenged with addressing SDoH and social injustices at several levels. Medicare views hospital readmissions as a marker representing lower quality of health care delivery to penalize hospitals providing care to the poor. This thesis addresses multiple social and economic factors associated with hospital readmissions, explores the interrelated components of readmissions at the personal and hospital system level, and delves into the interactions of bioethical principles associated with urban living. Hospital readmissions remain a serious issue nationwide and in order to reduce the rates of re-hospitalization the social and economic inequalities contributing to hospital readmissions are significant and must be addressed.
Temple University--Theses
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Nobel, Lisa. "Patient and Social Determinants of Health Trajectories Following Coronary Events." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsbs_diss/910.
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More than 1.2 million Americans are hospitalized annually with an acute coronary syndrome (ACS); many impaired quality of life after discharge with an ACS. This dissertation focuses on two novel aspects of patient health status (PHS) after ACS: how it can be predicted based on the socioeconomic status (SES) of the patient, and how it evolves over time. We used data from TRACE-CORE, a longitudinal prospective cohort of patients hospitalized with ACS. We measured PHS using both the SF-36 mental and physical component subscales (MCS and PCS) and the Seattle Angina Questionnaire (SAQ) health-related quality of life (HRQoL) and physical limitations subscales at the index hospitalization and at 1, 3, and 6-months post-discharge. Firstly, after adjusting for individual-level SES, we found that individuals living in the neighborhoods with the lowest neighborhood SES had significantly worse PHS. Secondly, we found that each of the components of PHS had subgroups with distinct patterns of evolution over time (trajectories). Both the PCS and the SAQ physical limitations subscale had two trajectories; one with average and one with impaired health status over time. For the HRQoL subscale of SAQ, we found three trajectories: Low, Average, and High scores. For MCS, we found four trajectories: High (consistently high scores), Low (consistently low scores), and two with average scores at baseline that either improved or worsened over time, referred to as Improving and Worsening, respectively. All PHS trajectories, except for MCS, predicted readmission and mortality during the 6 months to 1 year post-ACS discharge.
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Venkatapuram, Sridhar. "Health and justice : the capability to be healthy." Thesis, University of Cambridge, 2009. https://www.repository.cam.ac.uk/handle/1810/224951.
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This is an inter-disciplinary argument for a moral entitlement to a capability to be healthy. Motivated by the goal to make a human right to health intelligible and justifiable, the thesis extends the capability approach, advocated by Amartya Sen and Martha Nussbaum, to the theory and practice of the human health sciences. Moral claims related to human health are considered at the level of ethical theory, or a level of abstraction where principles of social justice that determine the purpose, form, and scope of basic social institutions are proposed, evaluated, and justified. The argument includes 1) a conception of health as capability, 2) a theory of causation and distribution of health capability as well as 3) an argument for the moral entitlement to a sufficient and equitable capability to be healthy grounded in the respect for human dignity. Moreover, the entitlement to the capability to be healthy is defended against alternative ethical approaches that focus on welfare or resources in evaluating and satisfying health claims. In specific, it is argued that human health is best understood as a capability to be healthy - a meta-capability to achieve a cluster of basic and inter-related capabilities and functionings. Such a cluster of capabilities and functionings is in line with Martha Nussbaum's central human capabilities. A theory of causation and distribution of health capability is put forward that integrates the 'classic' biomedical factors of disease (genetic endowment, exposure to hazardous materials, behaviour), social determinants of disease, and Drèze and Sen's econometric analysis of the causation and distribution of acute and endemic malnutrition. Furthermore, the argument critiques Norman Daniels's revised Rawlsian theory of health justice, and advocates for the capability approach to recognize group capabilities in light of 'population health' phenomena. Lastly, the thesis also argues that a coherent, capability conception of health as a species-wide conception will tend to make any theory of justice recognizing health claims a cosmopolitan theory of justice.
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da, Rocha Fernandes Joao Diogo. "The Social Environment and the Health Care sector." Master's thesis, Vysoká škola ekonomická v Praze, 2012. http://www.nusl.cz/ntk/nusl-125192.
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The objective of this thesis was to defend an alternative approach by health policy makers for improving health outcomes through investing on social factors of peoples' lives, rather than by increasing health expenditures. In order to defend this theory, this master thesis addresses two research questions: Which are the social determinants of health with largest impact on health status of individuals? And what is the statistical correlation between those social determinants of health and self-reported health status, and psychological health, for Germany, Denmark, Spain and Ireland? The first question was answered by developing a comprehensive research among the mostrelevant literature in the field of social determinants of health and the second through the construction of a statistical multiple regression model. According this study the social determinants with largest impact on the health status of individuals are: physical activity, education level, the welfare state, emotional support, socio-economic status, living conditions, working conditions, and life balance. Regarding the results of multiple regression models all variables followed the expected trend and it was possible to proof significant statistical correlation in 7 of the 8 determinants chosen, especially in the cases of working conditions and life balance, where those having problems managing these aspects of life experienced 50% or in some cases 30% of the health status of individuals with positive experiences in these life dimensions.
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Miller, Tiffany. "Social Determinants of Youth Heroin Use." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1406821411.
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Llop, Gironés Alba 1987. "Social determinants of health and the health system of Mozambique : Towards a comprehensive analysis of health inequalities." Doctoral thesis, Universitat Pompeu Fabra, 2018. http://hdl.handle.net/10803/665400.
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The present thesis aims to give a critical overview of the health care and health
inequalities for the Mozambican case. The thesis is divided into four articles, two of them
are quantitative articles analysing data from the Mozambican household budget survey,
while the other two articles employ different methodologies: a systematic review and data
source mapping. Findings show that in Mozambique, despite the overall health status has
improved over time, women, children, elders and the population living in rural areas of
the country are left behind in the progress to attain better health. Structural factors are the
major drivers of health inequalities and people’s access to basic services and material
conditions, although crucial, are not the main causes of health inequalities in
Mozambique. Another key finding is that a comprehensive view of the health system
based in primary health care is fundamental for addressing health care inequalities. In
Sub-Saharan Africa, the access to and quality of primary health care is mainly determined
by the social position, rather than by the need, and health care inequalities persist over
time. These results allow drawing conclusions for the improvement of the equity in the
access to quality care in Mozambique. In the country, 70% of Mozambicans use
healthcare services when having a health need, and despite there are no differences in the
direct payments for the public sector visits, significant socio-economic and geographical
inequalities were found for women and men in the access to and quality of care received.
Finally, this thesis highlights the important information gaps that exists in the national
health information system to monitor health equity in MozambiqueAquesta tesi té com a objectiu oferir una visió crítica de les desigualtats sanitàries i de salut per al cas de Moçambic. La tesi es divideix en quatre articles, dos d'ells són articles quantitatius que analitzen dades de l'enquesta sobre el pressupost familiar de Moçambic, mentre que els altres dos articles fan servir diferents metodologies: una revisió sistemàtica i un mapeig de fonts de dades. Els resultats mostren que a Moçambic, malgrat que l'estat general de salut ha millorat amb el temps, les dones, els nens, els ancians i la població que viu a les zones rurals del país es queden enrere en el progrés per aconseguir una millor salut. Els factors estructurals són els principals impulsors de les desigualtats en salut i l'accés als serveis bàsics i les condicions materials, tot i que són crucials, no són les principals causes de les desigualtats en salut a Moçambic. Una altra troballa clau és que una visió integral del sistema de salut basada en l'atenció primària de salut és fonamental per abordar les desigualtats en l'atenció de la salut. A l'Àfrica Subsahariana, l'accés i la qualitat de l'atenció primària de salut es determina principalment per la posició social, més que per la necessitat, i les desigualtats en l'atenció de la salut persisteixen al llarg del temps. Aquests resultats permeten extreure conclusions per a la millora de l'equitat en l'accés a l'atenció de qualitat a Moçambic. Al país, el 70% dels moçambiquesos fan servir els serveis de salut quan tenen una necessitat i, tot i que no hi ha diferències en els pagaments directes per a les visites al sector públic, es van trobar desigualtats socioeconòmiques i geogràfiques significatives per a les dones i els homes en l'accés i la qualitat de l'atenció rebuda. Finalment, aquesta tesi ressalta importants llacunes d'informació que hi ha en el sistema nacional d'informació de salut per a l'avaluació de l'equitat en salut a Moçambic
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Kniess, Johannes. "Justice in health : social and global." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:c1b36ded-85da-4888-91ce-83c164252f93.
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Within and across all societies, some people live longer and healthier lives than others. Although many of us intuitively think of health as a very important good, general theories of justice have hitherto paid little attention to its distribution. This is a thesis about what we owe to one another, as a matter of justice, in view of our unequal levels of health. The first part of the thesis addresses the problem of social justice in health. I argue that the basic institutional framework of society must be arranged so as to ensure an egalitarian distribution of the 'social bases of health,' that is, the socioeconomic conditions that shape our opportunities for a healthy life. Inequalities in health, including those caused by differences in individual lifestyles, are only fair when people have been given fair opportunities. This egalitarian approach to the social bases of health must be complemented by a sufficientarian concern for meeting all basic health needs, regardless of whether these originate in unfair social arrangements. The second part of the thesis takes up the problem of global justice in health. Although I argue against the idea that domestic principles of justice can be simply replicated on a global scale, I emphasise the fact that there are a number of international institutions and practices that shape people's opportunities for health. One of these is the state system - the division of the world into sovereign states - which I argue grounds the idea of the human right to health. I also examine two more specific examples of global practices that contribute to global inequalities in health, namely global trade in tobacco and the global labour market for healthcare workers. Both of these, I suggest, must be restricted in light of their impact on health levels worldwide.
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Crawford, Natasha. "The social determinants of health : an empirical analysis of ethnic and spatial inequalities in health." Thesis, University of Essex, 2017. http://repository.essex.ac.uk/20449/.
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This thesis consists of three self-contained research articles that empirically examine the ethnic and spatial patterning of health outcomes in England today. Health is defined here as a multidimensional concept encompassing physical and mental health and wellbeing, in line with the Public Health White Paper ‘Healthy Lives, Healthy People’ (HM Government, 2010). Each chapter utilises data from Understanding Society, a nationally representative panel study, which provides detailed information about the social and economic situations of people living in the UK.
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Jaramillo, Garcia Alejandra Paula. "Priority Setting: A Method that Incorporates a Health Equity Lens and The Social Determinants of Health." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19986.
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Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis.
Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success.
Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”.
Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.
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Herbell, Kayla. "Social Determinants of Health and Psychophysiological Stress in Pregnant Women: Correlates with Maternal Mental Health." Case Western Reserve University School of Graduate Studies / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1534160752855093.
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Miller, Jennifer L. "Social Determinants of Health and Disparities in Outcomes Related to Cardiovascular Health in Vulnerable Populations." UKnowledge, 2017. http://uknowledge.uky.edu/nursing_etds/31.
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The purpose of this dissertation was to explore the mechanism of association between social determinants of health (SDH), particularly limited health literacy, and disparate outcomes related to cardiovascular disease in vulnerable populations. Specific aims were to 1) compare quality of life (QOL), anxiety, and depressive symptoms between genders in implantable cardioverter defibrillator (ICD) recipients; 2) examine the association between multi-morbidity burden and QOL; 3) determine whether health literacy levels independently predict CVD risk in the male prison population; 4) examine the relationship between health literacy and decisiveness regarding end of life (EOL) choices, and 5) examine SDH as predictors of perceived poor health status in ICD recipients. Specific aim one was addressed by analysis of data collected from individuals in the Swedish ICD and Pacemaker Registry. Multiple linear regression was used to determine predictors of anxiety, depression, and quality of life in men and women. A higher prevalence of anxiety symptoms in women was noted with no differences in depressive symptoms noted between the genders. The majority of the variance in the predictive models for QOL was explained by the addition of the psychosocial variables for both genders. Specific aim two was addressed by analysis of data collected from individuals in the Swedish ICD and Pacemaker Registry. Logistic regression was used to determine predictors of QOL. Greater multi-morbidity burden was associated with lower QOL in ICD recipients. Specific aim three was addressed by analysis of data collected from male inmates enrolled in a bio-behavioral educational and counselling intervention program to reduce CVD risk. Nonlinear regression was used to determine whether health literacy was an independent predictor of CVD risk while controlling for social and clinical variables. Inmates with adequate levels of health literacy had lower ten year CVD risk profiles than those inmates with inadequate health literacy. Specific aim four was addressed by analysis of data collected from ICD recipients. Multinomial regression was used to determine predictors of decisiveness regarding EOL choices. Within the context of terminal illness, health literacy and race were found to be predictors of decisiveness regrading generator replacement while gender was found to be a predictor of decisiveness regarding the withdrawal of defibrillation therapy. Specific aim five was addressed by analysis of data collected from ICD recipients. Logistic regression was used to determine predictors of perceived poor health status. Residential status in the Central Appalachian region of Kentucky, not working outside the home, higher levels of health literacy, and comorbid depression were predictors of perceived poor/very poor health status.
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Gleeson, Deborah Helen, and d. gleeson@latrobe edu au. "The Conceptual and Empirical Utility of Social Capital for Public Health." La Trobe University. School of Public Health, 2001. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20050509.131918.
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This thesis evaluates the utility of �social capital� for public health in four dimensions (communication, explanation, practice and measurement) and at two levels (macro and micro), using interviews with public health workers and a theoretical analysis of social capital. It concludes that the concept is potentially useful for public health but that there are limitations to its utility, arising from the presence of two competing discourses or world views identified in the social capital literature: the rational choice discourse and the political economy discourse.
This thesis argues that although social capital is widely perceived to have rhetorical leverage in macro-level policy debates, its contested meaning draws into question the value of any consensus built on the glossing over of different world views. The concept has no value for communication at the micro level.
The rational choice theory of social capital appears useful for explaining the social determinants of health although it does not adequately account for the power structures which shape and constrain access to social capital, and it undervalues many aspects of social relationships. The political economy approach is more useful in these respects but is far more complex and difficult to quantify. It is unclear whether either of these theories adds much value to the existing literature which social capital tends to eclipse.
The concept has limited value for public health practice, as the dual world views embedded in it can be used to support widely varying policy directions. It is also limited by its inability to describe the dynamics of change or to identify levers for initiating change.
The meaningfulness of social capital indicators is compromised by the reductionism of the rational choice paradigm. The political economy discourse renders the development of quantitative indicators far more problematic but may be useful for informing qualitative research.
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Yamashita, Takashi. "HEALTH LITERACY AND HEALTH OUTCOMES: IMPLICATIONS FOR SOCIAL DETERMINANTS OF HEALTH, HEALTH DISPARITY AND LEARNING FOR HEALTH OVER THE LIFE COURSE." Miami University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=miami1307717893.
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Paquette, Elodie. "Social determinants of contraceptive use among young women in Kenya." Thesis, Stockholms universitet, Institutionen för folkhälsovetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-157340.
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Contraceptive use has far-reaching social and health benefits for women in low and middle-income countries. While socioeconomic factors are known to be associated with contraceptive use, few studies on this topic have focused specifically on young women, whose reproductive health is a target of the Sustainable Development Goals and the Family Planning 2020 agenda. This study used the Kenya Demographic and Health Survey to examine the association between three social determinants (wealth, education, and residence) and two contraceptive outcomes (modern method use and long-acting reversible contraceptive [LARC] use) in women ages 15-24 in 2008-09 (n=3,211 women) and 2014 (n=4,982 women). Results showed increases in the prevalence of modern method use and of LARC use. Low wealth was associated with non-use of LARC methods, and the same wealth pattern emerged for all modern method use between the two timepoints. An education gradient was observed for both outcomes. This study provides some evidence that the urban-rural gap is closing for contraception; however, rural residence continues to be a strong predictor of non-use of LARC methods. Results indicate that continued work is needed to ensure equitable progress in contraceptive use and method choice to contribute to improved reproductive health for young Kenyan women.
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Jaishankar, Gayatri, Deborah Thibeault, and Angelica Johnson. "Screen, Uncover, Connect: A Hands-on Approach to Elucidating the Social Determinants of Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/8871.
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Nandi, Sulakshana. "The role of community health workers (CHWS) in addressing social determinants of health in Chhattisgarh, India." University of the Western Cape, 2012. http://hdl.handle.net/11394/4540.
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Magister Public Health - MPHThe aim of this research was to describe the role of Community Health Workers, in the Mitanin Programme, in addressing social determinants of health in Chhattisgarh State of India, with the view to identify the pathways for strengthening and making recommendations on this aspect of the CHW’s work for existing or future CHW programmes. A comparative case study design using qualitative research methods was adopted for the study, with the sample comprising of two case studies of action on social determinants by CHWs. The definition of a case was ‘successful action by a CHW (Mitanin) or team of CHWs (Mitanins) on nutrition or violence against women in the village or cluster of villages for which the CHW/s are responsible’. The sampling of the cases followed the ‘replication logic’, that is, examination of similar cases to draw general lessons. Data collection was undertaken through In-depth Individual Interviews and Group Interviews with CHWs, community members and programme staff that participated with the CHWs in, and also benefitted from, their action on social determinants. Respondents were identified through a process of snowball sampling. Seventeen in-depth interviews and ten group interviews (total 27) were conducted as part of the study. A broad conceptual framework of the factors facilitating and constraining the action on social determinants by the CHWs, along with the pathways for action on social determinants by the CHWs, along with the pathways for action on social determinants by CHWs and their role, was developed at the start of the research. The analysis was done using this conceptual framework, which was refined during analysis, resulting in an explanatory framework. The analysis was two-fold. Firstly, both cases were analysed and written up separately and then they were analysed together in order to draw cross case conclusions. Thematic analysis was undertaken. Ethical Clearance was obtained from the UWC Senate Research Committee and permission was obtained from the State Health Resource Center, the body coordinating the Mitanin Programme in Chhattisgarh. A Participant Information Sheet and Informed consent forms for both the individual and the group interviews were prepared and administered. The form for the group interview included a confidentiality-binding clause. The study showed that the Mitanins in Durgkondal and Manendragarh (the Blocks under study) had effectively and successfully addressed the issues of nutrition and xvii violence against women as social determinants, in a manner visualized in the initial programme documents. Despite threats to the autonomy of the programme, pressures to formalise the Mitanin’s role, and backlash from vested interests, such action remained sustained, nearly ten years since the start of the programme.
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Mirbaha-Hashemi, Fariba. "Determinants of Mental Health Problems Among College Students." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc33227/.
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Many college students have reported struggling with mental health problems while dealing with challenging demands of college. The initial theoretical framework for this research was Pearlin's stress process model (SPM). Building on the SPM, the three additional mediating variables of perceived control, meaninglessness, and financial worries were added to create a composite model for the research. Mental health outcomes in the model were measured by a comprehensive range of factors, which included: psychological distress, suicide, substance abuse, and anger. Data were collected from a non-probability convenience sample of 463 undergraduate students attending a large state supported university in the southwestern region of the United States. Among the social status variables measured, being married, female, and white were significant predictors of poor mental health in the sampled college students. Poor self-image, feeling of meaninglessness, and worrying about current and future finances were significant mediating variables. Poor mental health could make individuals overwhelmed and discouraged. This is a formula for failure in college. The results of this study contribute to a better understanding of the correlates of mental health problems among college students. A greater understanding means that families and college administrations will have better ideas about how to intervene to reduce the stress of students and to focus the available and often limited resources to help young adults in their college experience.
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Sabbath, Erika. "Occupational Exposures as Social Determinants of Aging." Thesis, Paris 11, 2012. http://www.theses.fr/2012PA11T018.
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Cette thèse s’intéresse à la contribution des expositions professionnelles —chimiques, biomécaniques, et psychosociaux—tout au long de la vie dans les inégalités sociales de santé liés au vieillissement. Les trois papiers de la thèse essaient de combler les lacunes dans les connaissances sur les effets à long terme des expositions professionnelles et la contribution des expositions individuelles et conjointes dans ces inégalités. Le premier papier cherche à savoir si le niveau d’éducation atteint dans l’enfance modifie l’effet de l’exposition professionnelle aux solvants au cours de la carrière sur la fonction cognitive après 55 ans.. Nous avons trouvé que l’effet de l’exposition aux solvants sur la fonction cognitive était différent selon le niveau d’éducation.. Le deuxième papier discute les effets combinés des expositions biomécaniques et psychosociaux au cours de la vie professionnelle sur la santé physique et fonctionnelle après la retraite. Nous avons trouvé qu’une forte exposition à la fois aux risques physiques et psychosociaux au cours de la vie active est associée à une capacité fonctionnelle bien plus faible après la retraite que l’exposition à un seul type de risques. Aussi, l’effet était différent chez les hommes et chez les femmes. Le troisième papier est un papier méthodologique qui discute des alternatives aux formes longues des échelles généralement utilisées pour évaluer les expositions biomécaniques au travail. Nous avons cherché à vérifier si la question « Trouvez-vous votre travail fatiguant physiquement?» pourrait être une mesure de substitution acceptable pour évaluer des expositions détaillées.. Nous avons comparé la mesure à un item à une mesure plus complète de 38 expositions spécifiques dans huit domaines. Nous avons trouvé que la mesure à un item était plus valide chez les participants fortement exposés à des contraintes biomécaniques de travail. En somme, cette thèse a montré que les expositions professionnelles peuvent à la fois exacerber les disparités existantes en matière de santé et les perpétuer au delà de la retraiteThis dissertation focuses on how occupational exposures throughout the lifecourse—chemical, physical, and psychosocial—contribute to social patterns in aging outcomes, addressing the gap in knowledge about lasting effects of occupational exposures and the contribution of individual and combined exposures to social patterns in aging. The first paper explores whether childhood educational attainment modifies effects of occupational solvent exposure during the career on cognitive function after age 55. We found differential effects of solvent exposure on cognition by educational attainment. The second paper looks at combined physical and psychosocial exposures during working life and effects on physical health and functioning after retirement. This paper finds that high exposure to both physical and psychosocial hazards at work is associated with worse functional capacity in retirement than exposure to either one separately; the pattern of this relationship differs for men and women. The third paper is a methodology paper exploring alternatives to extensive testing batteries often used to evaluate physical workplace exposures. We tested whether the question “Do you find your work physically strenuous?” was an acceptable proxy measure for more detailed exposure assessments by comparing the measure to a comprehensive self-report measure of 38 specific biomechanical strains across eight domains. We found that the measure was most valid in the populations that were most highly exposed to physical strains at work. In general, this dissertation found that occupational exposures can exacerbate existing disparities in health and perpetuate disparities into and beyond retirement
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Andersen, Astrid Juhl. "Mental health and smoking behaviour during the COVID-19 pandemic : investigating social determinants." Electronic Thesis or Diss., Sorbonne université, 2023. https://accesdistant.sorbonne-universite.fr/login?url=https://theses-intra.sorbonne-universite.fr/2023SORUS580.pdf.
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En 2020, la pandémie de COVID-19 a provoqué une perturbation mondiale, entraînant rapidement la mise en place de mesures sanitaires qui ont changé la vie quotidienne des personnes. Cette thèse étudie les effets de cette pandémie sur la santé mentale et les habitudes tabagiques. L'objectif est de comprendre comment les troubles de santé mentale préexistants ont rendu les individus plus vulnérables, et comment les comportements tabagiques ont évolué durant cette pandémie, afin de mettre en lumière de potentielles inégalités sociales de santé. La première recherche a porté sur sept évaluations de l’anxiété et de la dépression entre mars et mai 2020. Elle a révélé un risque plus élevé de présenter de tels troubles au cours de la pandémie pour les personnes qui en présentaient déjà avant, chez les femmes, et les personnes souffrant de solitude durant la phase précoce de la pandémie. La deuxième partie de la thèse s’est intéressée à la prévalence du tabagisme, selon le niveau d'éducation. L'analyse, qui couvre la période 2009-2020, révèle qu’un faible niveau de diplôme est associé à une prévalence du tabagisme plus élevée comparativement à un niveau d'éducation supérieur, les personnes présentant un niveau supérieur étant plus susceptibles de réduire leur consommation de tabac, creusant ainsi le fossé des inégalités sociales. Le troisième volet a porté sur la mobilité sociale intergénérationnelle (progression ou régression du statut socio-économique des enfants par rapport à leurs parents) et son impact sur les habitudes tabagiques. Les résultats ont mis en évidence un gradient social dans le comportement tabagique, la mobilité ascendante sur l’échelle sociale protégeant contre le tabagisme à long terme. Cette thèse souligne l’importance de s'attaquer aux problèmes de santé mentale et au tabagisme dès le début des crises afin de réduire les inégalités en matière de santéIn 2020, the COVID-19 pandemic caused global disruption, prompting rapid sanitary measures that altered daily life. This thesis delves into the pandemic’s effects on mental health and smoking patterns. The objective is to understand how pre-existing mental health conditions rendered individuals vulnerable during the pandemic, and how smoking behaviours shifted. By studying these conditions, the aim is to illuminate health inequalities during crises. The research included up to seven assessments of anxiety and/or depression symptoms between March and May 2020. It found an increased risk of experiencing such issues for individuals with pre-existing symptoms, as well as for females and those experiencing loneliness during the initial pandemic phase. The thesis’s second focus was on smoking prevalence, especially among different levels of education. The analysis spanned from 2009 to 2020, revealing that lower education was associated with higher smoking prevalence; and that those with higher education were more likely to reduce tobacco use compared to their less educated counterparts, thereby widening the social inequality gap in smoking prevalence. The third aspect investigated intergenerational social mobility (the advancement or decline of children’s socio-economic status compared to that of their parents) and its impact on mid-life smoking patterns. Results highlighted the social gradient in smoking behaviour and revealed that upward mobility provided protection against long-term smoking. This thesis highlights the importance of addressing mental health and smoking at the outset of crises, whether they are related to health, climate, or the economy, in order to reduce social inequalities in health
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Jaishankar, Gayatri, and Deborah Thibeault. "Screen, Uncover, Connect: A Hands-on Approach to Elucidating the Social Determinants of Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/8870.
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Hong, Jihyung. "Socio-economic inequalities in mental health and their determinants in South Korea." Thesis, London School of Economics and Political Science (University of London), 2012. http://etheses.lse.ac.uk/494/.
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Suicide rates in South Korea (hereafter ‘Korea’) have seen a sharp upward trend over the past decade, and now stand amongst the highest in OECD countries. This raises urgent policy concerns about population mental health and its socioeconomic determinants, an area that is still poorly understood in Korea. This thesis sets out to investigate socio-economic inequalities in the domain of mental health, particularly for depression and suicidal behaviour, in contemporary Korea. The thesis first evaluates the extent of income-related inequality in the prevalence of depression, suicidal ideation and suicide attempts in Korea and tracks their changes over a 10-year period (1998-2007) in the aftermath of the 1997/98 economic crisis. Based on four waves of the Korea National Health and Nutrition Examination Survey (KHANES) data, concentration indices reveal a growing trend of pro-rich inequalities in all three outcomes over this period. To understand the potential impact of the observed widening income inequality, the next empirical investigation examines whether income inequality has a detrimental effect on mental health that is independent of a person’s absolute level of income. Due to the paucity of time series data, the analysis focuses on an association between regional-level income inequality and mental health, using the 2005 KHANES data. The results provide little evidence to support the link between the two at regional level. The thesis pays special attention to suicide mortality rates given their disconcerting trend in contemporary Korea. Using mortality data for 2004-2006, the third empirical investigation first elucidates the spatial patterns of suicide rates, highlighting substantial geographical variations across 250 districts. The results of a spatial lag model suggest that area deprivation has an important role in shaping the geographical distribution of suicide, particularly for men. The final empirical investigation sets out to understand the suicide trend in Korea in the context of other Asian countries (Hong Kong, Japan, Singapore, and Taiwan), using both panel data and country-specific time-series analyses (1980-2009). Despite similarities in geography and culture, the suicide phenomenon is unique to Korea, particularly for the elderly. The overall findings suggest that low levels of social integration and economic adversity may in part explain the atypical suicide trend in Korea.
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Salinas-Miranda, Abraham A. "Social Determinants of Racial and Ethnic Disparities in Perinatal Morbidity: Social Origins of Perinatal Health Study." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4937.
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BACKGROUND: The social causation of preterm birth remains elusive, without an adequate explanatory framework. Thus, this study proposed and evaluated a conceptual model of the social determinants of perinatal health for the understanding of perinatal health disparities.
METHODS: A prospective cohort study was conducted with pregnant women between 20 and 35 weeks gestation who were participating in two Healthy Start programs in Central Florida, from July 2011-August 2013. Perinatal health was operationalized based on gestational age, birth weight, and healthy start infant risk screen score. The predictors were: early life adversity, social position, maternal health-related quality of life, maternal stress, racism and discrimination, lack of social support, father involvement during pregnancy, intimate partner violence, and adverse maternal behaviors. Data collection consisted of a self-administered survey and birth outcome data was obtained from Healthy Start administrative databases. The statistical framework was structural equation modeling.
RESULTS: The study sample was racially and ethnically diverse (N, Hispanics=72; N, non-Hispanic blacks=61; and N, non-Hispanic whites=48). The majority of mothers in this study were single or not married (cumulative 76%), US born (74.6%), and with English speaking preference (74.6%). The sample tended to cluster in low income groups (cumulative 58% less than $25,000 annual household income) and with education levels of less than high school (79.6%). A greater proportion of Hispanic mothers were married (66.7%) compared to non-Hispanic blacks (34.4%) and non-Hispanic whites (47.9%). Only 41.7% had completed high school, compared to 63.9% non-Hispanic blacks and 64.6% non-Hispanic whites. Nearly all non-Hispanic blacks and non-Hispanic whites were born in the US, compared to only 43.1% Hispanic mothers. Only 40% of non-Hispanic blacks reported on currently living with the baby's father at the time of the survey, compared to 66.2% for Hispanic mothers, and 58.3% for non-Hispanic whites. Furthermore, non-Hispanic blacks reported a greater proportion of discriminatory experiences in daily situations (mean = 4.74), compared to the other groups (mean for Hispanics was 2.14, and mean for non-Hispanic whites was 1.95). Non-Hispanic whites reported the greater proportion of daily alcohol use (mean 3.8 beverages per month), compared to other groups (Hispanic mean was 0.69, and non-Hispanic blacks mean was 1.68). Non-Hispanic white mothers also presented a higher mean of adverse childhood experiences before 18 years of life (mean = 3.4), compared to other groups (mean for Hispanics was 1.63, mean for non-Hispanic blacks was 2.48). With the exception of the confirmatory factor analysis for intimate partner violence (low correlations with common factor), all other confirmatory factor analyses demonstrated an acceptable Chi-square to degrees of freedom ratio (<6), and the RMSEA was less than 0.08 (minimum for acceptance). Thus, structural equation models were estimated subsequently. The first model was a model of direct effects between social position and perinatal health (hypothesis 1: direct effects), which demonstrated a good fit as indicated by X2/DF ratio of 1.4 (Chi-Square = 19, DF =13) and a RMSEA of 0.05. However, the direct effect of social position was very small and non-significant (Beta=-.02, p-value =.76), supporting the conclusion that a simple direct effect of social position on perinatal health was not found in this population. The second model explored indirect effects of social position through intermediate factors (hypothesis 2: indirect effects), which demonstrated a good fit to the data, as indicated by a Chi-square/df ratio = 1.45 and RMSEA=.05. Social support was a statistically significant mediator between social position (Beta=0.284, p<0.05) and perinatal health (Beta=0.22, p<0.05). The third model incorporated adverse childhood experiences as predictor of social position effects. Adverse childhood experiences were significantly associated with social position (Beta=.363, p<0.05) and moderated the effects of social position on social support and perinatal health. In the presence of adverse childhood experiences, the social position was significantly associated to maternal health-related quality of life (Beta=-0.226, p<0.05) and maladaptive maternal behaviors (Beta=0.654, p<0.05).
CONCLUSION: This study demonstrated synergistic effects of social determinants of health. Controlling for all factors considered, social support was significantly associated with perinatal health, which presents implications for strengthening prenatal programs that provide support to pregnant women. Findings need to be replicated in larger studies with the US general population. Policy makers and researchers need to pay greater attention to the role of early life adversity on perinatal health outcomes.
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Begu, Besa. "Karies i Kosovo Relaterad till Sociala Bestämningsfaktorerer / Dental Caries in Kosovo Related to Social Determinants." Thesis, Malmö högskola, Odontologiska fakulteten (OD), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19689.
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Syftet med denna studie var att via intervjuer av nyckelpersoner, varav tre inom vårdsektorn och en antropolog, identifiera en del av de faktorer som påverkar arbetet med att förbättra den orala hälsan och i synnerhet införandet av ett förebyggande tandvårdssystem i Kosovo. Kvalitativa intervjuer med fyra nyckelpersoner genomfördes och analyserades enligt Graneheim och Lundmans kvalitativa innehållsanalys. Resultat av intervjumaterialet mynnade ut i följande kategorier: Förebyggande tandvård saknas, Socioekonomiska hinder, Brist på strategi och fakta och God vilja. Kategorierna visar på följande faktorer som påverkar situationen för den orala hälsan i Kosovo. Det finns en hälsoplan där man bland annat planerar att minska kariesförekomst med 10 procent fram till år 2014, men den verkställs inte. Detta får till följd att kariesprevalensen fortfarande är hög och akuttandvården dominerande. Resultat från intervjuerna visar även att sociala bestämningsfaktorer påverkar oral hälsa och tillgången till tandvård, patienter med låg socioekonomisk status undviker tandvården och söker vård endast vid akut värk. Respondenterna uppgav att epidemiologiskt underlag och forskning skulle underlätta utveckling av olika preventiva aktivitetsprogram. Brist på ett sjukförsäkringssystem och korruption anses förhindra utvecklingen av en fungerande förebyggande tandvård. I intervjumaterialet har faktorer identifierats som på sikt gynnar införandet av den förebyggande tandvården. Man har nyligen startat en kurs i förebyggande tandvård vid odontologiska fakulteten i Pristina. Studien visar att avsaknad av ett förebyggande tandvårdssystem försvårar situationen för den orala hälsan i Kosovo. De sociala bestämningsfaktorerna påverkar idag tillgången till tandvården och även utveckling av hälso- och sjukvårdssystemet.The aim of the study was that through interviews with key persons, including three in health sector and an anthropologist, identify some of the factors affecting the work to improve the oral health and especially the introduction of a preventive dental care system in Kosovo. Qualitative interviews with four key persons was conducted and analyzed, according to Graneheim and Lundmans qualitative content analysis. Results of the interviews fall into the following categories: Preventive dental care is lacking, Socio-economic barriers, Lack of strategy and facts and Good will. The categories show the following factors affecting the situation of the oral health in Kosovo. There is a health plan that includes plans to reduce tooth decay by 10 percent until 2014, but it is not being executed. This has the effect of caries prevalence is still high, and emergency dental care is dominant. Results from the interviews also show that the social determinants affect oral health and access to dental care, patients with low socioeconomic status avoids dental care and seek treatment only for acute pain. Respondents stated that the epidemiological data and research would facilitate the development of preventive activity program. Lack of a health insurance scheme and corruption are considered being barriers for the development of a workable preventive dental care. The interviews also identified factors which ultimately favor the introduction of preventive dental care. Recently the faculty in Pristina started a course in preventive dentistry. The present study shows that the lack of a preventive dental care system complicates the situation for the oral health of Kosovo. The social determinants are affecting the access to dental care and also development of the health care system.
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Acadia, Spencer. "Exploratory Analysis of Social E-health Behavior." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc500111/.
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Extant literature has documented well that people seek health information via the internet as patients and consumers. Much less, however, is known about interaction and creation behaviors in the development of new online health information and knowledge. More specifically, generalizable sociodemographic data on who engages in this online health behavior via social media is lacking in the sociological literature. The term “social e-health” is introduced to emphasize the difference between seeking behaviors and interaction and creation behaviors. A 2010 dataset of a large nationally representative and randomly sampled telephone survey made freely available from the Pew Research Center is used to examine social e-health behavior according to respondents’ sociodemographics. The dependent variable of social e-health behavior is measured by 13 survey questions from the survey. Gender, race, ethnicity, age, education, and income are used as independent variables. Logistic regression analysis was used to determine the odds of engagement in social e-health behavior based on the sociodemographic predictors. The social determinants of health and digital divide frameworks are used to help explain why socioeconomic variances exist in social e-health behavior. The findings of the current study suggest that predictable sociodemographic patterns along the dimensions of gender, race, age, education, and income exist for those who report engaging in social e-health behavior. This study is important because it underscores the fact that engagement in social e-health behavior is differentially distributed in the general U.S. population according to patterned sociodemographics.
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Sharif, Fatima. "Public Health Officials' Perspectives on the Determinants of Health: Implications of Health Frames on Policy Implementation in State Health Departments." Diss., Virginia Tech, 2015. http://hdl.handle.net/10919/73500.
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Recent public health scholarship finds that health outcomes are explained by the social and individual determinants of health rather than the individual-level determinants alone. The individualistic perspective has dominated the 20th century institutionalization of public health in the United States where the public health system has tended to focus largely, if not exclusively, on individual factors. This persistent orientation lies in contrast to another set of perspectives that have also persisted, focused on social causes, which are currently dominant in contemporary public health academic literature and in major, international health organizations. Whether the orientation within the United States is due to a prevailing paradigm among public health officials or is the result of new ideas about health causation being dampened under organizational weight is unknown. Despite public health being central to decreasing morbidity and mortality in the 20th century, significant gaps remain in researchers' understanding of what influences practice in the American public health system.
My dissertation research investigates the broad outlines of the determinants of health as understood by state public health administrators. I study how the understanding of the determinants of health affects the practice of public health through analyzing how the ideas of state public health administrators interact with the organizational dynamics of the public health organizations they lead. This mixed-methods dissertation uses survey research and in-depth interviews and quantitative and qualitative analysis.
I find that state public health officials' professionalization, length of tenure, level of education, and gender affect the perspective of health causation to which they adhere. I also find that the state public health officials with a social health frame more commonly report they are situated in organizations that are learning environments. Both organizational and ideational factors influence public health practice. The interview data expand this finding to paint a complex picture of organizational and ideational factors influencing one another as well as resulting practices. This research reveals that state public health officials often have strong health frames that are only able to shape the edges of their practice due to the political and organizational dynamics interacting with state public health departments.Ph. D.
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Gonçalves, Crhistinne Cavalheiro Maymone. "Atuação sobre os determinantes sociais da saúde em uma iniciativa de Campo Grande, MS - Projeto Viva Seu Bairro." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-21052010-170252/.
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Introdução: O Projeto Viva Seu Bairro (PVSB) foi uma iniciativa desenvolvida em seis regiões urbanas da cidade de Campo Grande MS, no período de 2001 a 2004, nas áreas de maior risco social, identificadas pelas equipes de agentes comunitários de saúde e saúde da família. O projeto teve como objetivo a redução das desigualdades sociais por meio de ações que atuaram sobre Determinantes Sociais da Saúde (DSS). Objetivo: A pesquisa buscou conhecer a relação entre o PVSB e os determinantes sociais da saúde, bem como identificar a presença da participação social e da intersetorialidade nas ações desenvolvidas. Material e Métodos: Trata-se de pesquisa de abordagem qualitativa. Foram realizadas entrevistas individuais com gestores da administração municipal e com técnicos da Unidade Técnica Central (UTC), responsável pelo gerenciamento do projeto. Seis grupos focais foram realizados, um em cada região urbana que teve a implementação da iniciativa, com representantes dos Conselhos Regionais Urbanos (CRU). Além disto, foi feita a análise de documentos relacionados ao PVSB. Para a análise dos dados, utilizou-se a análise de conteúdo, por meio da análise temática com a triangulação dos dados obtidos. Resultados: Os resultados da pesquisa apontam uma série de ações que incidiram sobre as condições materiais e psicossociais nas quais as pessoas vivem e trabalham, como proposto pelo modelo adotado nas recomendações do Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde (2008). As mais descritas pelos participantes foram as que visaram assegurar saneamento básico, habitação adequada, emprego, serviços de saúde e de educação de qualidade. Verificou-se o protagonismo do setor saúde no desencadeamento da iniciativa. Conclusões: A participação social foi fortalecida na cidade durante e após a iniciativa. Quanto à intersetorialidade, houve a busca por parcerias e o reconhecimento, por parte dos representantes de governo, da necessidade de se implementar redes sociais, o que, no entanto, não se institucionalizou como práticas da administração municipal. A discussão sobre a sustentabilidade ocorreu de modo insuficiente e a avaliação da iniciativa começou um ano e meio após o seu início, o que comprometeu a avaliação de processo. Os participantes da pesquisa reconheceram que o PVSB interferiu na melhoria da qualidade de vida da população local. Conclui-se que o PVSB configurou-se como iniciativa do campo da promoção da saúde, atuou sobre os DSS, fortaleceu os mecanismos de participação nos CRU e buscou mecanismos de ação intersetorialIntroduction - The Project \"Viva Seu Bairro\" (PVSB) was an initiative developed in six urban regions of the city of Campo Grande - MS, from 2001 until 2004, in the areas of greater social risk, identified by the teams of community health and family health agents. The project had as its aim to reduce the social inequalities through actions, which acted on the Social Determinants of Health (SHD). Objective - The research tried to know the relation between PVSB and the Social Determinants of Health, as well as to identify the presence of the social participation and the intersectoriality in the developed actions. Material and Methods - It is about a research of qualitative approach. Individual interviews were performed with managers of the municipal administration and with technicians from Central Technical Unity, responsible for the project administration. Six focal groups were carried out, one in each urban region that had the initiative implementation, with representatives from the Urban Regional Councils. Moreover, an analysis of the documents related to PVSB was done. The Content Analysis was used for the analysis of the data through the thematic analysis and then the triangulation of the obtained data. Results - The results of the research point out a series of actions that occurred to the material and psychosocial conditions in which the people lived and worked, as proposed by the model adopted in the recommendations of the Final Report of the National Commission on Social Determinants of Health (2008). The items most described by the participants were the ones that targeted to assure basic sanitation, appropriate dwelling, employment, health and education services of quality. It was verified the prognostic of the health sector in the breaking of the initiative. Conclusions - The social participation was strengthened in the city during and after the initiative. In relation to the intersectoriality, there was a search for partnerships and the recognition, from the government representatives, of the necessity to implement social nets, which however, was not institutionalized as a practice in the municipal administration. The discussion about the sustainability occurred in an insufficient way and the initiative evaluation started one year and a half after its beginning, which compromised the process of evaluation. The research participants recognized that PVSB interfered in the improvement of the local population life quality. It was concluded that PVSB configured as an initiative in the field of health promotion, acted on SHD, strengthened the mechanisms of participation in the CRU and looked for mechanisms of intersectorial action.
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Matilla, Santander Nuria. "Social determinants of Health in Europe: precarious employment and new forms of work." Doctoral thesis, Universitat Internacional de Catalunya, 2019. http://hdl.handle.net/10803/668430.
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Even though the health effects of precarious employment (PE) have been studied in the past recent years, data from years after the Great Recession has not yet been explored using a multidimensional approach in Europe. Further, digitalization of the labour market is happening, and new forms of work are appearing. But, its potential implications for the worker’s health are unknown. Given the similar characteristics of PE and gig work, the health impact of platform work could be huge. The main aim of this thesis is to describe the health status and occupational safety of precariously employed and gig workers, years after the Great Recession in Europe. The thesis was performed using two European surveys (Flash Eurobarometer 398 on Working Conditions and the Sixth European Working Conditions Survey) and occupational safety data obtained through direct observation in Barcelona (Spain). The results found in the thesis show that years after the Great Recession, PE is present in the European workforce. PE is more common among women, young workers and individuals with lower educational level. Moreover, as PE quartiles increase, so did the prevalence of declaring to suffer any health problem. The most precarious employees and unemployed individuals declare in similar magnitude health problems. In addition, to be precariously employed is not associated to exercise the right of sick leave shorter than 15 days. Instead, it is related to long sick leave (more than 15 days). Further, precariously employed workers are more exposed to violence and harassment, stress and repetitive movements or painful positions in the workplace than workers not precariously employed. Similarly, delivery gig workers do have an irregular use of personal protective equipment and frequently violate traffic regulations. Based on the results and conclusions obtained in the thesis, some recommendations from public health are pointed out. First of all, current labour market regulations should be reconsidered in order to achieve the 8th sustainable development goal of decent work and economic growth by 2030. Second, Public Health agencies should monitor precarious employment as another determinant of health. Third, it is necessary to solve the probable misclassification of gig workers as dependent self-employed in order to protect them from occupational risks. Finally, new approaches for addressing occupational safety at work in platform digital work should be carefully reviewed.
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Tolliver, Robert Matthew, Deborah Thibeault, Gayatri Bala Jaishankar, Karen E. Schetzina, and Jodi Polaha. "Linking Families to Resources: Assessing Social Determinants of Health in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5033.
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Background/Rationale: The American Academy of Pediatrics recommends universal surveillance of social determinants of health in primary care. Addressing these determinants is likely crucial to reducing extant health disparities. Such screening in urban pediatric primary care has been shown to increase access to relevant resources for families when combined with provider training in using a community resource binder (Garg et al., 2007). However, resources in more rural areas are often scarce and helping families navigate a complex resource system often requires a more individualized approach. Additionally, in an increasingly screener heavy pediatric environment, social determinant screeners that are comprehensive but brief are needed to reduce the burden on both patients and providers.
Methods/Results: A brief TEAM Care social determinants screener protocol was developed to meet the needs of families presenting to ETSU Pediatrics. Our clinic serves primarily low income families, many of which live in ruralareas. During the first eight months of data collection, 2043 TEAM Care screeners were administered at annual well child checks. The prevalence of caregiver endorsed concerns was as follows: financial concerns impacting ability to pay for food, housing, or utilities (7%), transportation problems (4%), caregiver depression (4%), concerns about caregiver drug/alcohol use (2%), domestic violence (1%), and literacy problems (1%). 13.4% of caregivers endorsed at least one concern on the screener. Caregivers who endorsed a concern were provided individualized resources via a warm handoff or phone call by integrated social work interns. Interns were available on an ongoing basis to check in with families, adjust resource recommendations as needed, and coordinate care with the child’s primary care physician. Our poster will report on an anticipated 3000 TEAM Care screeners collected during the first year of administration.
Conclusion: Last year at CFHA, we reported the initiation of the TEAM Care Screener, modeled after the WE CARE Screener (Garg et al., 2007) and designed to screen for social determinants of health in pediatric primary care via six items. Previous preliminary reports of this study included data from approximately 1000 screeners. A one year report of the TEAM Care screener will be completed in September 2017, making it ideal timing to present at CFHA in October 2017. We anticipate reporting prevalence data from 3000 screeners and incorporating results from a provider satisfaction survey of the screener process. The TEAM Care screener process was designed to maximize efficiency for families and providers, and the addition of social work interns ensures that families who endorse needs receive individualized help. A future goal is to more systematically follow up with families to determine how many were connected to recommended resources.
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Surapaneni, Lahari. "Design and Development of an Immersive Simulation for Social Determinants of Health Training." Wright State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wright1578848970708681.
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Osakwe, Godwin C. "Social Determinants of Health and Knowledge about HIV/AIDS Transmission Among Nigerian Adolescents." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3816.
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HIV is a virus that leads to AIDS. Millions of people are living with HIV. Globally, there is an increased incidence of this disease among adolescents. In literature, there is a gap regarding how social determinants of health have jointly or singly contributed to HIV/AIDS transmission. With the application of the AIDS risk reduction model (ARRM) to the secondary analysis of survey data, the purpose of this study was to determine whether any significant relationships existed between adolescents' childhood health care factors, demographic factors, social-level factors, structural-level factors, aspects of disease management factors, and knowledge about HIV transmission/AIDS among Nigerian adolescents. Survey data were used from Measure Demographic and Health Survey (MDHS) in Nigeria for 2008. Multiple linear regression revealed that childhood vaccinations were a weak predictor for HIV transmission risk (R2 - 0.020). Gender, age, place of residence, education, religion and culture, some disease management aspects (e.g., accessibility and affordability of care), and wealth index were all significant but weak predictors of knowledge of HIV/AIDS (R2 = 0.016, R2 = 0.019, R2 = 0.003 & R2 0.015). The potential positive social change effect of the study would be HIV transmission reduction through increasing knowledge of HIV/AIDS among adolescents in Nigeria. The results could be used by both governmental and nongovernmental organizations to influence childhood healthcare improvements and advance education to help reduce or eradicate the causes of HIV/ AIDS transmission among adolescents in Nigeria.
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Chang-Cabanillas, Sergio, Joshua Peñafiel-Sam, Samuel Alarcón-Guevara, and Reneé Pereyra-Elías. "Social determinants of mammography screening among women aged 50 to 59, Peru 2015." Taylor and Francis Inc, 2020. http://hdl.handle.net/10757/652448.
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Breast cancer (BC) screening could reduce its mortality; however, its access is influenced by societal forces. Our objective is to identify the social determinants associated with mammography screening (MS) in women aged 50 to 59 in Peru. In this cross-sectional analysis of the Peruvian Demographic Health Survey, 2015, MS within the past two years was evaluated through self-report. Prevalence for MS was 21.9% [95% CI: 18.9 to 25.1]. The average age was 54 years (s.d.: 2.5). The higher the socioeconomic status, the higher the prevalence of screening (3.2% vs 41.4% in extreme quintiles, p <.001). In the adjusted models, higher socioeconomic status (PR: 5.81, 95% CI: 2.28 to 14.79), higher education level (PR: 2.03, 95% CI: 1.30 a 3,15) and having health insurance from the Ministry of Health (PR: 2.21, 95% CI: 1.28 to 3.82) and EsSalud (PR: 4.37, 95% CI: 2.67 to 7.15), were positively associated with MS. Social inequalities in screening access exist and might translate into inequalities in cancer morbidity and mortality. The Peruvian government urgently needs to improve screening rates in these vulnerable populations.Revisión por pares
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Freitas, Rita Alexandra dos Santos Bento Mendes. "Risco em Saúde e Políticas Sociais:a Intervenção do Serviço Social Local na promoção do Acesso à Saúde." Master's thesis, Instituto Superior de Ciências Sociais e Políticas, 2016. http://hdl.handle.net/10400.5/11581.
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Dissertação de Mestrado em Sociedade, Risco e SaúdePretende analisar-se o papel do Assistente Social ao nível da intervenção social nas autarquias locais, analisando o impacto da intervenção e respostas sociais a situações de risco, originadas sobretudo por carência face a recursos materiais e imateriais, bem como o impacto destas carências. É brevemente caracterizada a situação socioeconómica e de saúde da população alvo, identificadas necessidade sociais em saúde, aspetos relacionados com pobreza e exclusão social, alguns determinantes sociais de saúde identificados na população e alguns aspetos da intervenção social em análise. Com base nesta análise será possível compreender-se alguns aspetos da relação entre risco, saúde e condições gerais de vida da população que recorre a acompanhamento social na de Freguesia, fazendo a ponte com os conhecimentos empíricos e práticos existentes.
In this work we pretend to understand the paper of a Social Worker in state local intervention, the impact of the intervention and social reply in situations of risk, orginally material or not, and the impact of them. Describe parts of the social and economic situation in health, needs in health, phenomena of poverty and exclusion and Social determinants of Health in population of Local Social Work. With this review we will try to understand parts of the relation in risk, health and life condition.
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Darmadi-Blackberry, Irene 1972. "Survival amongst longevity cultures : social, physical activity and nutritional determinants." Monash University, Monash Asia Institute, 2001. http://arrow.monash.edu.au/hdl/1959.1/9220.
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