Lecture Notes: Social Determinants of Health and Health Inequality

Overview

• Biological Perspective: Traditional view emphasizes genetic determinism.
• Broader Perspective: Emphasizes development, interaction with the environment, and socio-economic factors.
• American Health Paradox: Despite high medical spending, the U.S. ranks low in life expectancy compared to other developed nations.

Key Points

Health Disparities in the U.S.

• Spending vs. Outcomes: U.S. spends $2 trillion annually on healthcare but has poor health outcomes.
• Life Expectancy and Infant Mortality: Ranks low among industrialized nations.
• Health Insurance: Lack of coverage is not the sole cause of poor health outcomes.

Social Determinants of Health

• Economic Status: Impacts behaviors like diet and smoking.
• Education and Income: Strongly correlate with health outcomes.
• Living Conditions: Districts in Louisville show variance in health linked to socio-economic status.

Research and Case Studies

• Whitehall Study: Revealed health disparities even among those with universal healthcare.
• Social Gradient: Direct correlation between socio-economic status and health outcomes.
• Chronic Stress: Linked to socio-economic status; affects health through stress response and cortisol levels.

Societal Organization and Health

• Social Policy's Role: Lack of adequate policies can exacerbate health inequalities.
• Control of Destiny: Importance of perceived control over one’s life in managing stress and improving health.

Case Studies in Louisville

• Council Districts: Different areas show varying life expectancy linked to economic and social conditions.
• Examples of Individuals: Jim Taylor (affluent), Tondra Young (middle class), Corey Anderson (lower-middle class), and Mary Turner (poor) illustrate the impact of socio-economic status on health.

Racial Inequalities

• African Americans: Face worse health outcomes even with higher socio-economic status due to added stressors like discrimination.

Historical Context and Policy

• Improvements in Health: Historically linked to social policies (education, work conditions, housing).
• Economic Policy as Health Policy: Demonstrated by the narrowing of health gaps during periods of reduced economic inequality.

Global Context

• Comparison with Other Nations: Countries with better distribution of wealth have healthier populations.

Community Initiatives

• Local Actions: Communities like Louisville are taking steps to address health inequities through local policies and empowerment.

Future Directions

• Focus on Social Determinants: Key to improving health outcomes is addressing social and economic conditions.
• Public Health and Policy: Need for a movement towards equity and social justice in health.

Conclusion

• Investment in Equality: A fair and just society benefits all, reducing the nation’s overall health burden and improving productivity.
• Urgency: Need to act to prevent a future where younger generations have poorer health outcomes than their predecessors.