What Is Social Determinants Of Health Essay Example

The social determinants of health are complex, multifaceted concepts that involve more than just simple access to medical care. While having access to quality and affordable care is, arguably, one of the most essential factors in maintaining adequate health, research indicates that various factors ranging from education, economic stability, and resource insecurities are just as important when it comes to determining overall health (Artiga & Hinton, 2018). This is most evident in the case of Naomi and her daughter. Naomi is a single, undocumented immigrant mother living in Memphis, TN. As an immigrant, regardless of her zip code, she will already be facing difficulties with marginalization, acculturation, and, in her case, risk and fear of deportation (Chang, 2019).

In turn, her lack of a documented status, work visa, assumingly higher education and a potential language barrier leads to complications finding a job that provides her with both a livable wage and benefits such as health insurance. Research supports this by reporting that over half of undocumented immigrants, such as Naomi, live below the US poverty line and are more likely to receive lower wages and less benefits than their documented counterparts (Chang, 2019). Therefore, not only do her employers not provide her with insurance, but her wage further impedes her ability to afford her cost of living let alone self-financed health insurance. Further, after expenses, Naomi is left with a surplus of only $125/month to be used to provide for her family and, unfortunately, without insurance the cost of seeking medical care and subsequent treatment would far exceed that amount. In addition, even if treatment was sought, the potential of having a language barrier that could impede communication with medical staff would prove to be a significant obstacle for Naomi. This could then lead to inadequate care, miscommunications, and even medical errors. In the end, determinants such as immigration status, education level, and speaking appropriate English will all affect Naomi’s abilities to seek out medical care.

One resource that is available to Naomi in terms of healthcare is the Church Health (2020) organization located in Midtown. They are a local non-profit that caters to the uninsured by providing services such as a medical clinic, an emergency walk-in clinic, a pharmacy, a dental clinic, physical rehabilitation, eye care, as well as behavior health treatment. Naomi is able to utilize their walk-in clinic as a non-established patient (for a small fee) if she deems her daughter requires immediate medical attention or she can take the time to register as an established patient in order to seek more of a primary care setting. She would simply need to provide proof that she is an uninsured resident of Shelby County and that she works at least 20 hours/week to complete this process. Church Health (2020) also has access to Spanish resources, as this would assumingly apply to Naomi, that would allow her to more effectively communicate with her daughter’s providers and them with her. Finally, there is a pharmacy that would provide Naomi with significant discounts on the medications her daughter might require.

One additional resource that could be at Naomi’s disposal is the Mid-South Food Bank (2020) (MSFB), a continuum of the larger Feeding America organization. Through their programs such as Mobile Pantry, Kids Cafe, Food for Kids BackPack Program, and Healthy School Pantries, MSFB is capable of providing a variety of fresh produce, meat/dairy products, as well as non-perishable food items to the multiple impoverished and underserved Memphis populations. This could prove useful for Naomi in ensuring that her family has access to healthier food options that do not exceed her budget and could simultaneously aid in decreasing their risk for further health complications.

Naomi’s situation is one that is very applicable to a multitude of individuals living in the US today. She is an undocumented, female, immigrant that is essentially forced into working low-wage, menial jobs that often offer no benefits and little to no opportunity to climb the cooperate and social ladders. As a healthcare provider, it is imperative that conversations are had to aid in decreasing these determinants of health as well as the stigma and marginalization that surround these individuals.

In addition, it can be argued that it is our ethical duty to treat these individuals regardless of immigration status and to aid in removing the obstacles they experience when seeking healthcare. People are unnecessarily dying simply because of how cooperate healthcare has decided to monetize health. When taking the Hippocratic oath there is no addendum stating ‘I will only treat those who can afford to be treated’. It is remembering that these are not just illnesses that are being treated, but rather human beings that are worthy of being treated simply because they are alive.

Finally, it is not the responsibility of these marginalized groups to make the effort but rather us, the ones that have the capability to promote positive, systemic change from within. As providers, collaborating with various disciplines of various expertise is essential when expecting to provide holistic care. Treating just the presenting symptoms is not enough. It will be by collaborating as a team that we can provide patient-centered care that aids in improving all aspects of their life, albeit social work, local food pantries, shelters, etc. In the end, it needs to be the healthcare providers that change healthcare.

Exposure To Determinants Of Health And The Reduction Of Implicit Weight Bias

While human beings have been persistent throughout history in creating divisions based on perceived difference, these barriers can be broken down in thinking about the shared possession of implicit biases. Spawning from one’s primary socialization and early experiences, implicit biases are automatic attitudes and beliefs that can occur without intent or consciousness about another individual or group. (Rudman, 2004). While the types of implicit biases held by individuals vary, the perpetuation of implicit weight bias specifically may in fact spawn from societal institutionalization of perceived health in relation to weight. It’s from this societal perpetuation of assumptions that people are in complete control of their weight, and of the negative associations towards certain body sizes that have become ingrained in the population via social media, that it has become more important than ever before to find ways to reduce implicit biases regarding weight. In this particular study we have chosen to focus on how the level of exposure to determinants of health effect implicit bias.

Hypothesis: Increasing exposure to determinants of health will reduce implicit weight bias.

Predictors of Implicit Bias

In order to construct an effective means for reducing implicit weight bias, we must first gain an understanding for how such biases arise. One contributing factor to the development of implicit weight bias is that of early experiences. Throughout childhood and adolescence, individuals are unknowingly constructing their worldview and perceptions of others based, in large part, on the primary and secondary socialization they are exposed to. Therefore, one’s upbringing is important in determining what explicit and implicit biases they will carry throughout adulthood. Lydecker, O’Brian, & Grilo (2018), proposed that parents of children aged between five and fifteen years old would show implicit bias towards overweight children, yet parents who were overweight themselves or had children who were overweight would present less implicit weight bias due to increased positive exposure to obesity. As children often seek validation from parental and authority figures, the implicit attitudes held by such individuals are likely to inadvertently influence the malleable mindsets of those in adolescence. With this underlying assumption in mind, the Lydecker, O’Brian, & Grilo (2018) study had parents complete a survey about both their personal and their child’s weight, take the IAT for child obesity and the “Attitudes Towards Obese Person” scale to showcase both implicit and explicit weight biases held by participants. The study ultimately found that despite demographic features of both adult participants and children, parents showcased implicit bias against overweight children. Though overweight parents showed reduced explicit bias towards overweight children, such reductions weren’t found in relation to their implicit weight bias (Lydecker). Essentially, exposure to stigmatized weights may help in reducing explicit weight bias, however, it is not enough to prevent or even reduce implicit weight bias. This further elucidates just how ingrained weight bias is in our societal mindset, yet it also showcases that parents do hold implicit weight biases that are likely to surface in the upbringing of their children. Influencing future generations to hold similar conscious or unconscious attitudes about weight.

While early experiences and one’s upbringing are important predictors of the development of implicit biases, exposure to societal norms and idealism throughout adolescence is another influential factor. Though weight biases seem to defy borders, emerging in even the most remote areas around the world, the specific sociocultural context in which one grows up can be a critical influence in the implicit associations individuals develop in relation to different weights. Latner and Colleagues (2007) approached the development of weight based discrimination in adolescents by focusing on the effects exposure to media, such as television, has on children. Ultimately, this study asked 171 children, aged ten to thirteen, to look at twelve pictures showcasing children with and without obesity and disabilities. Participants ordered the pictures based on “liking”, rated how they felt towards the obese individuals pictured, and then distinguished their total media usage on a weekly basis (including television, video games, and magazines). Findings of this study established a correlation between increased media exposure and higher rates of dislike and stigma towards obese children (Latner). With American media outlets focusing on the promotion of thinness as a direct indicator of health and positivity, while advertising obesity in a much more negative light, the surface level interpretation weight elicited across such mediums becomes increasingly internalized by today’s youth (Eisenberg). Eisenberg and colleagues (2015) further elucidated such points in their study looking at prevalence of weight-stigmatizing incidents on popular television shows. Ultimately, they found that such portrayals of weight stigmatization aided in normalizing such weight biases amongst adolescents as behavior and attitudes that are accepted and expected (Eisenberg). It is with this over exposure to the normalization of weight bias, based on surface level attributions of appearance, that implicit weight biases form with disregard to the actual underlying determinants of health.

Consequences of Implicit Bias

The development of implicit weight biases ultimately lead to the emergence of stigmatization, which is the action of regarding others with disapproval. Cheng et al. (2018) performed a study utilizing questionnaires to determine the association of weight bias and perceived weight stigma with that of eating behavior and psychological distress amongst undergraduate students in Hong Kong. Ultimately, researchers in the study found that weight bias was related to increase perceptions of weight stigma and inappropriate eating behavior. However, results also showed that weight bias and perceived weight stigma were related to increased levels of anxiety and depression (Cheng). This is particularly important because it distinguishes that weight bias and perceived weight stigma have real physiological and psychological effects on individuals. In another study conducted by Juvonen, Lessard, Schacter, & Suchilt (2017), the emotional consequences of weight stigmatization were looked at by way of weight-based discrimination experienced by middle schoolers. Researchers found that perceived experiences of weight-based discrimination from peers were highly correlated with what was noted as “body dissatisfaction, social anxiety, and loneliness.” Results also showed that overweight students faced higher incidences of weight stigmatization from peers and experienced increased social exclusion and degradation as a result (Juvonen). With the development of implicit weight biases and the stigmatization that follows, individuals targeted by such attitudes and behaviors become increasingly vulnerable to demeaning treatment, social exclusion, distress, anxiety, depression, and inappropriate eating behaviors.

In addition to the physiological and psychological consequences of weight-related stigmatization, stereotypes and prejudice spawning from implicit biases can often be detrimental to individuals occupational and social aspirations. Giel and Colleagues (2012) evidenced such consequences in their study looking at weight stigmatization amongst human resources professionals. Participants in this study were asked to evaluate photographs of individuals of varying BMI (Body Mass Index) based on presumed prestige and achievements. Though participants were experienced hiring professionals trained to make decisions without employing personal biases, results showed that occupational prestige was underestimated for overweight individuals. Researchers performing this study also found that professionals disqualified overweight individuals more often than others from gaining employment and promotions (Giel). In distinguishing the detrimental consequences weight-related stigmatization has on occupational opportunities for those in prejudiced weight classes, we also highlight the growing need for educational interventions to reduce such implicit biases.

With such a goal in mind, Diedrichs & Barlow (2011) conducted a study focused on the effects of an educational intervention on weight biases held by pre-service health students. Students assigned to the intervention group attended lectures on obesity, weight bias, and weight determinants. The results from this group were compared to those from a control condition (no lecture) and from a comparison condition (lectured on obesity and behavioral determinants of weight). Ultimately, researchers found that educational intervention reduced both negative attitudes towards obesity and controllability beliefs about weight held by students (Diedrichs). As such results were only found in the intervention group, it can be deduced that educational exposure to weight bias and determinants of weight are more effective in reducing bias than exposure to behavioral determinants of weight. Ultimately, this study exemplifies just how pervasive the consequences of implicit biases are by addressing the weight-related stigmatization present amongst health professionals. With underlying beliefs about the controllability of weight, health professionals are more likely to approach overweight patients with less empathy and assistance overtime (Cossrow). While Diedrichs et al. elicits hope in the capacity of educational exposure as an effective means for reducing implicit biases, pointed research on different types of educational exposure in relation to weight is needed to determine the most effectual intervention design. Even so, the breadth and pervasiveness of the consequences posed to individuals who are negatively categorized based on their weight establishes a possible need for a study focused on general exposure to determinants of health as an intervention for reducing weight bias.

Conclusion

With this introduction and review of past research, we gain a deeper understanding of how implicit biases arise and become imbedded in everyday situations. Though implicit bias is subtle and often goes unregistered by individuals, the pervasiveness of its consequences reaffirm the need for an intervention that effectively reduces implicit bias. While prior research has shown surface level exposure to weight-based attributions of health only aid in generating stigma, it has also established educational exposure as a possible means for reducing implicit biases and its consequences by extension. Given this research, we have constructed the hypothesis that increasing exposure to determinants of health will reduce implicit weight bias.

African Women And Intersectional Determinants Of Health

HIV/AIDS is an epidemic of intersectional inequality is fueled by inequitable determinants of health with key influences at the macro, meso, and micro levels of any country (Watkin-Hayes, 2014 ) More so, HIV/AIDS has moved from a concept of death verdict to a well-managed chronic disease; thus, new social realities arise as “complex intersections between socio-economic, physical, political, and biological environment with social identities generate vulnerabilities and risks” (Black & Veenstra, 2011) to African women’s health. Their development of resilience to challenging structural determinants is not common to African women as these opportunities are not easily discerned and assessed individually due to increased risk to their social relationships. For instance, an inability to negotiate safer sex during sexual activities due to poverty still exists in Canada due to patriarchal cultural norms being carried down from their sending countries.

Gender has been well-acknowledged as a key determinant for population health in academic literature; however, vital upstream factors of health equity for African women were formally enumerated in PHAC (2009) as determinants of health: These include social supports networks, employment/working conditions, income and social status, healthy child developments, personal health practices and coping skills, education and literacy, social environments, culture, genetic and biologic endowments, and health services. Ironically, all these determinants affect the health of African women in Canada. The health of any populace is entrenched in their ability to access fundamental human rights; women have a right to enjoy their life without any discrimination of their identities. The equity approach, as a principle seen with the intersectionality paradigm, brings in an ease in affordability, accessibility and availability of range of social, economic and environmental products and services that determine the health and well-being of individuals or populations.

African women’s biological determinant of health is an innate constitution of their inheritance and with a predilection to acquiring negative health status from a heightened predisposition to certain diseases such as HIV/AIDS. For instance, there is an inherited predilection that increases the risk of contracting HIV virus during an unprotected penile-vaginal and even penile-anal intercourse due to an intromission of infected semen. This transmission of HIV virus to the women is related to the higher concentration of the virus in infected semen in comparison with vaginal secretion; a larger sensitive vaginal mucosal area transmission inhabits the infected semen for a longer period of time; potentialities of the female genital tract being abraded during an agreed or forced sex (gender violence common in SSA especially in war times and even in that safe confines of formal systems); and the ability of the virus to permeate into the reproductive tract of women by eroding the protective layers, a factor that hinders vaccination and microbicides as preventive strategies for females (PHAC, 2012, p. 42). Also, co-infection of other sexually transmitted infections such as Syphilis, gonorrhea, candida increases the vulnerability of the vaginal mucosa to the HIV virus due to the abraded surfaces arising from inflammatory processes.

The social determinant of health (SDOH) involves a variety of social, environmental and economic circumstances that drive the individual and group differences in health status. Daily, African women are saddled with diverse conditions where they are born, grow, live, work and age, (CSDH, 2010; Marmot, 2008) with obvious connections to their health emanating from the contextual distribution of power, money and resources. The SDOH include income and its distribution, education, unemployment & job security, employment & working conditions, early child development, food security, housing, social exclusion, social safety net, healthcare services, indigenous ancestry, gender, race, and disability. Two more determinants were added by Rapheal (2016) to include immigration status and geography. However, this special population of African women has become a rallying point for different international agenda for the many issues of SDOH that beleaguers them and make them vulnerable. Canada ratified these international documents: however, policy implementation and enforcement are challenging. Human rights for African women is part of the Rio declaration; however, having rights is one thing but it should be contextually ensured that they exercise these rights.

These issues of SDOH in Canada still lag behind in acknowledging and including their needs in social and health care policies; such as homelessness or poor-quality dwelling structures, stigma, addiction, poverty, physical and sexual abuses, untreated mental health problems, lack of unemployment opportunities, powerlessness, lack of choice, lack of legal resident status, and lack of social support. A typical example is their deep-rooted financial concerns that influence their access to social and health services for their lives and their families. Sustained source of income has to be maintained with little or no loss of employment as they are plagued by economic deskilling and low pay. Access to anti-retro viral (ARV) drugs becomes challenging by geographical and financial inaccessibility; more so, for an African woman that is not a conventional refugee or Canadian citizen, procuring their ARV drug procurement is out of pocket expense (PHAC, 2009). The achievement of zero level of blood virus with highly active antiretroviral therapy is far-fetched. Therefore, “Treatment as Prevention” in this time of Undetectable = Untransmittable may not be feasible. This has to be tackled through policy changes that will impact on an economic upturn for African women so as to reinvigorate contemporary HIV prevention, stigma interventions, health promotion and care. Different overlapping social effects with the integration of intersecting inequalities and the impacts of assessing SDOH by these women becomes an interaction of toxic combination of poor social policies and programs, unfair economic arrangements. These toxic combinations comprise structural determinants and conditions of daily life that constitute the larger part of health inequities between the dominant society and the marginalized group (CSDH, 2008).

These drivers or influences, as structural factors define those who accesses health services; such as subsidized mental health centres, social services such as community women centres with free information, counselling and care services for immigrant women with diverse needs; and material resources such as housing and certain safe physical environments. Despite the sensitizing and discriminating stances to HIV for African women, internalized denials that stem from religious norms, gossips and lies within communities and families exists (CHABAC, 2019). These limits support from social structures and capital that function through relationships of interpersonal trust, norms of reciprocity, and mutual aid. These social safety nets act as resources for individuals and facilitate collective action to influence people’s health-relevant behavior. These influences are facilitated through transmission of supportive relationship norms for positive health outcomes. However, their normative identity has not been dismantled through upstream factors. As such their framing by the dominant society perpetuates their non-access to downstream factors. Hence, African women are not socially privileged due to their social location. In effect, effective impact from upstream factors should include removal of social exclusions seen as stigma and discriminations associated with their universal access to health and social services as they are accompanied with life stressors. Watkins-Hayes (2014) pointed out that, “HIV interacts with already existing social advantages or disadvantages, becoming a component of identity (as HIV related stigma) that intersects with other identities and together, these interlocking positions produce social meanings; limit or grant power; and interact with structures, institutions, and individuals to shape the experience of being HIV positive” (p.443). For these abuses and social profiling, these women are expected by their originating culture to keep silent and take it in their stride (Brown-Speights et al, 2017; Etowa et al 2007; Etowa et al, 2017. However, the impact on their access to care and quality of care translates to poor individual and population health outcomes (Caiola, 2014).

As a western nation, the inability of women in certain social situations been incapable of driving the negotiations of current HIV prevention options; such as abstinence to a certain extent, behavior change, condoms and medical male circumcision of their sons or early treatment initiation in their relationships (Kharsany & Karim, 2016) go a long way to reveal the social nature behind the acquisition of HIV/AIDS (Stephenson & Kippax, 2012).

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