Exam 16: Understanding Social Determinants of Health

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Why might it be argued that fetal development and early childhood are the key determinants of health? How would such an argument link to a life course approach? In what ways are child developmental issues linked to adult employment, income, and health-relevant behaviour?

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Students should show recognition that fetal and early childhood development establishes the parameters for, and the capabilities and vulnerabilities of, the person for the rest of their life. Brain, cognitive, emotional, and physical development determines employability and quality of job (hence working conditions and income), which in turn determine housing and neighbourhood options, and together, developmental factors, employment, income, housing, and neighbourhood largely determine behaviour.

Identify the major differences between the individual-level approach to health and the population-level approach.

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The answer will focus on the framework that was presented in the Introduction, Chapters 1, and Chapter 14 of the book. It should highlight the difference between the individual-level approaches, focusing on biomedical and behavioural strategies and those aiming at improving population health. The failure of individual-level intervention to close the gap in health between groups in society should be noted, along with its limited capacity to improve overall population health. The population-level approach should be linked to the reduction of health inequalities via a focus on the broader determinants of health.

Describe and contrast the differences between two major theoretical traditions in social epidemiology. Compare how each understands social support, the health impacts of neighbourhood characteristics, and the health relevant features of employment.

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The answers will explain the differences between materialist/neo-materialist tradition and psychosocial approach. Each perspective should be fully explained. Discussion of the specific areas should key in on how materialist theory gives central place to the resources available to the person, whereas psychosocial approaches centre on relationships, how those are perceived, and thus how emotions and neuro-endocrine systems are activated.

Discuss the following statement: Collective action and government policy are central to objectives in population health, whether the issue is road safety, food safety, quality of neighbourhoods, or environmental protection.

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Canada relies very heavily for employment and for its national wealth on the export of cheap beef, chicken, pork, and grain, and export of energy in the form of oil, gas, coal, and electricity. Moreover, many jobs and the prosperity of many Canadian businesses depend on the housing boom. Agri-business, the energy industry and the housing boom all have enormous downsides in terms of sustainability and population health. Discuss some of those downsides and outline some ideas regarding how Canada could make population-health friendly changes in its core economic activities of agriculture, energy, and construction.

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You are a newly appointed provincial Minister of Health. What are your priorities for the improvement of population health? Why?

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What are the social determinants of health? Choose three determinants and explain how they impact population health.

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How do the strengths of cohort studies inform population health and provide evidence for effective population health policies? Provide an example of an "evidence-based" policy that relies on cohort study findings. How do the weaknesses of health research, especially confounding and the discovery of associations rather than causality, make evidence-informed policy and programs difficult?

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