The Social and cultural determinants of health
Health is commonly said to be wealth. When our health is not optimal, the body will not function appropriately to aid our day-to-day economic activities. But what really are the factors that determines or affects our health status. This article seeks to present information from studies regarding the social and cultural factors that determines or affects our health with no interest in a specific group of people.
The causes of diseases vary among individuals. To some, it may be a defect in a body part, or maybe eating unhealthy foods and drinks, or a lack of exercise, or their levels of stress. But really, what are those things that cause the stress, or make individuals to eat a type of meal, or have a type of drink, or shapes the opportunities they have to be active?
The answers really lie in the situations in which people are born to, grow, pursue their daily economic activity and age: the social and cultural determinants of health. These can make individuals and societies at large to progress, or not. McGovern, Miller and Hughes-Cromwick made it known in the Health Policy Brief of 2014 in United States of America that even though some diseases are plainly due to genetics, these play a much minute role in determining a person’s health than where they are born to, grow, pursue their daily economic activity and age. The social and cultural determinants can include family, friends and communities, money and resources, housing, education and skills, good work, transport, our surroundings and the food we eat to name a few. There have been some studies on the aforementioned factors influence on health. Of the mentioned factors and for the sake of brevity, family, friends and communities, money and resources and surroundings will only be considered in this article.
Valtorta made it known in a study conducted in 2016 about how feeling lonely and socially isolated can be risk factors for stroke and coronary heart disease. These has to do with family, friends and communities. The study found that a 30% risk increase of cardiac disease and associated stroke is associated with being lonely and socially isolated. Mental Health Foundation in the USA, in a publication in 2016, also states that happiness and longevity as health indicators are more likely to be with people who are more connected socially in a family and that they tend to have less mental health issues or physical problems compared to people who are less socially connected. On this note, one can say that an absence of a social connection can lead to a lack of exercise as indicated by Hawkley, Thisted, and Cacioppo in a study conducted in 2009. It can also be energizing and empowering to indulge in community activity like recreational clubs which can help to create a sense of purpose. Such community activities may also help to protect wellbeing and health as stated by Daly and Allen in a 2016 study that has to do with inequalities in mental health, impairment of cognition and dementia amongst older people. Therefore, if people can be brought together instead of isolating them, then it is certain that we will enjoy low costs of health and achieve a happier society.
Money and resources could as well affect or determine our health. In 2014, Jones, in a longitudinal study conducted in UK about the price gap between less or more healthy foods, it was found that healthy behaviours can be unattainable in the presence of inadequate income and it appears that we need to spend 3 times more to get energy from healthy foods than we need from unhealthy foods. Lane in 2016 also found that 40% of persons, who have debt that cannot be managed, said the likelihood to retrain or study is less probable. Benzeval in 2014 also found that health is damaged by poverty and poverty risk is increased by poor health. These findings imply that for people to be able to invest in themselves for the future, a financial self-sustainability is required.
Considering the factor of surroundings, the National Children’s Bureau, UK, in 2013, reported that children who live in areas that are deprived of favourable conditions have 90% likelihood to not have access to places such as green spaces and playgrounds. This basically implies that our surroundings do have influence on our health, and it makes people to feel the favourable conditions they provide. Nice places, buildings and spaces are capable of enabling people to be inclined to be active physically and to feel secure, play and socialize. For instance, in 2016, the NHS Health in Scotland reported that physical activeness requires a well-cared-for and easy to access green space. When people are near to facilities and services such as schools and shops, it is easier to go to them. Such prevents the elderly from being isolated in a social sense as buttressed by the Public Health of England in 2017.
From the presentations above, it is important to understand that everybody in a society needs to have an opportunity to make healthy decisions and live a healthy life. But the inequalities present in resources at all levels of human endeavour, nationally or globally can render the circumstances surrounding the daily lives of people more challenging and subsequently, the people become more vulnerable to ill health. These inequalities do not only exist between the poor and the rich but cuts across population and impact people of all ages in all ramification of life and all diseases considered major. It is quite a possibility to create the favourable conditions that will bestow people with healthy lives.
With an interest in Finland, it is expected for a typical Nordic society, that the living standard will be high with little socio-economic disparities. But despite the age-long tradition of ensuring social inequalities by way of introducing welfare and structural measures, some comparative analyses have shown that social inequalities with respect to health are on the rise (Fosse and Helgesen, 2019). For instance, the income gap existing between the rich and the poor in Finland, measured by the Gini Index was reported to have increased between 1985 and 2013. The gap obtainable in Finland is second to that of Sweden, which is the highest among the Nordic countries (Fosse and Helgesen, 2019).
Also, studies have shown that there is a direct link existing between high levels of social inequality and ill health. However, Therese Nilsson, an associate professor, said in a report from the health equity in the Nordic region conference, Stockholm 2018, that results of available studies appear to be ambiguous and little is known about how and why inequality might be a cause of ill health. Social comparisons, violence, lack of trust and criminality were mentioned as possible reasons for inequality leading to ill health.
Be that as it may, decision makers at varying levels can make policies and instruments that will provide people with greater control over their respective health and health behaviours, as well as those of their immediate or extended families. Such policies and instruments may include good and affordable health care, fair wages and renumerations along with creating opportunities that are of benefits to the masses at large. If there are proportionate action at the level of the disadvantaged, the inequalities due to the factors that determines health can be ameliorated and population’s health and wellbeing will be improved. Making changes to the environments is a more effective and just way to influence the wellbeing of a whole population instead of waiting for them to be ill and treating them as patients.
Therefore, solutions require that all members of society at large, acknowledge the health impact of activities they do and come together to act. If this come to be, we could see positive changes in the health of the people and a reduction in health inequalities that exist between various groups in society.
Authors:
Habibat Badamasi BSc nursing student in Novia UAS.
Anita Wikberg, Supervisor, RN, RM, PhD, Senior lecturer at Novia UAS
References
- Benzeval M et al. (2014). How does money influence health? Joseph Rowntree Foundation. Available from: www.jrf.org.uk/report/how-does-money-influence-health.
- Daly S, Allen J. (2016). Inequalities in mental health, cognitive impairment and dementia amongst older people. UCL Institute of Health Equity. Available from: http://cdn.basw.co.uk/upload/basw_53658-8.pdf
- Fosse k. and Helgessen M. K. (2019). Policies to address the social determinants of health in the Nordic countries. Nordic Welfare Centre. ISBN: 978-91-88213-47-1. Available at www.diva-portal.org/smash/get/diva2:1366078/fulltext01.pdf.
- Hawkley LC, Thisted RA, Cacioppo JT. (2009) Loneliness predicts reduced physical activity: Cross-sectional & longtitudinal Analyses. Health Psychology. 28(3):354–363. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791498/pdf/nihms146884.pdf.
- Jones NRV et al (2014). The growing price gap between more and less healthy foods: analysis of a novel longitudinal UK dataset. PLOS One.;9(10):e109343. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190277/pdf/pone.0109343.pdf.
- Lane J. (2016) A debt effect? How is unmanageable debt related to other problems in people’s lives? Citizens Advice. Available from: www.citizensadvice.org.uk/about-us/policy/policy-research-topics/ debt-and-money-policy-research/a-debt-effect.
- McGovern L, Miller G, Hughes-Cromwick P. (2014). Health Policy Brief: The relative contribution of multiple determinants to health outcomes. Health Affairs. Available at https://www.healthaffairs.org/do/10.1377/hpb20140821.404487/full/healthpolicybrief_123.pdf.
- Mental Health Foundation (2016). Relationships in the 21st century: the forgotten foundation of mental health and wellbeing. Available from: www.mentalhealth.org.uk/publications/relationships-21st-century-forgotten-foundation-mental-health-and-wellbeing
- National Children’s Bureau (2013). Greater Expectations: raising aspirations for our children. Available from: www.ncb.org.uk/sites/default/files/uploads/documents/Policy_docs/GEXP _final% 20WEB.pdf.
- NHS Health Scotland (2016). Place and communities. Available from: www.healthscotland.scot/media/1088/27414-place-and-communties-06-16.pdf.
- Public Health England (2017). Spatial Planning for health: an evidence resource for planning and designing healthier places. Available from: www.gov.uk/government/uploads/system/uploads/attachment_data/ file/625568/Spatial_planning_for_health_an_evidence_resource.pdf.
- Valtorta NK (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. Available at https://heart.bmj.com/content/heartjnl/102/13/1009.full.pdf.
