0:02 welcome back to this Global Health
0:03 YouTube channel today we're going to be
0:06 talking about the social determinants of
0:07 health what I'm gonna do is I'm gonna
0:09 share with you a framework that I've
0:11 developed for thinking about the social
0:13 determinants of health my framework is
0:14 relatively simple and the reason is this
0:16 we basically just kind of look at two
0:17 things we're gonna say look let's try
0:19 and understand what it is that we mean
0:21 by the words social and then let's look
0:23 at the reasons that people get sick and
0:24 let's see if we can join the dots
0:27 between these two buckets so let's start
0:28 by thinking about what it is that we
0:30 mean by the words social and and of
0:32 course we all have an intuitive sense of
0:35 what the word means but I've divided the
0:37 word social or the idea of social into
0:39 three different categories or three
0:40 different buckets and I want us to look
0:42 at each of these so the three ways that
0:43 we can think about this idea of social
0:46 are firstly our social environment
0:49 secondly our social identity and thirdly
0:51 our social position or what we sometimes
0:53 call our socio-economic position and
0:54 let's look at each of these in a little
0:57 bit more detail so if we start with a
0:59 social environment this is the political
1:02 economic and cultural setting in which
1:04 we live so you might live in a country
1:06 whose health policy includes providing
1:08 free access to health care you might
1:09 live in an affluent or deprived
1:11 neighborhood you might live in a culture
1:13 that accepts and encourages gender
1:15 equity or you may not as the case may be
1:17 now let's talk about your social
1:20 identity social identity is a function
1:22 of the groups that you either
1:25 voluntarily or involuntarily are a part
1:27 of in other words that you identify with
1:30 or that you are identified with it could
1:31 be your family your gender your
1:34 ethnicity your race citizenship the
1:35 Tennis Club that you belong to your
1:38 language group etc etc and for each of
1:40 these groups there are a set of rules
1:42 that society has adopted and applied to
1:45 the us those that are part of a group
1:48 and the them those that are not part of
1:50 the group so in some parts of the world
1:52 whether or not you can access education
1:54 depends on your gender in other parts of
1:56 the world you might be denied access to
1:57 clean water or housing or healthcare
2:00 because of your ethnicity or race and in
2:02 each of these cases your access to
2:03 certain freedoms and certain
2:06 opportunities is affected by the groups
2:08 or the social delineations with which
2:11 you are identified now let's look at the
2:13 idea of socioeconomic status
2:16 or your social position of course our
2:18 gut feeling is that socioeconomic status
2:19 is just about how much money you have
2:22 and while that's a big part of it it's
2:23 not the whole picture
2:25 think for a minute about what money does
2:27 for you it's a sort of a discretionary
2:29 resource that you can exchange for
2:31 whatever you can afford and it gives you
2:33 the power of resources and opportunities
2:37 in other words it gives you options you
2:38 have a degree of what we call personal
2:41 agency but there are other things that
2:43 contribute to that agency things like
2:46 education occupation social status etc
2:48 and when we see differences in
2:51 socioeconomic status across these social
2:53 groups or these social delineations that
2:55 we talked about earlier we call that
2:58 inequality and when that difference is
3:00 because of a systematic and fairness in
3:02 the rules that apply to those groups
3:05 like racial or gender discrimination we
3:07 call that inequity so let me just
3:10 summarize inequality is the unequal
3:12 distribution of goods and opportunities
3:14 and freedoms across social groups and
3:18 inequity is the unfairness that leads to
3:22 inequality okay so now we've got a good
3:24 sense of what it is that we mean by the
3:26 word social next we're gonna take a look
3:29 at health and what did it what are the
3:30 things that cause people to be healthy
3:32 or unhealthy as the case may be and then
3:33 we're gonna join these two groups up and
3:35 see how they relate to each other but
3:37 before we carry on a big thank you to
3:39 USC for sponsoring this video he has a
3:41 quick message from USC and then we're
3:43 gonna get back into the teaching
3:46 hello from sunny California I'm dr.
3:48 Shobha Kumar and a professor and
3:50 director of the master of Public Health
3:54 online program at USC the USC online mph
3:57 program is 100% online and delivered
3:59 through state-of-the-art technology that
4:00 allows students to engage with
4:02 classmates and professors in live online
4:05 sessions we have a fantastic curriculum
4:06 with lots of choices and taught by
4:09 world-class faculty this program can
4:11 prepare you for an exciting career in
4:13 public health so if you're interested
4:15 just click on the link below this video
4:17 to learn more we offer three start dates
4:19 per year and look forward to welcoming
4:23 you so we've looked at the idea of
4:25 social now we're gonna look at health
4:26 and we're gonna ask the question why do
4:28 people get sick or why do people remain
4:30 healthy as the case may be and then
4:32 we're gonna look at these two ideas and
4:34 see how they can connect up firstly
4:37 there's simply your biology your age or
4:40 sex your genes etc next your access to
4:41 things like nutritious food safe
4:44 drinking water clean air shelter next
4:47 exposure to hazards things like violence
4:49 conflict war natural disasters
4:51 infectious disease agents then of course
4:53 there are unhealthy behaviors things
4:54 like poor diet smoking sedentary
4:57 lifestyle then there's your access to
4:58 health services and of course that
5:00 includes services to treat you if you're
5:02 sick and it includes preventative
5:04 Services like vaccinations services and
5:06 health promotion and finally there are
5:08 psychosocial factors so let's take a
5:09 look at each of these and ask the
5:10 question what are the social
5:13 determinants that can affect them the
5:14 first determinants of health is of
5:17 course your biology your age your sex
5:20 your genes etc now this is the one
5:22 determinants of health that is not
5:24 really affected by your social
5:26 environment your social position your
5:28 social identity etc so we're not going
5:30 to talk a lot about your biology as a
5:32 determinant of health because it's kind
5:33 of quite disconnected from the social
5:35 determinants except to say that some of
5:37 your biology like to age or your sex can
5:40 have implications for your social
5:41 identity your social position and your
5:43 social environment as can any of the
5:45 other determinants of health
5:47 in fact even being healthy or unhealthy
5:50 or disabled can impact on your social
5:51 identity your social environment your
5:54 social position etc so I want you to see
5:54 how this into
5:56 can actually happen in both directions
5:59 access to nutritious food safe drinking
6:02 water at clean air shelter people living
6:03 in abject poverty or unable to access
6:06 even the most basic amenities needed to
6:09 be healthy there are about 3.1 million
6:11 children that die every year due to
6:13 malnutrition now globally there are more
6:15 than enough resources to address the
6:17 basic needs of the very poor but we as
6:19 society choose not to we hide behind
6:21 physical and social distance between
6:24 them and us and we use that to obfuscate
6:26 any real moral responsibility to act
6:28 exposure to hazards like violence and
6:30 conflict and natural disasters and
6:32 infectious disease agents violence and
6:34 conflict are the quintessential example
6:36 of people applying different rules to
6:39 people in the other group the not as to
6:43 them so much so that in times of war we
6:45 not only deny those people that group
6:46 the right to be protected from violence
6:49 but we take deliberate actions to harm
6:51 them and even kill them unhealthy
6:53 behaviors like poor diet smoking in
6:55 their sedentary lifestyle drinking a
6:57 gluten-free Kalyan radish smoothie after
6:59 45 minutes of yoga followed by the steam
7:01 bath the local gym this might be an
7:03 incredibly healthy way to live but let's
7:06 be honest it's a luxury people living in
7:08 poverty or in lower socioeconomic strata
7:09 are far more likely to engage in
7:11 unhealthy behaviors because they need to
7:14 respond to and prioritize the immediate
7:16 pressures of life over the future
7:17 possibility of cardiovascular disease
7:20 for example next access to health
7:21 services including prevention like
7:23 vaccinations services and health promotion
7:23 promotion
7:26 how the state provides access to health
7:28 services dramatically impacts on the
7:30 health outcomes of a population and the
7:32 people who are most vulnerable are as
7:35 always the poor I am a huge fan of
7:37 universal health coverage and I've got
7:38 another video on that if you want to
7:40 watch it please do and finally
7:42 psychosocial factors so your social
7:44 environment and your social identity and
7:46 your socio-economic position of course
7:47 as we've discussed can affect your
7:49 physical health but all of these things
7:52 can affect your mental health your sense
7:53 of who you are your sense of well-being
7:56 your psychological well-being they
7:57 affect the way we see ourselves they
7:59 affect the pressures that we face they
8:00 affect the agency that we have to deal
8:02 with problems and of course they affect
8:04 our access to the mental health services
8:06 that we might need and I find
8:08 quite problematic that in a lot of the
8:09 discussion around the social
8:11 determinants of health psychosocial
8:13 factors and psychological and mental
8:15 health is often under addressed or not
8:18 addressed at all thanks for watching I
8:19 hope you found this useful stay and
8:20 watch another video if you've got the time
8:21 time
8:22 subscribe to this YouTube channel if you
8:24 haven't already until next time take care
