Social Determinants of Health Analysis

Introduction

The leading cause of mortality in Australia is heart disease or, in clinical terms, cardiovascular disease (CVD). The common risk factors that are responsible for CVD include smoking, hypertension, diabetes, obesity, lack of exercise, and genetic defects from family history. However, the listed biomedical risk factors do not account for the total percentage of CVD cases in terms of prevalence, incidence, morbidity, and mortality. Studies in the health community have shown that social determinants play a significant role in the morbidity of heart diseases. According to the World Health Organization (WHO), social determinants are “the conditions in which people are born, grow, live, work and age.” (Social Determinants of Health, 2020). Hence, the circumstances in which individuals live and die are consequently shaped by social and economic forces that determine the distribution of money, resources, and power. The social determinants cause health inequalities, and for this report, low socioeconomic status is the health inequality under investigation. Since the solutions for classical risk factors utilize most of the existing research and resources, this report will propose some intervention criteria that address lower socioeconomic status populations in Australia.

Social Determinants of Heart Disease for Lower Socioeconomic Status Populations

• The burden of heart disease within lower socioeconomic status populations.

The lower socioeconomic status is a health inequality in some populations in Australia are as a result of external factors and conditions that are beyond the control of the populace. Because of mainly poverty and other social issues, people in these population groups have registered a higher likelihood of contracting cardiovascular disease. Furthermore, health groups like the Australian Institute of Health and Welfare (AIHW), have reported more deaths due to heart diseases in populations with lower socioeconomic status than those in higher socioeconomic statuses. Between 2014 and 2015, an Australian study done in the areas with the lowest socioeconomic conditions showed that 20% of the people living in those areas were 1.6 times more likely to have at least two chronic diseases of which CVD was always among these conditions (AIHW, 2016). The report compared this likelihood to 20% of Australians living in areas with the highest socioeconomic status.

Another report by AIHW compared the disparity of the death rates due to CVD between the lowest and the highest socioeconomic areas in Australia (AIHW,2019). The results from data collected in 2016 showed that if all people in Australia had had equal CVD mortality rates like the ones living in the highest socioeconomic areas, the total mortality rate would have reduced by 25%, translating to 8,600 fewer deaths. The same report also compared the mortality rates for men and women separately. The report showed that males residing in the lowest socioeconomic areas had 1.52 times higher mortality rates than males living in most upper socioeconomic regions. Females in the same age group showed less disparity, which was 1.33 times higher.

• Discuss how the social determinants of health can explain the burden of heart disease within the lower socioeconomic status populations.

Low socioeconomic status is a health inequality signified by forms of disadvantages like poverty, limited access to services and goods, and discrimination. A social gradient develops when on one side of the population, wealthy people living comfortable lives in terms of better housing, richer diets, better clothing, and access to luxuries. The other side of the population consists of underprivileged people struggling with life in terms of lousy housing, more deficient diets, inadequate clothing, and no access to luxuries. Also, the social gradient abides when one population side can easily access vital goods and services, while the other side can hardly access the same products and services. Finally, a social gradient establishes when the greater population discriminates against the lower population, based on race, disability, and gender (Korda et al., 2016).

The social determinants that are relevant to heart disease in populations with low socioeconomic status include socioeconomic position, employment, work social exclusion, and early life circumstances. Education, occupation, and income indicate socioeconomic status. The three indicators link in that; education attainment equips one with steady employment and income source (Schlesinger and Phillips, 2020). Education helps an individual and his/her family make healthier choices against risk factors of CVD and cope with heart disease diagnosed in any member of the family. Therefore, lack of education often leads people to make poor health choices like smoking out of ignorance or because they do not care due to stresses of lack of employment and income.

Additionally, due to lack of income as a result of no education, coping with heart disease is difficult due to expensive medication, consultation fees, and the expenses of the necessary lifestyle change, hence the mortality rate increases. Employment and work are related to the points above; however, unemployment causes financial problems, which lead to psychological stress and, later, depression (Li and Kinfu, 2016). Depression increases the chances of risky behaviour like smoking and neglect of one’s health, all of which lead to a higher risk of health diseases.

Unequal capabilities and rights characterize social exclusion, and unequal access to resources, lead to health inequalities. For instance, the Aborigines and Torres Strait Islanders face extensive discrimination and racism, which has led to limited access to education and health services. Also, due to discrimination, these indigenous groups have lived in seclusion, further limiting their access to health services and resources (Davy et al., 2016). The article recorded that more cases of CVD are in the indigenous communities, and their inability to cope with heart conditions has led to a higher death rate. The circumstance of the early life of children is a crucial social determinant because formative years of children are likely to affect the rest of their lives. Children from underprivileged backgrounds have a higher likelihood of limited education, employment, and income, which translates to lower health literacy and care. Such children are likely to smoke more, and their parents expose them to smoking at an early age, which increases the prevalence of heart disease.

An Intervention to Address Social Determinants of Heart Disease for [Chosen Population]

• Propose a public health intervention to prevent heart disease in the lower socioeconomic status populations that address at least one social determinant of health

Free health care communications and delivery is a promising intervention strategy to combat the high prevalence of CVD in areas with lower socioeconomic status. Implementation of health education and communication effort would help address one social determinant, education. As previously highlighted, the lack of knowledge is in populations of lower socioeconomic status, which leads to higher risks of heart diseases. In the underprivileged communities, a lack of education has led to ignorance on behavioural risks like smoking, which contribute to heart diseases (Schultz et al., 2018). Other behavioural risks that need sensitization against include consumption of highly fatty and oily diets. Therefore, health groups could deliver health communication on behavioural risks and how they contribute to heart disease. After that, the health groups could offer education on better health choices like quitting smoking, avoidance of fatty foods, and the need for more physical exercise to reduce the risk of CVD. Health communication and education is essential because it is an effective short-term remedy to the consequences of a social determinant that has developed for a long time.

Delivery of freely funded quality health care that targets heart disease in areas of lower socioeconomic status will significantly curb the cases of CVD. Free health care will address the discussed unemployment because unemployment limits monetary funds necessary health care needed to timely prevent and timely identify CVD (Martínez-García et al., 2018). Furthermore, monetary funds help people cope with heart conditions. Free health care will also address social exclusion. Social exclusion, as previously discussed, often leads to seclusion from the larger society and limited access to health resources and service. Therefore, bringing free and quality health care to the areas with secluded communities will solve the mentioned issues; hence heart conditions will be diagnosed earlier and coping mechanisms instilled. Also, the health delivery groups can enact preventive measures against CVD to the secluded communities.

• Explain what other sectors can be involved aside from the health sector

The local government can intervene to control heart diseases in several ways that address some social determinants. First, the local governments could look into the areas with lower socioeconomic status and identify employment opportunities that suit those with no or less education to promote their financial situation (Tomaselli et al., 2018). The local government could also find alternative job placement for individuals from the same areas who are unemployed after losing their jobs. Also, the local government could create policies that leave job positions strictly for people faced by social exclusion. All these efforts attempt to increase the financial capabilities of the disadvantaged groups to improve their access to health care services and resources while also addressing that social determinant, that is, employment. Access to health care services will consequently elevate the chances of CVD prevention and diagnosis. Furthermore, the local government could provide attractive education opportunities for the children in the underprivileged communities to break the intergenerational transmission of disadvantage. The education will be the ultimate solution of reducing future rates of CVD in the communities and also address the social determinant, that is, education.

Conclusion

In conclusion, the burden of heart diseases in populations with lower socioeconomic status is evident, as depicted by summary statistics showing higher prevalence and mortality rates as compared to the areas with higher socioeconomic status. Some of the social determinants linked to CVD included socioeconomic determinants that comprised of education, income, and occupation. Other social determinants included employment and work, social exclusion, and early life circumstances. The health intervention suggested is free health care communication and delivery, which could help reduce cases of CVD and address dome social determinants. The proposed response by non-health sectors is by the local government, which could solve CVD issues by addressing social determinants that include employment and social exclusion.

References

1. AIHW. (2016). Australia’s health in 2016. Canberra: AIHW.
2. AIHW. (2019). Indicators of socioeconomic inequalities in cardiovascular disease, diabetes, and chronic kidney disease. Canberra: AIHW.
3. Davy, C., Harfield, S., McArthur, A., Munn, Z., and Brown, A. (2016). Access to primary health care services for Indigenous peoples: A framework synthesis. International Journal for Equity in Health, 15(1).
4. Korda, R., Soga, K., Joshy, G., Calabria, B., Attia, J., Wong, D., and Banks, E. (2016). Socioeconomic variation in the incidence of primary and secondary major cardiovascular disease events: an Australian population-based prospective cohort study. International Journal for Equity in Health, 15(1).
5. Li, J., and Kinfu, Y. (2016). Impact of socioeconomic and risk factors on cardiovascular disease and type II diabetes in Australia: comparison of results from longitudinal and cross-sectional designs. BMJ Open, 6(4), p.e010215.
6. Martínez-García, M., Salinas-Ortega, M., Estrada-Arriaga, I., Hernández-Lemus, E., García-Herrera, R. and Vallejo, M. (2018). A systematic approach to analyze the social determinants of cardiovascular disease. PLOS ONE, 13(1), p.e0190960.
7. Schlesinger, N., and Phillips, S. (2020). Social determinants of health in Australia. [online] PwC. Available at: https://www.pwc.com.au/health/health-matters/social-determinants-in-health-australia.html [Accessed 18 Feb. 2020].
8. Schultz, W., Kelli, H., Lisko, J., Varghese, T., Shen, J., Sandesara, P., Quyyumi, A., Taylor, H., Gulati, M., Harold, J., Mieres, J., Ferdinand, K., Mensah, G. and Sperling, L. (2018). Socioeconomic Status and Cardiovascular Outcomes. Circulation, 137(20), pp.2166-2178.
9. Social Determinants of Health. (2020). Retrieved from World Health Organization: https://www.who.int/social_determinants/sdh_definition/en/
10. Tomaselli, G., Roach, W., Piña, I., Oster, M., Dietz, W., Horton, K., Borden, W., Brownell, K., Gibbons, R., Otten, J., Lee, C., Hill, C., Heidenreich, P., Siscovick, D. and Whitsel, L. (2018). Government continues to have an important role in promoting cardiovascular health. American Heart Journal, 198, pp.160-165.