2.1 The social determinants of health, learning and behaviour
Keeping in mind that these scenarios are simplistic and fictional, what are the factors that are working for and against each family?
Are some of the factors social determinants?
Does society have a responsibility to support these families and, if so, what kinds of policies and programs might be helpful or protective?
The concept of social determinants of health was introduced in the overview section of this module. On this page, we will consider some of the research related to social determinants.
….SDOH are about the quantity and quality of a variety of resources a society chooses to make available to its members……more and more evidence has accumulated of how the inequitable distribution of SDOH results in avoidable differences in health outcomes or health inequities among Canadians” (Raphael, 2016. p. 7).
Early, groundbreaking research about the social determinants of health, the Whitehall studies, were conducted in Britain by Sir Michael Marmot and colleagues.
Sir Marmot, professor of Epidemiology at University College London, discusses the studies in the next clip.
The studies found a clear and lasting social gradient of health among British civil servants. It would be easy to assume that somehow the findings of the Whitehall studies are specific to British society, at that time, only. But in the next clip, Marmot explains why this assumption would be wrong.
Marmot says social gradients show that “action has got to be across the whole of society, not simply on the poor. If you focus only on the bottom, you miss most of the problem”. What does this mean?
How does gradient research support this argument?
Adversity and epigenetic change
Adverse environments of poverty, neglect and trauma affect the expression of genes involved in the development and regulation of the nervous system in children, which in turn guide brain development, calibrate stress responses and influence lifelong risk of developing mental illnesses and other challenges. Similarly, positive early environments of nurturance, care and stability can affect gene expression, leading to decreased risk for mental health issues and optimized brain preparation for learning and normal social and emotional development” (Sokolowski and Boyce, 2017a, para 3).
Dr. Thomas Boyce is a pediatrician and distinguished professor emeritus in the Departments of Pediatrics and Psychiatry at the University of California, San Francisco. In the next video clip he explains researchers are looking at social disadvantage to see what epigenetic changes might be occurring because of exposure to stressful social conditions. There are some interesting results in animal models. Applicability to humans is being studied.
The next reading, from the Encyclopedia on Early Childhood Development, provides an overview of the evidence that adverse circumstances effect both people and animals at a cellular level, basically providing physical evidence for the social determinants of health.
What are some examples of how adversity correlates with epigenetic changes in humans and animals?
How might you be able to use this information?
If you were trying to convince someone of the importance of interventions to reduce or mitigate adversity in the lives of children and families, what rationale would you use to advocate for change?
Listen now as Dr. Noralou Roos, founder of the Manitoba Centre for Health Policy at the University of Manitoba, compares how different risk factors impact a child’s health. She discusses social factors such as having low-income parents or a teen mother as well as biomedical factors, such as being born prematurely or at a low birth weight.
Roos explains some research looking at early risk factors, impacts on later development and whether there are differences in birth characteristics between those with risk factors and those without.
What are the social characteristics Dr. Roos has found to be risk factors for children? Why do you think these are generally not as recognized as biomedical risk factors (e.g., child born prematurely)?
Roos asks “How do we get people to care about these factors?” How would you respond?
Based on the data that Roos discusses, where do you think investments need to be made to improve children’s health and well-being? How could you use this information to advocate for policies and programs to support better outcomes for children?
Now listen as Dr. Butler-Jones, former Chief Public Health Officer for Canada, answers the question of what the most pressing health issues are for children in Canada today. In the second video, he explains why it’s important to set healthy trajectories early in life.
The Lancet series on early child development
The 2016 Lancet series, Advancing early childhood development: From science to scale, contains a wealth of the most current research on early childhood development, including meta analyses compiled through collaboration among leading experts in early child development (ECD). As you read the executive summary, think about to what extent managing the social determinants of health are critical to improving not only children’s lives but overall population health.
The executive summary front page begins with these words:
“Young children’s healthy development depends on nurturing care—care which ensures health, nutrition, responsive caregiving, safety and security, and early learning.”
How are all of these factors examples of social determinants of health?
Can you name at least one piece of evidence for each of the key messages cited in the summary?
How would you explain to someone who is not involved in the early child development (ECD) sector that the burden and cost of inaction in relation to ECD is high?
Why is health considered the best starting point for reaching the youngest children?
Dr. Zulfiqar Bhutta, founding director at the Centre of Excellence in Women and Child Health at the Aga Khan University, offers his perspective on social determinants in a low income country.
What recommendations to improve the access and quality of early childhood care and education (ECCE) programs are outlined in the brief?
In your region of the world, are there national policies and initiatives working towards these goals?
Want to know more? Lancet series on early child development
In the next three clips, Dr. Maureen Black, professor of Pediatrics at the University of Maryland, describes the evolution of the influential Lancet series on early child development.
Want to know more? Conditional cash transfer programs
Around the world, researchers are considering how the deprivations and challenges of poverty specifically impact children’s lives; whether investments are reaching them; and what strategies and policies are most effective in reducing childhood poverty. Conditional cash transfer programs are one means that have been used as a strategy to break the cycle of poverty. Dr. Lia Fernald, professor of Community Health Sciences at the School of Public Health, University of California, Berkeley, describes how cash transfer programs work to not only address families’ short term needs but also positively impact the long term health and development of their children.
In the videos that follow, Fernald describes some of the program evaluation findings.
How do conditional cash transfer programs support and enhance protective factors in children’s lives?
Do you think cash transfer programs could work in wealthier countries? Why or why not?
