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Here's a wee Friday 
on the structural/ social determinants of health over the lifecourse
I'll refer to Hertzman's piece on the ubiquitous, persistent graded relationships between social factors & health
#SDOH #healthinequalities
https://www.pnas.org/content/pnas/109/Supplement_2/17160.full.pdf
on the structural/ social determinants of health over the lifecourseI'll refer to Hertzman's piece on the ubiquitous, persistent graded relationships between social factors & health
#SDOH #healthinequalities
https://www.pnas.org/content/pnas/109/Supplement_2/17160.full.pdf
Hertzman observes that the pattern of association between social factors and health/ disease is present over time and across contexts. Let's go through these points
-An omnipresence across countries
Ex: Under-5 mortality rate in 1990 & 2016 + household poverty for all low-income and middle-income countries (excl China) combined & by region
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30059-7/fulltext
Ex: Under-5 mortality rate in 1990 & 2016 + household poverty for all low-income and middle-income countries (excl China) combined & by region
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30059-7/fulltext
-An omnipresence across countries
Ex: Trends in inequalities in premature mortality across Europe. Here its education & mortality by decade among women
https://jech.bmj.com/content/69/3/207.short
Ex: Trends in inequalities in premature mortality across Europe. Here its education & mortality by decade among women
https://jech.bmj.com/content/69/3/207.short
-Its resurgence on emerging health conditions
Ex: No surprise that we can use #Covid19 as an example here. The French Epicov study has shown that exposure to #SARSCoV2 was socially patterned in May2020
https://www.elsevier.com/__data/assets/pdf_file/0020/1085501/Drees-Covid-oct-2020.pdf
Ex: No surprise that we can use #Covid19 as an example here. The French Epicov study has shown that exposure to #SARSCoV2 was socially patterned in May2020
https://www.elsevier.com/__data/assets/pdf_file/0020/1085501/Drees-Covid-oct-2020.pdf
-Not fully explained by "classic" risk factors: smoking, alcohol, nutrition
In analyses of social factors & health which then adjust for behavioural factors there usually remains an 'unexplained' association
[This links with method issues mediation analyses]
![-Not fully explained by "classic" risk factors: smoking, alcohol, nutrition In analyses of social factors & health which then adjust for behavioural factors there usually remains an 'unexplained' association[This links with method issues mediation analyses]](https://pbs.twimg.com/media/EtdQfZjWQAgXmRD.png "-Not fully explained by \"classic\" risk factors: smoking, alcohol, nutrition In analyses of social factors & health which then adjust for behavioural factors there usually remains an 'unexplained' association[This links with method issues mediation analyses]")
In analyses of social factors & health which then adjust for behavioural factors there usually remains an 'unexplained' association
[This links with method issues mediation analyses]
-Observed gender/ sex differences
Ex: Here, the change in life expectancy over time by social deprivation in Germany is more pronounced among men compared to women. This is observed in other countries too & using different social measures
Ex: Here, the change in life expectancy over time by social deprivation in Germany is more pronounced among men compared to women. This is observed in other countries too & using different social measures
-Begins as a developmental gradient in early life
Ex: Below, differences in vocabulary between children from disadvantaged/ advantaged socioeconomic positions was clearly evident at 18 months & amplified over time
https://onlinelibrary.wiley.com/doi/full/10.1111/desc.12019?casa_token=gn7J_KGtUMEAAAAA%3ASE5pxKb6KSVHk7clJjSeG97UlG2JiKX1v0g4R-TlZOr_XZc0Ocv-N6OSipUQUBGjgulu3oOBfmjXuUS6
Ex: Below, differences in vocabulary between children from disadvantaged/ advantaged socioeconomic positions was clearly evident at 18 months & amplified over time
https://onlinelibrary.wiley.com/doi/full/10.1111/desc.12019?casa_token=gn7J_KGtUMEAAAAA%3ASE5pxKb6KSVHk7clJjSeG97UlG2JiKX1v0g4R-TlZOr_XZc0Ocv-N6OSipUQUBGjgulu3oOBfmjXuUS6
-A large array of potential pathological processes
Associations exist between social factors and cardiovascular diseases, cancers, metabolic diseases, infectious diseases, psychopathologies etc
There is increasing evidence for a common biological soil
Associations exist between social factors and cardiovascular diseases, cancers, metabolic diseases, infectious diseases, psychopathologies etc
There is increasing evidence for a common biological soil
Some big questions we ask in my team:
Do social processes affect health through biology? How?
To work on this our research rests upon 3 pillars
Do social processes affect health through biology? How?
To work on this our research rests upon 3 pillars
Caveat!Socially-patterned biological phenomena must not be confused with genetic explanations
Now you know why we might take an interest in social-to-biological processes
Of course, there are many many other factors of interest when studying health inequalities...
Here's an overall way in which I tend to think about it, inspired by lots of other existing models
End
Of course, there are many many other factors of interest when studying health inequalities...
Here's an overall way in which I tend to think about it, inspired by lots of other existing models
End
