5.4 Social and economic determinants of mortality

Mortality rates aren't just about biology. Social and economic factors play a huge role in who lives longer. Income, education, and job type all impact our health risks and access to care.

These factors create complex pathways to health disparities. Stress, lifestyle choices, and environmental exposures vary by socioeconomic status. Understanding these links is key to addressing unfair differences in how long people live.

Social and Economic Determinants of Mortality

Socioeconomic Status and Mortality

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• Socioeconomic status (SES) combines income, education, and occupation to significantly impact mortality risks
• Income inequality strongly associates with higher mortality rates
  • Lower-income groups face increased health risks
  • Reduced access to quality healthcare for lower-income individuals
• Educational attainment inversely relates to mortality risk
  • Higher education levels correspond to lower mortality rates
  • Increased health literacy and better health behaviors in more educated populations
• Occupational factors contribute to mortality differentials
  • Job stress impacts health outcomes (high-pressure finance jobs)
  • Workplace hazards affect mortality (construction, mining)
  • Employment stability influences long-term health (job security, benefits)

Healthcare Access and Social Capital

• Access to healthcare plays a crucial role in mortality outcomes
  • Preventive services reduce long-term health risks (regular check-ups, screenings)
  • Quality medical care improves survival rates (advanced treatments, specialized care)
  • Health insurance coverage determines healthcare utilization (insured vs uninsured populations)
• Social capital influences mortality risks through various mechanisms
  • Social support networks provide emotional and practical assistance (family, friends, community groups)
  • Information sharing improves health knowledge and behaviors (health education programs, community workshops)
  • Community resources enhance overall well-being (public parks, community centers, local clinics)
• Fundamental causes theory explains persistent health inequalities
  • SES affects multiple disease outcomes through various mechanisms
  • Explains why health disparities persist despite changing disease patterns (shifts from infectious to chronic diseases)

Pathways to Health Disparities

Stress and Health Behavior Pathways

• Stress pathway hypothesis links chronic stress to increased health problems
  • Lower SES associated with higher chronic stress levels
  • Physiological wear and tear increases susceptibility to various diseases
  • Stress-related health issues include cardiovascular problems, weakened immune systems
• Health behavior pathways explain how SES influences lifestyle choices
  • Diet quality varies by socioeconomic status (access to fresh produce, nutritional education)
  • Physical activity levels differ across social groups (availability of safe recreational spaces, leisure time)
  • Substance use patterns vary by SES (smoking rates, alcohol consumption)

Material Deprivation and Environmental Exposure

• Material deprivation pathway focuses on limited financial resources
  • Impacts access to health-promoting resources (nutritious food, safe housing)
  • Affects ability to afford preventive healthcare services (regular check-ups, dental care)
  • Influences overall quality of life and health outcomes (stress from financial insecurity)
• Environmental exposure pathways highlight SES-related hazards
  • Air pollution exposure varies by neighborhood (industrial areas, traffic congestion)
  • Unsafe working conditions more common in lower-wage jobs (lack of protective equipment, exposure to toxins)
  • Neighborhood violence affects physical and mental health (stress, injury risk)

Life Course and Psychosocial Factors

• Life course perspective emphasizes cumulative impact of SES
  • Prenatal development affected by maternal SES (access to prenatal care, nutrition)
  • Childhood experiences shape long-term health trajectories (education, early healthcare)
  • Adult SES influences health behaviors and access to resources (job opportunities, healthcare access)
• Psychosocial pathways explore social relationships and perceived status
  • Social support influences health outcomes (emotional support, practical assistance)
  • Perceived social status affects mental and physical health (stress, self-esteem)
• Allostatic load concept explains cumulative physiological effects
  • Chronic exposure to adverse conditions leads to physiological dysregulation
  • Increases risk of various health problems (cardiovascular disease, diabetes, mental health issues)

Public Policies for Health Equity

Healthcare and Income Policies

• Universal healthcare policies aim to reduce disparities
  • Ensure equitable healthcare coverage across populations
  • Improve overall population health outcomes (reduced mortality rates, increased life expectancy)
  • Examples include national health services (UK's NHS) and single-payer systems (Canada's Medicare)
• Income redistribution policies mitigate income inequality
  • Progressive taxation systems tax higher incomes at higher rates
  • Social welfare programs provide financial support (unemployment benefits, food assistance)
  • Minimum wage laws ensure basic income levels for workers

Education and Workplace Policies

• Educational policies focus on improving access and quality
  • Reduce educational disparities through targeted interventions (early childhood education programs, school funding equalization)
  • Address long-term health inequalities through improved education (increased health literacy, better job prospects)
• Occupational health and safety regulations protect workers
  • Reduce workplace hazards through safety standards (protective equipment requirements, exposure limits)
  • Improve working conditions for vulnerable populations (regulations for high-risk industries)
  • Enforce labor laws to prevent exploitation (working hour limits, rest break requirements)

Housing and Public Health Interventions

• Housing policies address living environment issues
  • Affordability measures reduce housing insecurity (rent control, affordable housing initiatives)
  • Quality standards ensure safe living conditions (building codes, inspections)
  • Neighborhood improvement programs address community-level factors (green spaces, community centers)
• Public health interventions target specific health behaviors
  • Smoking cessation programs reduce tobacco-related mortality (nicotine replacement therapy, counseling services)
  • Obesity prevention initiatives promote healthy lifestyles (school nutrition programs, public education campaigns)
• Intersectoral collaboration promotes coordinated efforts
  • Health in All Policies (HiAP) approach integrates health considerations across policy domains
  • Cross-sector partnerships address complex health determinants (collaboration between housing, education, and health departments)

Social Change and Mortality Trends

Technological and Demographic Shifts

• Technological advancements in healthcare impact outcomes
  • Personalized medicine tailors treatments to individual genetic profiles
  • Telemedicine improves healthcare access in remote areas
  • Potential to exacerbate disparities if access is not equitable (digital divide, cost barriers)
• Demographic shifts influence mortality patterns
  • Population aging increases prevalence of age-related health issues (chronic diseases, cognitive decline)
  • Changing family structures affect social support systems (smaller families, geographic dispersion)
  • Adaptations required in social and economic policies (healthcare system reforms, retirement policies)

Environmental and Economic Changes

• Climate change disproportionately affects vulnerable populations
  • Increased frequency of extreme weather events (heat waves, floods)
  • Changes in disease patterns and food security (vector-borne diseases, crop yields)
  • Targeted interventions needed to mitigate health impacts (climate-resilient infrastructure, early warning systems)
• Globalization and economic restructuring impact socioeconomic conditions
  • Changes in income distribution due to global market forces (job outsourcing, wage pressures)
  • Shifts in job markets affect occupational health risks (decline in manufacturing, rise of service sector)
• Artificial intelligence and automation transform labor markets
  • Potential job displacement in certain sectors (manufacturing, transportation)
  • New occupational health risks emerge (sedentary work, mental health challenges)
  • Adaptations needed in education and social safety nets (reskilling programs, universal basic income discussions)

Social Norms and Health Challenges

• Shifts in social norms influence health behaviors
  • Changing attitudes towards smoking (decreased social acceptability)
  • Evolving dietary patterns (increased awareness of nutrition, plant-based diets)
  • Transformations in social support systems (online communities, changing family dynamics)
• Increasing prevalence of chronic diseases shapes mortality patterns
  • Rise in non-communicable diseases (diabetes, heart disease, cancer)
  • Growing burden of multimorbidity in aging populations
  • Adaptations required in healthcare systems and social policies (integrated care models, long-term care provisions)