User:Blessingijames/Social determinants of health in poverty

Key: Plain text, from Wikipedia article; Bold face, my additions; Italics, my copyedited sentences

Governance/policy[edit]
Type and structure of governments and their social and economic policy more deeply affects the health of the impoverished than other populations. Every component of government- from finance, education, housing, employment, transportation, and health policy- affects population health and health equity. Life expectancy variation between countries can be partially attributed to the type of political regime, whether that be fascist, communist, conservative, or social-democratic. '''It is suggested by WHO that those who are the most vulnerable and affected by policy changes that influence their quality of health should have a direct hand in the construction and adoption of these same policies. This power in contribution would have a positive impact on their health outcomes, due to their ability to participate autonomously in policies that influence their health.''' However, changing the status of government regime does not always end the type of policies in place, as seen in South Africa. The end of South Africa's apartheid regime has still not dismantled the structures of inequality and oppression, which has led the persistent social inequality to perpetuate the spread of HIV, diminishing population health. Also, the political economy, encompassing production organization, physical infrastructure, and political institutions [9] play a large role in determining health inequalities.

Social services and healthcare availability[edit]
'''The social environment that impoverished people dwell in is often a precursor to the quality of their health outcomes. Without equitable access to basic social needs, it is difficult to have a quality standard of health while under a significant financial burden. The Commission of Social Determinants of Health, created in 2015 by the World Health Organization, was a pioneer in the push for more focus on "creating better social conditions for health, particularly among the most vulnerable people”. These basic social needs that influence social environment include food security, housing, education, transportation, healthcare access and more factors that can affect health. Social services and social service programs, which provide support in access to basic social needs, are made critical in the improvement in health conditions of the impoverished.''' Impoverished people depend on healthcare and other social services to be provided in the social safety net, therefore availability greatly determines health outcomes. Since low living standards greatly influence health inequity, generous social protection systems result in greater population health, with lower mortality rates, especially in disadvantaged populations. A successful example of such social service program is the Senior Companion program, an extension of the United States federal program Senior Corps. The program provides assistance for adults who have physical and mental disadvantages. It pairs up senior volunteers with patients who come from low-income background to help them increase their social capability, ability to live independently and more accessibility to healthcare. A mixed-method study explores that the program does target various social determinants of health and have positive effects on enrolled elders' health status (although less positive correlation long-term). It concludes that the program does have enthusiastic impacts on clients and volunteers' overall wellness. The result is homogeneous with conclusions from other studies, with emerging themes include: companionship, reduced depression, access to healthcare, isolation, and increased social network. '''Another example of a utilized social service program in Northern California is the UCSF Benioff Children's Hospital Oakland Find Program. This program employs a method of addressing the social determinants of health, liaison work, contextualized by their predominantly impoverished patient population. This liaison work involves caseworkers in the clinic connecting patients to basic social needs resources. Similar positive results have been found, suggesting that this liaison work is effective in bettering the health status of those in marginalized positions of society.'''

Nations that have more generous social protection systems have better population health (Lundberg et al., 2007). More generous family policies correlate with lower infant mortality. Nations that offered higher coverage and reimbursement for pensions and sickness, unemployment, and employment accident insurance have a higher LEB (Lundberg et al., 2007), as well as countries with more liberal pensions have less senior mortality. (Lundberg et al., 2007)

Access to Healthcare[edit]
The health care system represents a social determinant of health as well as it influences other determining factors. People's access to health care, their experiences there, and the benefits they gain are closely related to other social determinants of health like income, gender, education, ethnicity, occupation, and more. For poor people, systematic barriers in the social structure are formidable, especially financing. Medicaid and maternity coverage structures have complex and time-consuming registration processes, along with long waits and unsure eligibility. A study of the Emergency Department found that the majority of patients presenting with mental illness were those on Medical (20.4%) and Medicare (31.5%), whereas only 12.4% of privately insured patients presented with mental illness. California has expanded its eligibility of Medi-Cal under federal law to cover as many people as possible. Inequalities in health are also determined by these socioeconomic and cultural factors. Health care is inequitably distributed globally, with pronounced inequality for the poor in low- and middle-income countries. One study demonstrated that doctors treat poor populations differently, showing that disadvantaged patients are less likely to receive the recommended diabetic treatments and are more likely to undergo hospitalization due to the complications of diabetes (Agency for Health Care Research and Quality, 2003). According to the WHO, healthcare systems can most improve health equality when institutions are organized to provide universal coverage, where everyone receives the same quality healthcare regardless of ability to pay, as well as a Primary Healthcare system rather than emergency center assistance.

These structural problems result in worse healthcare and therefore worse health outcomes for impoverished populations. Health care costs can pose absolutely serious threats to impoverished populations, especially in countries without proper social provisions. According to US HHS, "In 2009, children 6–17 years of age were more likely to be uninsured than younger children, and children with a family income below 200% of the poverty level were more likely to be uninsured than children in higher-income families." In elderly populations, individuals below 400% of the poverty line were between 3 and 5 times more likely to lack insurance. Children below 200% of the poverty line were also less likely to have insurance than wealthier families. Also, in 2009 in the US, 20% of adults (ages 18–64) below 200% of the poverty line did not receive their necessary drugs because of cost, compared to only 4% of those above 400% of the poverty line. Increasing healthcare costs (including higher premiums) imposed a burden on consumers. In 2010, President Obama introduced the Patient Protection and Affordable Care Act (ACA), expanding health care to many that lacked coverage. The U.S. had the highest rate of uninsured people, and the highest health care costs, of all industrialized nations at the time. The ACA helped 20 million Americans get coverage and decreased the rates of uninsured from 16% in 2010 to 8.6% in 2016. The ACA brought coverage to people who had suffered from downgrades in Employee Insurance programs, by providing a health insurance marketplace, giving them access to private insurance plans along with income-based government subsidies. This can be seen in other nations, where in Asia, payments for healthcare pushed almost 3% of the population of 11 countries below 1 US$ per day. '''However, under the current U.S. administration, there have been shifts in how federal funding is allocated to social service programs. Although, initiatives like the National Prevention Council have been established to address prevention, there have also been some drawbacks. Because of this political shift, entities that address the social determinants of health in poverty, like social service programs, are threatened under these new policies. These policies reallocate funding away from public social service programs, causing resources that promote prevention and public health to be limited. The problem most present with state provisioned resources like public social service programs that aim to alleviate health disparities are the ever changing political spheres that either propel or block communities from access to effective health care resources and interventions. Despite the strength of political influences, it has been shown that, globally, shifting attention to addressing social needs like healthcare access has dramatically affected the health of impoverished communities.'''

Notes:

- insert piece(s) on past and present interventions

- rather possible interventions: liaison work, definition, what it entails

- the most effective, historically based?

- integrate rather than make a new section

- HOW IT AFFECTS SDoH in pov !! not reviewing interventions

- MAIN POINT: How [BLANK] affects health outcomes of the poor