User:Tyding/sector

CHANGES: Added interventions and challenges of measuring interventions to social determinants of health, under International Health Inequalities. Also made some changes to the format of the section, to better integrate past text with my additions.

Before Edits
Reducing the health gap in a generation requires that governments build systems that allow a healthy standard of living where no one should fall below due to circumstances beyond his or her control. Social protection schemes can be instrumental in realizing developmental goals rather than being dependent on achieving those goals. They can be effective ways to reduce poverty and local economies can benefit. Policies to reduce child poverty are particularly important, as elevated stress hormones in children interfere with the development of brain circuitry and connections, causing long term chemical damage. Studies showed that the immune system of participants were stronger if their parents had the security of home ownership while the participants were growing up. In most wealthy countries, the relative child poverty rate is 10 percent or less; in the United States, it is 21.9 percent. The lowest poverty rates are more common in smaller well-developed and high-spending welfare states like Sweden and Finland, with about 5 or 6 percent. Middle-level rates are found in major European countries where unemployment compensation is more generous and social policies provide more generous support to single mothers and working women (through paid family leave, for example), and where social assistance minimums are high. For instance, the Netherlands, Austria, Belgium and Germany have poverty rates that are in the 7 to 8 percent range.

The Commission on Social Determinants of Health (CSDH) in 2005 made recommendations for action to promote health equity based on 3 principles of action: "improve the circumstances in which people are born, grow, live, work, and age; tackle the inequitable distribution of power, money, and resources, the structural drivers of conditions of daily life, globally, nationally, and locally; and measure the problem, evaluate action, and expand the knowledge base." These recommendations would involve providing resources such as quality education, decent housing, access to affordable health care, access to healthy food, and safe places to exercise for everyone despite gaps in affluence. Expansion of knowledge of the social determinants of health, including among healthcare workers, can improve the quality and standard of care for people who are marginalized, poor or living in developing nations by preventing early death and disability while working to improve quality of life.

After Edits
Reducing the health gap in a generation requires that governments build systems that allow a healthy standard of living where no one should fall below due to circumstances beyond his or her control. Social protection schemes can be instrumental in realizing developmental goals rather than being dependent on achieving those goals. They can be effective ways to reduce poverty and local economies can benefit.

Interventions
Three common interventions for improving social determinant outcomes as identified by the WHO are education, social security and urban development. Due to the nature of the interventions and their impact, and their disproportionally heavy impact on children, evaluation of interventions has been difficult.


 * 1) Education: Many scientific studies have been conducted and strongly suggests that increased quantity and quality of education leads to benefits to both the individual and society (e.g. improved labor productivity) . Health and economic outcome improvements can be seen in health measures such as blood pressure , crime , and market participation trends . Examples of interventions include decreasing size of classes and providing additional resources to low-income school districts. However, there is currently insufficient evidence to support education as an social determinants intervention with a cost-benefit analysis.
 * 2) Social Protection: Interventions such as “health-related cash transfers”, maternal education, and nutrition-based social protections have been shown to have a positive impact on health outcomes  . However, the full economic costs and impacts generated of social security interventions are difficult to evaluate, especially as many social protections primarily affect children of recipients.
 * 3) Urban Development: Urban development interventions include a wide variety of potential targets such as housing, transportation, and infrastructure improvements. The health benefits is clearly evident, especially with internal housing improvements (smoke alarm installation, concrete flooring) on children . In addition, there is a fair amount of evidence to support external urban development interventions such as transportation improvements, which is highly effective in developed countries, but can also guide the culture of many developing countries towards sanitation and better transportation policies . Affordable housing options (including public housing) can make large contributions to both social determinants of health, as well as the local economy.

The Commission on Social Determinants of Health (CSDH) in 2005 made recommendations for action to promote health equity based on 3 principles of action: "improve the circumstances in which people are born, grow, live, work, and age; tackle the inequitable distribution of power, money, and resources, the structural drivers of conditions of daily life, globally, nationally, and locally; and measure the problem, evaluate action, and expand the knowledge base." These recommendations would involve providing resources such as quality education, decent housing, access to affordable health care, access to healthy food, and safe places to exercise for everyone despite gaps in affluence. Expansion of knowledge of the social determinants of health, including among healthcare workers, can improve the quality and standard of care for people who are marginalized, poor or living in developing nations by preventing early death and disability while working to improve quality of life.

Challenges of measuring value of interventions
Many economic studies have been conducted to measure the effectiveness and value of social determinant interventions but is unable to accurately reflect effects on public health due to the multi-faceted nature of the topic. While neither cost-effectiveness nor cost-utility analysis are able to be used on social determinant interventions, cost-benefit analysis is able to better capture the effects of an intervention on multiple sectors of the economy. For example, tobacco interventions have shown to decrease tobacco use, but also prolong lifespans, increasing lifetime healthcare costs and is therefore marked as a failed intervention by cost-effectiveness, but not cost-benefit. Another issue with research in this area is that most of current scientific papers focus on rich, developed countries, and there is a lack of work done on developing countries.

Policy changes that affect children also present the challenge that it takes a significant amount of time to be able to gather data. In addition, Policies to reduce child poverty are particularly important, as elevated stress hormones in children interfere with the development of brain circuitry and connections, causing long term chemical damage. Studies showed that the immune system of participants were stronger if their parents had the security of home ownership while the participants were growing up. In most wealthy countries, the relative child poverty rate is 10 percent or less; in the United States, it is 21.9 percent. The lowest poverty rates are more common in smaller well-developed and high-spending welfare states like Sweden and Finland, with about 5 or 6 percent. Middle-level rates are found in major European countries where unemployment compensation is more generous and social policies provide more generous support to single mothers and working women (through paid family leave, for example), and where social assistance minimums are high. For instance, the Netherlands, Austria, Belgium and Germany have poverty rates that are in the 7 to 8 percent range.