Social Context of Public Health and Health Promotion

Subject: Health Care
Type: Exploratory Essay
Pages: 5
Word count: 1499
Topics: Public Health, Health


This work addresses issues relating to the role of social and structural factors influencing health-related life styles of people in the United Kingdom (UK). In this context, issues including public health promotion and related governmental policies aimed at improving healthy life styles have been critically examined. This work claims that social and structural factors exert a substantial effect on the health-related life styles of people in the UK.     

According to World Health Organisation (WHO), several factors, in combination, influence the health of communities and individuals. Individual health is determined by circumstances and the environment. The relevant major influencers are: place of residence, environmental status, genetics, income and education level, and associations with family and friends. Health determinants, include, social, economic and physical environments, and individual behaviours and characteristics (World Health Organization, 2017). 

In this regard, the structural and proximal levels have been identified as the principal levels of the conceptual framework of the WHO Commission on Social Determinants of Health. Thus, structural determinants are basic structures that produce social stratification, including national and international education, economic, political and social welfare systems. However, proximal determinants denote daily life conditions, including access to education, family environment, peer relationships, and availability of housing, food and recreation. Moreover, proximal determinants emerge from social stratification; and cultural, community and religious factors (Viner, et al., 2012, p. 1642). Thus, proximal determinants establish individual disparities in vulnerability and exposure to factors that worsen health and cause illness.

Effect of Social Circumstances on Health

The social circumstances of birth, development, life and work have significant influence upon health and wellbeing. To some extent, these are correlated to income and wealth. However, low income does not necessarily indicate the presence of adverse social determinants of health (British Medical Association, 2011). The following figure depicts the life expectancy and disability-free life expectancy in the upper and lower curves, respectively, vis-à-vis individuals residing in various areas of England. 

The study of Marmot et al. serves as the primary source for evidence, in this regard, about the significance of social determinants of health. In their studies with Whitehall civil servants, they had noted a steep inverse gradient between mortality and employment grade. Moreover, mortality rate of employees in the lowest grade was thrice that of employees in the highest grade. Subsequent studies, demonstrated strong social gradients in morbidity regarding angina, diabetes, chronic bronchitis, hypertension, lung cancer and other indicators (Halfon, et al., 2010, p. 11). In addition, sleep can also be impacted by socio-economic factors, including, home, work and neighbourhood environments. These can produce short-term health effects, which can impact colleagues, customers and others (Braveman & Gottlieb, 2014, p. 23).

Moreover, the Health Behaviour in School-Aged Children study discovered that family affluence constituted a cardinal predictor of young people’s health. Cost can limit the opportunities of families to undertake healthy behaviours, including the consumption of vegetables and fruit, and participation in fee-based physical activity. In addition, young people from low affluence households tend to have inadequate access to health resources (Currie, et al., 2012, p. 6). This could increase their vulnerability to psycho-social stress and ill health. Upon comprehending these effects, it would become much more feasible to identify the reasons behind socio-economic disparities in adult health. 

Furthermore, financial difficulties at the age of 16 years is a statistically significant determinant of health deterioration upon attaining adulthood, especially among males. Propper et al. showed that low income spells during the early years have an adverse impact upon childhood and adolescent health, which continues into adulthood (Dias, 2009, p. 1066). Moreover, health endowments are critical, as illness incidence during adolescence is positively correlated to failing health. 

Empirical Studies on Health Disparities 

Several empirical studies on socio-economic disparities in health address cultural and behavioural factors. Such studies analyse data pertaining to socio-economic status, health and lifestyle, and have demonstrated that most of the observed socio-economic health disparities emerge from the differential distribution of behavioural factors among socio-economic groups. Thus, the Regional Heart Study and the British Whitehall Study had disclosed that 50% of the enhanced danger of heart disease mortality among the lowest socio-economic group resulted from blood pressure, cholesterol, obesity, smoking and other lifestyle related factors  (Stronks, et al., 1996, p. 654). Moreover, working conditions, housing, and material deprivation can adversely impact health.

In addition, comparison of data from 2005 to 2012, by the Monitoring Poverty and Social Exclusion report, showed that in the lowest socio-economic class, 26% of females and 23% of males were at mental health risks, and that 75% of the people with mental health issues did not receive prolonged treatment. Furthermore, poverty increased risk of mental health problems, and could be a causal factor and consequence of mental ill health (Elliott, 2016, p. 7). Finally, mental health was seen to be moulded by several traits, such as the economic, physical and social environments of the people.

Hence, the Government should formulate health and social policies that ensure adequate response to social risks, their functioning and liability to change. This facilitates health systems and social interventions that address the impacts of social determinants, effectively (Halfon, et al., 2010, p. 14). Social determinants, per se, do not act in isolation and function as multiple interacting factors. 

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Political Ideology Reducing Health Inequalities

Nevertheless, considerable variation persists in European nations, regarding social inequalities in health. Some of these nations ignore these inequalities, whilst others formulate policies to address them (Borrell, et al., 2013, p. 101). Thus, in the UK, several policies to reduce health inequalities were formulated to address increasing socio-economic inequalities in the 1980s and 1990s. The Government undertook several initiatives, vis-à-vis education, employment and social security that stressed upon childhood poverty and assistance to the poorest social classes. However, other social security measures had an opposite effect. Thus, the link between social security benefits and earnings was severed. For instance, child benefit value had been restricted, and lone parent allowance abolished (Black, et al., 1999, p. 725).

Therefore, Seedhouse claimed that health promotion activity is motivated by political ideology.  Biomedical approaches reflect values of maintaining the status quo, prudence and conservatism. Moreover, the community development approaches represent social democracy and egalitarianism. The difficulty lies in the failure to clarify the values underlying health promotion decisions (Raphael, 2000, p. 362). Thus, ideology, per se, concentrates upon certain factors, whilst ignoring others.

Models of Social Determinants of Health 

Models of social determinants of health have expanded, and encompass the social determinants of health inequalities. An instance is provided by Brunner and Marmot’s model, which had been initially developed to correlate clinical and public health perspectives. Thereafter, it was applied to the social processes underlying health inequalities. Thus, it became a model of the social factors that promote health inequalities and cause ill health. The Acheson report included this model with the express purpose of illustrating the manner in which socio-economic inequalities in health emerge from differential exposure to risks (Graham, 2004, p. 109). Vis-à-vis public health interventions, the effectiveness of intricate interventions is determined by socio-economic and environmental conditions, organisational readiness, target population and policy context. This necessitates inclusion of intervention theory and understanding regarding the manner of interaction of interventions with context (Bonell, et al., 2012, p. 2300).This is indispensable as local capacity to implement complicated interventions varies significantly. 

Furthermore, these Interventions are primarily focused upon lifestyle drift and improving healthy behaviours. Policy tends to stress upon healthy behaviour interventions and neglects distal causes, like poor living conditions. Such unsatisfactory progress is due to the difficulty involved in analysing health inequalities of interventions in upstream structural determinants (Pons-Vigues, et al., 2014, p. 209).

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This research work examined the effect of social and structural determinants on the health-related life styles of people in the UK. In a study regarding social determinants of health, Marmot et al. claimed that employees in the lowest grade had a much higher mortality rate than those in the highest grade. This evidences the fact that the inequalities in income level affect the health-related life of the people. According to Propper et al. poverty in early years of life has adverse effects upon health in childhood and adolescence. A study by Curie et al. revealed that poor economic conditions influence the health of young adults.  

Research by Regional Heart Study and British Whitehall Study, disclosed that the 50% increase in the risk of mortality by heart disease in the lowest socio-economic group resulted from life style related factors, including, blood pressure, cholesterol, obesity and smoking. Moreover, the Monitoring Poverty and Social Exclusion report disclosed that mental health issues resulted from economic, physical and social environment factors. 

The UK Government had formulated policies to address socio-economic inequalities. However, their non-comprehensiveness rendered them incapable of countering the problem. The issue of social and structural factors, affecting health-related life is complex and demands a comprehensive approach and proper implementation. Thus, it can be surmised that social and structural factors affect health-related life styles to a major extent.  

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