How SDOH Affect Quality of Life Throughout the Life Stages

How Social Determinants of Health Affect Quality of Life Throughout the Life Stages

References

Solutions: Moving Foward

Arnold, R. et al. (1991). Chapter 3: Shaping Our Tools. In Educating for a Change. Toronto: Between the Lines Press and the Doris Marshall institute for Education and Action, pp. 101-108.

Canadian Child and Youth Health and Housing Network. (2013). More than shelter: the impact of housing on children and youth in Canada. Retrieved from: http://www.housingandchildhealth.ca/

Canadian Pediatric Society. (2015). Housing need in Canada: Healthy lives start at home. Retrieved from: http://www.cps.ca/en/documents/position/housing-need

Centre for Social Justice (no date). Behind every hungry child is a starving Mom. Retrieved from: http://www.socialjustice.org/index.php?page=fact-sheet---behind-every-hungry-child-is-a-starving-mom---canada

Freire, P. (1970). Chapter Two. In Pedagogy of the Oppressed. New York: Continuum Publishing Co. pp. 57-74.

Gustafson, D. (1999). Embodied Learning: the Body as an Epistemological Site. In Meeting the Challenge: Innovative Feminist Pedagogies in Action, M. Mayberry and E.C. Rose (Eds.). New York: Routledge. pp.249-273.

Mikkonen, J. & Raphael, D. (2010). Social determinants of health: The Canadian facts. Retrieved from http://www.thecanadianfacts.org/the_canadian_facts.pdf

Research Alliance for Canadian Homelessness, Housing and Health. (2010). Housing Vulnerability and

Health: Canada’s Hidden Emergency. Retrieved from: http://www.stmichaelshospital.com/pdf/crich/housing-vulnerability-and-health.pdf

Research shows that:

(Mikkonen & Raphael, 2010)

Policies and Policy Makers

• Through initiatives such as transforming knowledge into action, policy reform, promotion and support of healthy lifestyles through community agencies and organizations, SDOH can be addressed and the status quo can be changed for the better.
• Through social and political action addressed through public policy that focuses on living conditions such as housing, food security, and employment; improvements can be made.

• In Canada we have the option of supporting political leaders and parties that address the SDOH such as public pension, universal health care, and housing programs (Mikkonen & Raphael, 2010).
• Policy makers are currently aware of the changes that have the ability to better the SDOH, however, many are not taking action to support public health policy.
• Canadians also have the ability initiate change by raising concerns about health and health care policies with the local agencies and organizations in their communities.

Power Flower

A Closer Look at 4 SDOH

Education and Awareness

Learning Activity 2

Housing

Early Childhood Development

Case Study Discussion

There are several aspects related to housing which affect health. Consider some of the following examples and how they might affect you or your clients.

Research is showing that our experiences and our environments within the first few years of life have a profound impact on our lifelong health.

An interesting line of science, called epigenetics, explores the ways that genetic activity can be affected by our experiences, or even by the experiences of our parents and grandparents.

Stress in the early years has been found to play a major role in our health prospects.

Please consider the following in your journal: What are some factors which can affect stress levels in the early years? What are some ways that social services may contribute to family stress; how can social work and social policy contribute to reducing stress for families?

An excellent place to learn more about the impacts of childhood experience on health outcomes is through a UBC research organization called the Human Early Learning Partnership. It conducts long-term research throughout BC with the aim of benefiting health outcomes by contributing to policy and program development. Here is a link to their website which includes community-specific data that they have collected from across BC: http://earlylearning.ubc.ca/

Overcrowded Housing

• Through educating individuals, professionals and communities about the SDOH and the variables that affect health policy and community well-being, we can create social awareness.
• From this awareness, communities can collectively encourage and demand that elected representatives begin to center health care and health care reform.

Affordability

Physical Housing Conditions

In 2006, overcrowded housing affected over 73, 000 Canadian households (Canadian Child and Youth Health and Housing Network, 2013).

Overcrowded housing is linked to increased risk of communicable diseases; mental health issues such as depression and stress; and poor academic performance (Canadian Child and Youth Health and Housing Network, 2013).

Imagine how living in an overcrowded home might affect your sleep patterns, your ability to freely choose noise level, screen time, what and when you eat, and so on.

The following video explores the biological connections between early childhood experiences and lifelong health. Please watch the first 4.5 minutes of the video, or feel free to continue on and enjoy the whole thing!

In 2006, 35% of Canadian households were spending more than 30% of their income on housing, which is Canada's definition of unaffordable housing (Mikkonen and Raphael, 2010).

High costs of housing can create circumstances in which people must choose between housing and other basic needs such as nutritious food and warm clothing and is linked to food insecurity and inadequate nutrition (Canadian Pediatric Society 2015).

Time Sensitive Activity (Required to Post)

Time frame: Wednesday to Friday (March 16 - 18)

Choose to reply to either Part 1 or 2 below and formulate a 150-200 word response and reply to at least one other classmate's post.

-Exposure to lead dust can affect learning ability and behavior in children.

-Air Quality affects respiratory health (ie: asthma and lung function) and has been linked with poor concentration.

-House disrepair can lead to physical injury.

-Pests such as bedbugs and rodents can lead to mental health issues such as anxiety, and physical health issues such as skin infections and allergic reactions. Pests have also been linked with developmental delays in infants whose caregivers may be reluctant to place them on the floor for movement exercises such as crawling and rolling.

-Poor housing conditions are linked with children's mental health including sleep disorders, anxiety, and depression.

(Canadian Child and Youth Health and Housing Network, 2013)

Stability and Accessibility

Location

-Access to green spaces encourages less screen time and more physical activity and peer interaction, and reduces parental stress (Canadian Child and Youth Health and Housing Network, 2013).

-Density and traffic are linked to stress levels in children, as well as respiratory issues (Canadian Child and Youth Health and Housing Network, 2013).

-Perceived safety of one's neighborhoods affects likelihood of spending time outside, and is linked with increased anxiety disorders in children (Canadian Pediatric Society 2015).

-Access to grocery stores increases likelihood of eating fresh foods.

(Canadian Child and Youth Health and Housing Network, 2013)

Unstable housing (needing to move often) is linked with poor school performance, and behavioural and emotional problems for youth (Canadian Pediatric Society 2015).

Inaccessible Housing for people with disabilities can increase injury to people with a disability and their caregivers. Ability to get around one's home independently can affect self esteem (Canadian Pediatric Society, 2015) and therefor has implications on mental health.

Vulnerable Housing

People who are homeless or who are vulnerably housed in shelters, hotels, and rooming houses, were found to:

-live 7 to 10 years less than adequately housed Canadians,

-face higher rates of physical violence,

-and higher rates of chronic health conditions such as Hep B and C, high blood pressure and asthma.

Though they are accessing emergency room services at high rates, their health needs are not being adequately met.

(Research Alliance for Canadian Homelessness, Housing and Health, 2010).

Education

Food Insecurity

Moving Forward

Part I - In examining the 14 SDOH you have learned about, please consider the following:

• Based on the case example, in which areas of the SDOH do you think Suzanne's and her family's health is affected?
• Which SDOH are more visible/hidden?
• How do intersecting factors, such as gender, race, class and ability, further impact Suzanne's family?

Part II - From an anti-oppressive social work perspective, please consider the following:

• How does your own social location affect what you hear?
• Whose identities, voices, etc are invisible/hidden?
• As a social worker, what is your ethical responsibility in working with this family? How far does that responsibility extend?

Optional Journal Questions

• People with higher levels of education tend to be healthier.
• Education intersects with other SDOH such as income, employment security, and working conditions.
• Education facilitates engagement in change through the political process and other societal factors that influence health.
• Education can contribute to an understanding of one's own health.
• Parents' education influences the intellectual and emotional development of their children

• What were your thoughts on how education relates to health before?
• What are some factors that influence access to education?
• Do you think all education has the same impact on health around the world?
• What level of education do you think is necessary to ensure good health?
• What role can social workers play in making education more accessible as a SDOH?

Learning Activity 1

Reflective Writing

Optional Journal Questions

The following is a video made by the Canadian Institute for Health Information called 'The Ottawa Hospital and Ottawa Inner City Health: The Population Health Approach in Action' from Public Health Ontario'. The film looks at approaches that the Ottawa Hospital is taking to address social determinants of health in its community. Please watch the video and then move on to LA 3.

• Access to quality and quantity of food directly impacts nutritional intake, a key component of health
• It is estimated that about 9% (1.1 million) Canadian households experience food insecurity and is more common in households with children
• Dietary deficiencies are associated with increased likelihood of chronic disease
• Malnutrition during childhood has long term effects on physical and psychological development

• What were your thoughts about how food relates to health before?
• How have they changed?
• Why do you think food insecurity is more common in households with children?
• Do you have/know a personal story about food insecurity?

In a publication called, Social Determinants of Health: The Canadian Facts, Mikkonen and Raphael (2010) offer a list of 14 social determinants of health. We have placed these SDOH within a Power Flower diagram, a learning tool borrowed from Arnold, James, et al. (1991).

Self-paced Activity (Not required to Post)

Suggested time frame: Monday to Wednesday (March 14 - 16)

Reflect on your personal experiences regarding the 14 Social Determinants of Health (SDOH) discussed in the introduction. Identify what Gustafson (1999) calls “the knowing that is discoverable in our experiences as embodied beings” (p. 250) by exploring your position in each individual petal (SDOH) of the power flower. For example, under Food Security, you might write that you can afford to buy fresh produce and meat in the store of choice.

Introduction

Case Study: Grandmother Raising Grandchild

Learning Activity 3

History, Relationships, and current Functioning

Goal of this Learning Event

Identifying Information

“How do Social Determinants of Health affect quality of life throughout the life stages?”

Solutions: Moving Forward

Prior to moving into her own apartment, she was living with an abusive partner for five years. Her former partner suffered from mental illness, and was very controlling of her, so that she was constantly living in fear. Her three children are all from different relationships, and she struggled with mental health and addictions herself, though she is now stabilized. She has found herself using her grandson as a “crutch”, as she suffers from anxiety and depression. She often feels very overwhelmed, sad, and lonely, and would like to start a new relationship if she could find a nice man. She has been dating on-line and recently met a man, who has served 5 years in prison, which makes her a bit nervous. However, she likes him and would like to pursue the relationship.

Suzanne raised three children as a single mother: Ronald, Darcy and Jessica. All of her children are grown and in their late twenties to early thirties. Sebastian’s mother, Jessica, struggles with mental health and addictions, and has two other girls in foster care. Jessica was 16 when she had her first child, and is currently expecting her fourth child, which is due in July. Suzanne has a restraining order against Jessica, who has been verbally and physically abusive towards her, and put her own son at risk. Sebastian has no contact with his father, who is in out of drug and alcohol rehabilitation; he has First Nations status. The grandmother from the father’s side still lives on reserve, though it is an unsafe and unhealthy environment for Sebastian. Sebastian attends day-care on reserve to learn more about his cultural background.

Suzanne is frequently called on to help out with her other grandchildren from her sons, both of whom are Metis and currently unemployed. One of her sons just became a father again a few months ago, and lives with his girlfriend in the same apartment building. Her younger son lives with her and is a "weekend father", which means Suzanne helps out when his daughter is with him and living space in the apartment gets cramped.. Though he is unemployed, he does not receive income assistance – he said he would rather be working odd jobs for cash than to be reliant on welfare. However, he cannot help out much with food or rent, nor can he afford to get a driver’s licence or insure a car. This is difficult, as Suzanne is currently unable to drive due to the problems with her eyes. She also does not a have a safe place to park her car, which has been broken into recently and siphoned for gas. This adds further stress to her life.

This week, in our learning event, we will explore together how these vulnerable populations – children/youth and seniors – are marginalized and impacted by social determinants and how social changes can bring about improvement in the health of individuals, families and communities.

Suzanne is 52 years old. She is the primary caregiver of Sebastian, her daughter’s son. Sebastian, who is almost 4 years old, has lived with Suzanne since his birth in 2012.

Suzanne has multiple health issues, which make it difficult for her to take care of Sebastian. She suffers from a low immune system due to Hepatitis, which frequently causes her asthma and allergies to flare up. Further, Sebastian has complex needs, as he is developmentally delayed due to his mother’s drug use during pregnancy – his speech and psycho-social development is at the level of a 2 year old, and he suffers from multiple sensory issues. Yet, Suzanne wanted to ensure Sebastian does not have to go through the foster care system like his other siblings.

Suzanne is unable to work, and has no education past grade high school. She has been on disability since 2014. Prior to being accepted by the Ministry for PwD (Persons With Permanent Disabilities) she was receiving EI (Employment Insurance) for close to a year, after she quit working at an Esso station.

Suzanne currently lives in a one-bedroom apartment with her youngest son, in addition to Sebastian. Her unit is in an old, low-rise apartment building in need of renovations. About 4 months ago there was a bed bug outbreak in her unit, and since then she has been sleeping on a foam mattress on the floor, as she cannot afford to replace her bed.

She can barely afford her cell-phone and rent of $750. Aside from her PwD cheque of $906.00, she gets $800.00 from MCFD to cover all of the costs for taking care of Sebastian; this makes her ineligible for any other caregiver benefits, such as the child tax benefit. Suzanne gets a hamper from the local food bank once per month.

Time Sensitive Activity (Required to Post)

Time frame: Friday to Sunday (March 18 - 20)

Post a 150-200 comment and respond to at least one classmate's post.

Our health is not maintained or guaranteed by medical treatments, individual lifestyle and choices or the health care system. Health is determined by the living conditions of Canadians such as income, employment, housing and education. These living conditions, also referred to as social determinants of health, are the primary factors that “shape the health of Canadians” (Canadian, 2010; Mikkonen & Raphael, 2010).

Presenting Problem

Strengths

Learning Event Instructions and Timelines:

Suzanne came to see a Social Worker for financial, emotional and parenting support. She also wants to address her mental and physical health concerns. She is still recovering from eye surgery, and needs new glasses. She struggles with self-esteem issues, and has difficulties setting boundaries with her grown children. She was formerly part of a women’s empowerment group, as well as a support group for “grandparents raising grandchildren”, and is now looking for on-going support.

Suzanne feels exhausted and realizes she is at her limit. Just recently, MCFD called Suzanne asking is she would be willing to take on Jessica’s new baby once it arrives. She understands that she is unable to take care of any more grandchildren, though she feels very bad about her daughter Jessica expecting another child. She fears the child will have developmental challenges and become a part of the foster care system. Jessica lost a previous child at five months, so there is a small chance she will have a miscarriage. Yet, it is unlikely, as she has surpassed the most fragile stages of pregnancy.

Feedback:

Social Determinants of Health

Introductory Video

Discussion Questions and Search:

Find an organization in your community that addresses SDOH in some way and share how it does so with classmates.

How can social workers help in altering the status quo or advocating for change in order to improve the health outcomes of vulnerable Canadian?

Thank you for taking part in this learning event!

Suzanne is very supportive of people in her community who are in need, and likes being the caregiver for others - she sees this as being her greatest strength. Suzanne enjoys being surrounded by family and friends. Her sons support her with Sebastian whenever they can, and help protect her from Jessica. She also has an older sister, Catherine, whom is an important source of support for her.

She is proud of herself for being able to budget her money and live within her means. Suzanne has made a lot of progress in terms of her self-esteem and setting boundaries with her daughter, whom she realizes she can no longer help. It took her a long time to let go of feeling responsible or guilty for her daughter’s misfortune.

Suzanne is very resilient, and has been avoiding substance use for over 10 years. She she occasionally smokes marijuana, though never in front of Sebastian. She has also cut-back on smoking cigarettes.

Course of Treatment

1. Monday to Wednesday: Complete and enjoy the readings, videos, and personal reflective exercises within the Learning Event.

2. Wednesday evening: Post your 150-200 word response to LA 2 in the CourseSpaces forum.

3. Wednesday to Friday: Respond to the post of at least one classmate.

4. Friday evening: Post your 150-200 word response to LA 3 in the CourseSpaces forum

5. Friday to Sunday: Respond to the post of at least one classmate.

6. Sunday: Respond to our feedback/evaluation questions on the Course Spaces Forum.

Throughout the Learning Event, there will be non-required, personal activities offered to help you to reflect on the materials. Consider using a journal for these activities.

Suzanne receives medication for anxiety and depression from her family doctor, and sees a social worker/family support worker to help her with all of her other needs. Her file was opened in 2011, while it has been closed and re-opened various times. At one point she was referred by MCFD, though she is now considered a self-referral. She also receives some supports from a team of child development specialists in regards to Sebastian’s care.

Suzanne has received support with practical issues, such as getting new glasses, and is hoping to access crisis funding for a new bed from the Ministry. She is also interested in attending a women’s group to help with setting boundaries, healthy relationships, assertiveness and any other areas she could benefit from.

This introductory video, adapted from a video published by Public Health Ontario, outlines how our living conditions (i.e. social determinants of health) shape the health of people in Canada.

The purpose in asking for your feedback is to create a space in which we can share ideas about teaching using this presentation as an example. In alignment with Freire's (1970) ideas around subjectivity, we hope that we can use this learning event as the object to be considered by ourselves, the subjects.

Please post your feedback on the Course Spaces Forum by Sunday night.

Part 1: Very briefly, what are your learning highlights from this event?

(ie: New knowledge, understandings and feelings you leave with; new skills; ideas you can use in your work.)

Part 2: Your assessment of the Learning Event

1. What parts of the learning event/learning activities did you find most useful? Why?

2. What parts did you find least useful? Why?

3. What ideas could you suggest for improvement?

* These questions are adapted from Arnold et al. (1991, p. 108).