Social Determinants of Health Assessment 2022

Running head: SUMMATIVE ASSESSMENT 2
Summative Assessment 2
Name of the Student
Name of the University
Author Note

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Introduction
Social Determinants of Health (SDH) are defined as certain factors in the environment
under which the people live, born, learn to work, play, and worship and age that modulates a
wide range of health-related factors, proper health functioning and overall quality of life.
Social, economic and physical conditions influence the social determinants of health and
thereby affecting the health related quality of life. A detailed picture of SDH is explained in
the diagram below:
Figure: Framework for the social determinants of health
(Source: Dahlgren and Whitehead 2007)
The following essay aims to discuss and explain how the determinants of health
impact the individual and community-related health. Affect of the social determinants of
health on the health-related quality of life of individuals will be further explained with the
help of suitable examples. The main focus will be given towards lifestyle factors (physical
exercise, tobacco smoking and alcohol drinking) as the main SDH.

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Key social determinants of health
Socio-economic factors
People from poor socio-economic condition are vulnerable to poor health, illness and
disability. They also have shorter lifespan in comparison to the people from higher socio-
economic status (Mackenbach 2015). Improvement in the socio-economic ladder helps to
improve the health condition. The individual indicators like education, occupation and
income is used to define the socio-economic position of an individual (Artiga and Hinton
2019). Educational qualification is associated with good health throughout the life. Adler et
al. (2016) stated that education equips individuals to achieve a stable employment status and
thus helping to secure income, proper housing and adequate healthcare access. Education also
assists in selected healthy lifestyle condition. Occupation also has a strong link with the
socio-economic determinants of health and proper occupational status helps to maintain a
quality life and improves the social status as well. Income and wealth also play an important
role in defining the socio-economic position of an individual and thus helping to define health
apart from improving the socio-economic condition, a standard or higher income enables
higher access to services and amenities that provide proper health benefits like quality food,
proper housing and sanitation facilities and additional healthcare support. Loss of income
resulting from sudden illness, disability and injury can adversely impact the socio-economic
condition of a family or an individual (Artiga and Hinton 2019).
Early life
The foundation of adult health occurs during the early life of an individual (Adler et
al. 2016). Different aspects of the early stages of the childhood development like the
social/emotional, physical and language/cognitive significantly influence the level of
academic success, economic participation and health of an individual (Artiga and Hinton
2019). Proper physical development along with proper emotional support during the early

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years of life acts as a building block for further social, emotional, physical and cognitive
well-being. Children from disadvantaged family are more likely to experience poor schooling
and thus affecting the adult opportunities to maintain a healthy life like employment
opportunity (Adler, Glymour and Fielding 2016).
Social Exclusion
Social exclusion is a vast concept that is used to explain the level of social
disadvantage and lack of proper resources, facilities, participation and other skills Adler,
Glymour and Fielding 2016). Social exclusion can result from social discrimination,
unemployment and social stigmatization. Poverty, religion, culture ethnicity, sexual
orientation, refugee status and gender modulate the extent of social exclusion. For example
people who are poor ethnic background like indigenous population are more likely to suffer
from social exclusion and discrimination and resulting in poor mental and physical health
condition. Social exclusion thus increases the risk of disability and illness (Adler, Glymour
and Fielding 2016).
Employment and work
Unemployed individuals have higher risks of death and disability in comparison to the
people of similar age and are employed (Garg, Boynton-Jarrett and Dworkin 2016). The
psychosocial stress resulting from unemployment has a significant impact on the mental and
physical well-being of the individual (Garg, Boynton-Jarrett and Dworkin 2016). According
to the Office of National Statistics (2019), at least 3.8% of population in the UK are
unemployed and the percentage has decreased by 0.2% in comparison to the last decade. The
level of male unemployment rate is higher in comparison to female. Adler et al. (2016) stated
that the unemployed people tend to suffer from mental health depression. Unemployment
people suffering from depression tend to avail unhealthy lifestyle condition leading to poor
health-related quality of life.

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Housing
Safe yet affordable housing is associated with proper health and this is turn impacts
the degree of individual’s participation in work, academic field and community. If also
affects the degree of family and social relationships. Healthy relationships further help in the
development of the healthy mental and physical health (Garg, Boynton-Jarrett and Dworkin
2016).
Residential environment
Residential environment has a significant impact on the health-related quality of life
of the individual. Proper sanitation, recreational activities and food and social participation
are the part of the healthy residential environment. The government of UK is provides proper
financial aid and support in order to improve the level of sanitation under the residential
housing and thereby helping to reduce water borne or other contagious diseases (Government
of UK 2012).
Lifestyle habits
Lifestyle habits or health behaviour shapes up the health and well-being in the life of
an individual. The heath-related behaviour or the lifestyle habits might be intentional and
unintentional and can promote or detract an individual from healthy life. The main actions
that help to classify the health-related behaviour include proper diet, physical activity,
smoking, alcohol abuse, risky sexual activities and adherence to the medical treatment.
Healthy lifestyle behaviours are dynamic and vary through the life-span and across the
different environmental settings (Short and Mollborn 2015).
Tobacco Smoking
Tobacco smoking is one of the important determinants of health-related and falls
under the lifestyle factors affecting health. According to the Office of National Statistics

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(2018), in UK, 14.7% of people who are 18 years and above have smoked cigarettes during
the year 2018. This equates to at least 7.2 million people of the total UK population and thus
can be considered statistically. The rate smoking is higher among men in comparison to
female. Smoking is the largest cause of cancer in the UK like lung, larynx, oesophagus, and
oral cancer. Smoking of tobacco for the prolong period of time or from early age increases
the risk of developing bowel, bladder, kidney, liver and ovarian cancer along with the
development of leukaemia. Tobacco smoking in the UK leads to an estimated 115,000 death
in the UK (Cancer Research UK 2019). Cigarette smoking is higher in the deprived areas of
the UK or between the people who resides under the poor socio-economic condition. For
example, remote areas in the UK like Scotland and Wales have higher rate of smoking in
comparison to England and Northern Ireland (Cancer Research UK 2019). Adults residing in
the routine and manual occupation households initiate the smoking habits at younger age in
comparison to the adults who resides under the managerial and professional occupation
(Cancer Research UK 2019). Martinez et al. (2018) stated that there is an inverse association
between the socio-economic status and the smoking habits. The poverty level, the level of
personal earnings and employment status affect the smoking status of an individual.
Unemployment and poor financial status create psychological distress creating sleep
disturbances and this increases the smoking tendency. Hovanec et al. (2018) analyzed 12 case
control studies in order to identify the relationship between the lung cancer development,
smoking habits and the socio-economic status. The analysis of the results showed that there is
a strong association between the socio-economic status of an individual and developing to
smoking habits that eventually lead to the development lung cancer. Poor socio-economic
status like lack of proper education, financial unrest and nutritional intake increase the risk of
smoking among the pregnant women (Quinn et al. 2017). According to the National Health
Service (NHS) (2019), women residing under poor economic status in the UK are more likely

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to smoke during pregnancy leading to poor health related outcome of life of the child along
with the chances of the carbon mono-oxide poisoning.
Alcohol Drinking
Office of National Statistics (2017) UK stated that at least 29 million people who are
older than 16 years have drank alcohol and this amount to nearly 56.9% population in the
UK. The binge drinking is common among the men in comparison to female. The study
conducted by Collins (2016) stated that socio-economic status (SES) is one of the leading
factors that influence alcohol consumption and alcohol-related harm. People with high SES
tend to consume similar or greater amounts of alcohol in comparison to the people who reside
under the lower SES. However, the people under the low ESE bear an unequal burden of the
negative alcohol-related consequences. This relationship is further complication by several
moderating factors like ethnicity, race and gender. Thus, people who reside under the poor
SES, or marginalized communities (racial or ethnic minorities or homeless individuals)
experience high rate of negative alcohol-related consequences. Hall (2017) argued that
alcohol drinking is the major contributor of the global burden of disease and this further add
to the health-related inequalities and life expectancy. The reasons behind the association of
drinking patterns, health quality and socio-economic status are debated. Alcohol drinkers
from lower SES develop complex health-related condition in comparison to the alcohol
addicts of higher SES. Unregulated consumption of alcohol lead to the development obesity,
type 2 diabetes mellitus and cardio-vascular disease. Alcohol consumption also increases the
risk of developing cancer and thus affecting the health-related quality of life. Katikireddi et
al. (2017) further stressed in their study that the disadvantaged social groups have higher
alcohol-related harms in comparison to the individual who are from the advantaged areas the
reason behind this is difference in the drinking pattern, healthcare access and the mental
health. According to the Mental Health Foundation (UK) (2019), people who are suffering

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from depression are more likely to indulge in binge alcohol drinking. The reason behind this
is, alcohol temporarily alleviate the feelings of anxiety and state of depression and thus
helping to alleviate the mood. However, in the long run, consumption of alcohol is associated
with the development of addiction leading to complex physical and mental health-related
outcome. SES factors like Unemployment, social exclusion, poor education and lack of
proper housing might result in the development of depression and thus increasing the
tendency of alcohol consumption.
Physical Activity
Socioeconomic determinants influence physical activity behaviour leading to poor
health-related outcome (O’Donoghue et al., 2018). Ball et al. (2015) stated that the
participation of physical activity along with sedentary behaviour follow a particular social
gradient. For example, people who are from the advantaged group are more likely to practice
physical activity regularly and are less likely to lead a sedentary life and thus they are less
likely to develop non-communicable diseases resulting from the inactive lifestyles. Mondal
and Mishra (2017) have argued that people from the high SES status like the employees of
the corporate sectors tend to lead a sedentary life that is characterized zero to mild physical
activity. Lack of regular practice of physical activity increases the risk of developing non-
communicable or lifestyle diseases. However, exposure to the health-care services, health-
related awareness along with financial status assist the people from the high SES to combat
with the non-communicable diseases in comparison to the people from the poor SES.
Government of UK (2019), is trying to promote physical activity among the mass irrespective
of the SES by educating the mass about the good of it. The main health benefits of physical
activity include reduction in the mortality rate, reduction in the rate of developing cardio-
vascular disease, diabetes, reduction in severity of cancer and complex mental health

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condition and reduction in the development of other lifestyle diseases like musculoskeletal
disorders.
Conclusion
Thus from the above discussion, it can be stated that SDH cast a significant impact on
the health-related quality of life of an individual. SDH also helps to modify the health-related
behaviour. People who reside under the poor SES experience are said to enjoy poor SDH
leading to poor health related outcomes. Poor SES also helps to modify the health behaviour
or the lifestyle habits. The main lifestyle habits leading to poor health-related outcomes
among the poor SES people include lack of physical activity, tobacco smoking and alcohol
consumption. Even if the unhealthy lifestyle behaviour is common across the SES, the lack of
access to proper healthcare services, poor financial status along with poor environmental
condition lead to the development poor health-related outcomes.

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References
Adler, N.E., Cutler, D.M., Fielding, J.E., Galea, S., Glymour, M.M., Koh, H.K. and Satcher,
D., 2016. Addressing social determinants of health and health disparities. National Academy
of Medicine, pp.1-16.
Adler, N.E., Glymour, M.M. and Fielding, J., 2016. Addressing social determinants of health
and health inequalities. Jama, 316(16), pp.1641-1642.
Artiga, S. and Hinton, E., 2019. Beyond health care: the role of social determinants in
promoting health and health equity. Health, 20, p.10.
Ball, K., Carver, A., Downing, K., Jackson, M. and O'Rourke, K., 2015. Addressing the
social determinants of inequities in physical activity and sedentary behaviours. Health
promotion international, 30(suppl_2), pp.ii8-ii19.
Cancer Research UK. 2019. Tobacco Statistics. Access date: 18th November 2019. Retrieved
from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/
tobacco#heading-Seven
Collins, S.E., 2016. Associations between socioeconomic factors and alcohol
outcomes. Alcohol research: current reviews, 38(1), p.83.

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Dahlgren, G. and Whitehead, M., 2007. Policies and strategies to promote social equity in
health. 1991. Stockholm: Institute for Policy Studies.
Garg, A., Boynton-Jarrett, R. and Dworkin, P.H., 2016. Avoiding the unintended
consequences of screening for social determinants of health. Jama, 316(8), pp.813-814.
Government of UK (2019). Physical activity: applying All Our Health. Access date: 18th
November 2019. Retrieved from: https://www.gov.uk/government/publications/physical-
activity-applying-all-our-health/physical-activity-applying-all-our-health
Government of UK. 2012. Water and sanitation: UK to double its support. Access date: 18th
November 2019. Retrieved from: https://www.gov.uk/government/news/water-and-
sanitation-uk-to-double-its-support
Hall, W., 2017. Socioeconomic status and susceptibility to alcohol-related harm. The Lancet
Public Health, 2(6), pp.e250-e251.
Hovanec, J., Siemiatycki, J., Conway, D.I., Olsson, A., Stücker, I., Guida, F., Jöckel, K.H.,
Pohlabeln, H., Ahrens, W., Brüske, I. and Wichmann, H.E., 2018. Lung cancer and
socioeconomic status in a pooled analysis of case-control studies. PLoS One, 13(2),
p.e0192999.
Katikireddi, S.V., Whitley, E., Lewsey, J., Gray, L. and Leyland, A.H., 2017. Socioeconomic
status as an effect modifier of alcohol consumption and harm: analysis of linked cohort
data. The Lancet Public Health, 2(6), pp.e267-e276.
Mackenbach, J.P., 2015. Socioeconomic inequalities in health in high-income countries: the
facts and the options. Oxford textbook of global public health, 6.

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Martinez, S.A., Beebe, L.A., Thompson, D.M., Wagener, T.L., Terrell, D.R. and Campbell,
J.E., 2018. A structural equation modeling approach to understanding pathways that connect
socioeconomic status and smoking. PloS one, 13(2), p.e0192451.
Mental Health Foundation (UK). 2019. Alcohol and Mental Health. Access date: 18th
November 2019. Retrieved from: https://www.mentalhealth.org.uk/a-to-z/a/alcohol-and-
mental-health
Mondal, H. and Mishra, S.P., 2017. Effect of BMI, body fat percentage and fat free mass on
maximal oxygen consumption in healthy young adults. Journal of clinical and diagnostic
research: JCDR, 11(6), p.CC17.
National Health Service (NHS) 2019. England’s top midwife warns ‘tens of thousands’ still
smoking during pregnancy. Access date: 18th November 2019. Retrieved from:
https://www.england.nhs.uk/2019/07/englands-top-midwife-warns-tens-of-thousands-still-
smoking-during-pregnancy/
O’Donoghue, G., Kennedy, A., Puggina, A., Aleksovska, K., Buck, C., Burns, C., Cardon,
G., Carlin, A., Ciarapica, D., Colotto, M. and Condello, G., 2018. Socio-economic
determinants of physical activity across the life course: A" DEterminants of DIet and
Physical ACtivity"(DEDIPAC) umbrella literature review. PLoS One, 13(1), p.e0190737.
Office of National Statistics. (2018). Adult smoking habits in the UK: 2018. Access date: 18th
November 2019. Retrieved from:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/
healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018

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Office of National Statistics. (2019). Unemployment. Access date: 18th November 2019.
Retrieved from:
https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/unemployment
Office of National Statistics. 2017. Adult drinking habits in Great Britain: 2005 to 2016.
Access date: 18th November 2019. Retrieved from:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/
drugusealcoholandsmoking/bulletins/
opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain/2005to2016
Quinn, P.D., Rickert, M.E., Weibull, C.E., Johansson, A.L., Lichtenstein, P., Almqvist, C.,
Larsson, H., Iliadou, A.N. and D’Onofrio, B.M., 2017. Association between maternal
smoking during pregnancy and severe mental illness in offspring. JAMA psychiatry, 74(6),
pp.589-596.
Short, S.E. and Mollborn, S., 2015. Social determinants and health behaviors: conceptual
frames and empirical advances. Current opinion in psychology, 5, pp.78-84.