Social Determinants & Health Inequalities

This assignment delves into the complex relationship between social determinants, health inequalities, and contemporary healthcare practices. It examines various social and cultural perspectives, theories, and approaches that contribute to these issues. The discussion covers topics such as the impact of negative school experiences, the Pavilion School approach, socially just schooling, and the role of spirituality in healthcare.

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Social and Cultural Perspectives Relating to Health

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Critical Reflection on the social and cultural Perspectives related to Health
This reflective journal will critically examine the social perspectives and cultural factors, social
determinants approaches, social and cultural theories and approaches related to the public health,
social changes, movements, inclusion, and social justice, and health inequalities. This journal
will put the critical reflections on the social and cultural factors and perspectives responsible for
the public health through my own learning experiences, thoughts, views, and opinions.
The anthropological and social perspectives are focused on correlating the public health issues
with the cultural and social issues. The culture is the system of shared values, beliefs,
assumptions, concepts, ideas, and experiences that are shared among the people in their social
lives. The cultural is a social system that establishes rules and standards as well as creates the
liabilities, obligations, and responsibility of the society members to be social for developing the
social relationships with the families, communities, and society as well as protecting the families,
land, and natural environment. The society is comprised of the individuals or population that is
marked by the relative separation from the distinctive culture and surrounding
populations(Australian Social Inclusion Board, 2012). The culture guides the humans or living
people how to behave with the family members, society people, relative, community and local
environment through a set of guidelines.
The anthropology focuses on the small-sized, rural areas, and underdeveloped cultures rather
than the industrialist, large-scale, urban population or capitalist cultures. The anthropological
approach relates to the cultural relevance for issuing the power, control, defiance, and resistance
affiliated with the health problems, healing, and illness. The social epidemiology focuses on the
social variables or demographic differences, such as social status, marital status, income, family,

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social backgrounds, occupation, and disposable income. While, the cultural epidemiology
focuses on the cultural diversities, disease classification, cultural risks, behavior, assumptions,
and cultural health issues. The social epidemiology in the case of Titanic marine mortality shows
the relationship between the social class and mortality, while the cultural epidemiology
emphasized the cultural values of the women, crew, and children in the maritime accidents
interacting with the social class and rules (Cameron, et al., 2012).
The cultural factors comprise of the healing system, illness experience, and patient-practitioner
transactions. The diseases require for the curing and illness requires for the healing. The healing
system of illness is categorized to the health problems and diagnosing the illness. The genres in
the narrative medicine include medical fiction, medical autobiography, lay exposition, writing
exercises of the healthcare training, and the stories from the practices. From the theory of Burk,
the key concepts include biographical disruption and narrative reconstruction. The chronic
narratives include contingent (origins, symptoms, and effects of illness), moral (social, ethical,
and harmony relationship with society people, relatives, colleagues and family), and core
narratives (identity change and self-presentation). The life-threatening illness includes chaos,
quest, and restitution). From the concept of Cassell (1991), the people realize pain when the pain
is overwhelming and out of control, source of pain is unknown and apparently sight without end.
While, the suffering is opposite to this in which source of pain is known, controlled position, and
ended (Fraser, 2009).
The illness narratives explain the illness events, reconstruct the history of chronic illness, and
transform the illness from the individual to the collective phenomenon. The illness narratives
encourage the people to write, speak, represent, illustrate, and enact with the stories. The lay
accounts of the health and illness include using body as a machine under siege, will-power

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account, robust individualism, god’s power account, cultural critics, and health promotional
account to maintain the healthier life style. The spirituality promotes connectedness that includes
relationship with self, others, natural places and things, and with the transcendence. The
spirituality is expressed through the values, beliefs, norms, practices, traditions, and customs.
The malignant social psychology concept of Kitwoodb (1997) includes labeling, outpacing,
disruption, ignoring, withholding, banishment, treachery, intimidation, disempowerment,
imposition, mockery, accusation, stigmatization, invalidation, disparagement, and objectification
causing for the public health problems and issues (Cobb, et al., 2012).
The social factors could be considered for understanding how the social relationships, processes,
and organizations create inequalities. The social systems structures, changes, and functioning
affect the society members. The social system is required to ensure adaptation to the
environment, goals-attainment, social integration, and motivation of the society members. The
structural features of the social system, such as political system (government intervention and
bureaucracy and political parties), economy system (economic conditions, banking system, and
industry), kinship (marriage and family relationship), and cultural and community organizations
(schools, church, hospitals, and media organizations) are such concerns that affect the public
health problems and safety issues.
The society is characterized by the social interaction, harmony relationships, and linkages
between the social people and social organizations. The social structure system could be
improved by avoiding or preventing the public health issues, illness, diseases, and accidents by
developing effective social health structure through the establishment of the hospitals, clinics,

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and health care system and employing the health professionals rehabilitating them to carry-out
their roles, duties, and responsibilities effectively (Fraser, 2010).
The sick person could be kept exempted from playing the normal social duties and responsibility.
Goffman describes the symbolic interaction that bridges the sociological and psychological
approaches. Germov approach defines the social system as cumulative action of the human
efforts, interpretation, and interactions. The healthcare professionals could perform the social
services for curing or healing the sickness or accidents. Applying the objective and scientific
knowledge can assist to control on the diseases or social inequalities based on the gender, class,
and ethnicity.
According to the Feminist perspectives, the healthcare professionals enforce the motherhood and
social norms of the femininity in their healthcare practices. The women’s lives are revolved
around the reproductive life cycle through the peripheral structures repressed and exploited by
the society (Australian Social Inclusion Board, 2012). According to the Marxism approach of the
social inequality, the society is exploitive and conflicted as the healthcare professionals focus
and reinforce the individualized understanding of health. From the perspective of Foucault, the
social construction is the social networking of power relationship in which the illness is
identified through a set of tables.
According to the social determinant approach, the social factors should be considered affecting
the public health in the society. The social determinants of health are brought about to make
changes in the health either for better health or worse cure or treatment. The social determinants
include the social policies, ethnicity, gender, social backgrounds, socio-economic status, political
and economic changes, social norms, network, social science, cultural change, community focus
and intervention, biological science, and health facilities and clinics are such issues that affect

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the health issues of the society people. The poor health conditions, unemployment, unsafe
workplace, globalization, and urban slums cause for the health problems in the societies. The
environmental determinants influencing the public health include physical environmental
conditions, working environment, unemployment, housing, overcrowding, water and sanitation,
pollution, land degradation and biodiversity agriculture and foods production, and use of
pesticides, fertilizers, and insecticides in the crops are such determinants that affect the health
issues (Frohlich and Potvin, 2010).
The biological determinants affecting the public health include age (higher age mortality rates),
sex (higher male mortality rates), and heredity factors (genetic effect on health issues). Public
health is the most powerful social determinant that is more than the absence or prevention of
disease, sickness, and disability. The old public health policy focuses on the physical and
hygienic work environment for reducing/preventing the illness or diseases, while new health
policy focuses on the social environment for healthier and social life.
From the social scientific perspective of Germov (2006), the social scientific approach depends
upon the cultural, historical, structural, and critical factors that shape the social system. The
social determinant approach could be understood better from the highly-articulated presentations
of Sir Harry Burns who represented about the spiritual care and health for improving the health
outcomes, conditions, and well-being through an international teleconference held at Glasgow
(Fraser, 2010). The reports on the social determinants of the WHO by Michael Marmot (the
chairman of the WHO) represented how the social determinants affect the health and well-being
of the society individuals.

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The contemporary practices about the health services, social, and ecological/holistic approaches
are related to the public health. The healthcare services, such as hospitals, healthcare centers,
private clinics, community health centers, midwifery, infant welfare, general healthcare
practices, population health, and aged care facilities are aimed at improving the health system
through the proper care in the form of curing, treatment, and prevention of the illness, disease
control, and health promotion. The expert treatment requires referring, accessing,
prognosticating, diagnosing, curing, treating, and managing the health system as well as
researching the investigating treatments. The social health services, such as agricultural and
community groups, water, housing, and social environment, transportation, schools, colleges,
electricity supply, and commodity pricing and income levels affect the healthcare system of the
society individuals (Hahn and Inhorn, 2009).
The social healthcare system is aimed at improving the health promotion through the social
inclusion, citizen participation, social exclusion, and the core social activities (such as
negotiations, social power, networks, allocation, mediation, prioritization, counseling, and
collaboration with the society members). For improving the public health in the societies, the
healthcare systems in the communities or society areas are required more specialist medical
teams in the disability and chronic illness, more hospitals and healthcare clinics, charity
healthcare foundations, primary or emergency healthcare treatment, and long-term care facilities
and provisions of the medical therapies for the disabled and chronically-ill people (Rumbold,
2012). The social approach of the healthcare system is related to understanding the social
determinants, health behaviors, health policies, illness experience, and professional health
expertise or knowledge for influencing the health system. But, the contradictory health analysis,
complex social discussion, and physical system can create limitations to the social health system.

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The holistic or ecological approach focuses on communication, human dignity, life fulfillment,
achievements, commitment, sharing, dedication, sacrifice, social responsibility, faithfulness and
ecological adaptation for the health promotion or improving the health conditions. The
ecological/holistic approach is aimed at understanding the environmental determinants and
global environment and cultural system that shape the physical environment. The ecological
approach could face problem in persuading, convincing, and influencing the people. According
to this approach, the health promotion is aimed at healing, curing, and wholeness as the illness is
caused from the failure to engage with the life and inability to develop capabilities. The
healthcare promotion in the society includes the core activities, such as guiding, healing, curing,
nurturing, empowering, liberating, sustaining, and reconciling (Lynch, 2012). The BPS health
care approach focuses on understanding the biological determinants (sex, age, and heredity
effect), addressing the individual health behaviors and connecting the psychological processes
with the individual behaviors.
Health education and training, employment, housing and accommodation, economic resources,
family functioning and community well-being, population size, cultural programs and leisure
activities, social cohesion, economic growth, and environmental quality are major areas of the
individual health and community well-being. The resources, such as natural capital (sunlight,
water, fauna, flora, atmosphere, soil, minerals, energy sources, and ecosystem), economic capital
(economic assets, income sources, financial and non-financial corporations, like technology,
transport and communication, infrastructure, and public facilities), and human capital (skills,
knowledge, capabilities, and experiences) affect the healthcare system of the society individuals.

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The social capital includes the networks (bridging, bonding, and linkage), network composition
(family, friends, relatives, colleagues, association, organization/groups, and general people), and
network structure (size, communication mode, density and openness, power relationship, and
social mobility/movements). It also involves the network transactions (sharing knowledge and
information practices, negotiations, sanctions, and sharing the physical, financial, and emotional
support), and network qualities (social relationships, social norms, social changes or inclusion
purpose, cohesion, social, civic, community, and economic participation), reciprocity, mutual
trust and understanding, and civic participation that affect the health system of the society
individuals (Parker, 2012). According to the concept of Weber, the social circumstances shape
the life styles. The social capital reflects the cooperation, participation, and mutual trust, but it
can also create the social exclusion and inequalities.
The social exclusion is denial or abuse of the resources, rights, and inability to participate in the
social relationships. It is connected with the boundaries of the social, political, legal, and
economic areas and affects the living standards, equity, and cohesion among the society people.
The mechanism of the social exclusion includes systematic discrimination, discomfort,
deformity, mental disorder, and tribal factors (religion, race, and ethnicity). The lack of the
human, financial, and social capital, unemployment, language, ethnic, and discrimination
barriers, and environmental deficiencies create barriers to civic or social participation. According
to Social Exclusion Matrix of Bristol (2007), the social exclusion has three dimensions including
quality of life (care, well-being, nutrition, living environment), resources (material, financial,
economic, physical, humans, and social resources), and participation (economic, social, cultural,
civic, and emotional participation).

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The social inclusion is the socially inclusive conditions where an individual feels valued,
respected, self-motivated, and participated. The social inclusion includes being socially
responsible and inclusive for promoting the health. It creates opportunities for the individuals
through learning, work, engagement, and having a voice. The learning culture, education and
training, employment, healthy working conditions, adequate sources, participation, and
empowerment are favorable conditions of the social inclusion that affect the quality of life and
welfare of the society individuals. The social justice promotes the fairness, equality, and
transparency by avoiding the discrimination as the fairness is central to the social justice
approach (Teater, 2010). It is based on two theories arrangement-focused (focused on the
institutional arrangements and structures) and realization focused (situation based or focused on
the agency).
AS per the theoretical concept of Bruce Rumbold, the social changes, social justice, and social
inclusion encourage the health promotion. The social changes, such as social movements foster
the goal achievement, morality, social interactions and transaction for meeting their personal and
social needs and expectations. The social movements, such as health access movements,
embodied health movements, and constituency basis health movements are collective efforts for
promoting the health awareness for the wellness and welfare of the society people by avoiding
their health problems, grievances, and illness. For example- the Breast Cancer movement and
HIV AIDS Movement are the social health movements that are run for the rehabilitation,
treatment, and public awareness for the prevention. The embodied health social movements
embody the healthcare practices and experiences into the social awareness and challenge the
scientific and medical knowledge (Rumbold, 2012). These involve the collaboration with the
health professionals, scientists, and researchers in pursuing the treatment, funding, prevention,

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and research. For example, SANE supports the communities, families, cares, and society people
through the mental health care services. The cultural competence recognizes the ability of the
individuals to work effectively with the people of diverse cultural backgrounds. It includes the
cultural responsive, humility, aware, relevant, and sensitive.
The cultural conditions (language differences, arts, historical backgrounds, cultural programs,
sports events, religions), political conditions (government intervention and spending pattern,
society constructions, power, political processes), legal (judiciary system, legal processes, rules
and regulations, legal rights, representation, regulatory frameworks and mechanism, movement,
associations, civil and constitutional laws), and institutional conditions (institution for promoting
the public health (WHO, UNESCO), promotion of economic stability (international monetary
fund, reserve bank), and agencies for the policy implementation (ombudsman and
tribunals)affect the social health system.
From the journal of Sabrina Gupta, it is reflected that Anglo-Australian people (AA, Australian
born living in India, Sri Lanka) faced the cardiovascular or heart diseases because of the
Australian origin. While, on the other hand the Australian dwelling South Asian People (SA
Indian, and Sri Lankan Background people, immigrants to Australia) faced the type 2diseases
and low BMI because of the country of Indian subcontinent origin (Scambler, 2009). This case
emphasizes the racism (physical characteristics) and ethnicity (social characteristics), such as
discrimination, heterogeneity, difference in social status, engagement, and behaviors, and
different risk profiles. From the demographic studies, it is reflected that the most participants
(AA- 88%, SA 81%-among them faced diabetes 2 in comparison to CVD disease (AA- 13% and
SA-37%) for the age range (AAs-39-74 years and SAs-28-80 years).

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The societies follow the social hierarchical structures that reflect the gradient health system that
is better at the top than bottom. The most number of the diseases concentrated at smaller ages are
at the bottom. For example, from the WHO report, the life expectancy for India, Philippines,
Korea, Lithuania, Poland, Mexico, Cuba, US, UK are representatively 61, 65, 65, 66, 71,72, 75,
75, and 76. The difference of the life expectancy from 1972-1976 and 1992-1996 for men
increased from 5.5 to 9.5 and for women increase from 5.3 to 6.4. The WHO reports also show
that the most number of deaths in the USA caused from the heart diseases (26%), Melignant
Neoplasm (20%), CVD (6%), chronic illness (4%), injuries (3.5%), and diabetes (2.5%). The
causes for the deaths in the societies of the USA include Tobacco use (18%), Physical inactivity,
poor dieting (15%), and alcohol consumption (3.5%). Managing health and illness is required
biological (better cure and treatment), socio-cultural (pursuing social equity), and psychological
explanation (promoting the healthier life styles).
The health inequalities show differences in mortality, morbidity, the lack of access to health
services, workplace injury rates, and infectious diseases that are unavoidable, unnecessary,
unjust, and unfair. The health inequalities are caused due to the income and education disparities,
socio-economic status, poor nutrition, physical inactivity, smoking, alcohol consumption, and
unfair trade, the lack of autonomy, globalization impact, and ethnicity. The life expectancy,
literacy, infant and mortality, imprisonment, social mobility, trust, cohesion, obesity, mental
illness, alcohol consumption are indexes of the social and health problems (Parker, 2010).
According to Scambler (2009), the exercise of power includes violence, exploitation, powerless,
marginalization, and cultural imperialism. The stigma arises from the social consensus that labels
the individuals in the specific category.

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Ageing, dying, and disability are likely to increase in the years of life. The Healthy End of Life
Program (HELP) is a part of the community development model that includes OTTAWA
Charter, community development, compassionate communities, social change, social network
research, and public health principles. The Victorian Council support the community
development by focusing on building the organizational capacity, community capacity, using
evidence-based and sustainable public health interventions, and evaluate the effectiveness of this
approach.
According to OTTAWA Charter, the health promotion is required strengthening the community
action, developing personal skills, reorienting the health services, creating the harmonious and
supportive environment, and mediating, enabling, and advocating for the health. The public
health management services promote the palliative care services (strengthening community
action, creating healthy environment, build public health policies, and personal skills
development) and compassionating communities. The compensation focuses on responding with
generousness and humanity to the person’s pain, discomfort, distress, grievance, and anxiety
(Lynch, 2012). The effectiveness of the social health system requires clean and safe
environment, community involvement, sustainable ecosystem, and diverse innovative economy,
ease of access of the health services, and pollution and risk free environment. According to
public health model of bereavement support, the risk factor is classified into three categories
high risk 6.4% (10%), moderate risk (35.2%) 30%, and low risks 58.4% (60%).
Education is used as a social determinant of the health for the well-being, and better health of the
individuals in the society because it is used to educate and aware the people and influence their
health behaviors directly. While, the negative school experience is related to the abuse of power,
violence, smoking and alcohol consumption, fighting, disconnection and disobeying the family

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members and peers, irregular routines, and substantial use. The Pavilion School approach
focuses on the 50/50 staffing model, building positive and harmony relationship between the
staffs and students, no exclusion, constructed classes, flexible schooling time and student
working (Puchalski, et al., 2012). The socially just schooling approach includes dimensions
affective justice (Lynch), Distributive justice (Fraser), Representative Justice (Fraser),
Recognitive Justice (Fraser) and Contributive Justice (Sayer).
From the above reflections, it is critically reviewed that there are several social and cultural
perspectives, approaches, theories, and factors that create the social and health inequalities,
problems, and contemporary health practices affecting the life styles, living standards, and social
healthcare system of the individuals in the society.

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References
Australian Social Inclusion Board (2012) Social inclusion in Australia: How Australia is faring.
[Online]. Available at: http://www.socialinclusion.gov.au. (Accessed: 25 October 2017).
Cameron, A., Lart, R., Bostock, L., and Coomber, C. (2012) Factors that promote and hinder
joint and integrated working between health and social care services. London: SCIE.
Cobb, M., Puchalski, C., and Rumbold, B. (2012) The Oxford Textbook of Spirituality in
Healthcare. New York: Oxford University Press.
Fraser, N. (2009) Scales of justice: Reimagining political space in a globalizing world. New
York: Columbia University Press.
Fraser, N. (2010) ‘Injustice at intersecting scales: On ‘social exclusion’ and the ‘global poor’.
European Journal of Social Theory, 13 (3), pp. 363-371.
Frohlich, K. and Potvin, L. (2010) ‘Commentary: Structure or agency?’Int J Epidemiology, 39,
pp.378-379.
Hahn, R. and Inhorn, M. (2009) Anthropology & Public Health: bridging differences in culture
& society. New York: Oxford University Press.
Lynch, K. (2012) ‘Affective equality as a key issue of justice: A comment on Fraser’s 3 -
Dimensional framework’, Social Justice Series, 12(3), pp. 45-64.
Parker, J. (2010) Effective Practice Learning in Social Work. Exeter: Learning Matters.
Rumbold, B. (2012) ‘Models of spiritual care’, The Oxford Textbook of Spirituality in
Healthcare. Oxford: Oxford University Press. pp. 177-183.
Scambler, G. (2009) ‘Health-related stigma’, Sociology of Health and Illness. 31(3), pp.
441-455.

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Teater, B. (2010) An Introduction to Applying Social Work Theories and Methods. Maidenhead:
Open University Press.