Social and Economic Determinants of Health Inequality

This assignment delves into the complexities of health inequality in Australia, particularly among the elderly. It examines how social and economic factors contribute to unequal living and working conditions, influencing access to food, housing, education, and ultimately, exposure to different vulnerabilities. The assignment highlights the need for action on the social determinants of health across all stages of life, emphasizing equity and multisectoral responses.

Report ‐ Social Determinants of Health
Introduction
Heart, stroke and vascular disease are health conditions known as heart or
cardiovascular diseases. Heart diseases are the leading cause of death in the
world, causing many more deaths compared to other diseases. In 2017, 27% of
all deaths in Australia was related to cardiovascular conditions. (Australian Bureau
of Statistics, 2018)
In 2011 Coronary heart disease was responsible for 7.7% of the total burden of
disease in Australia. Statistics from the Australian Institute of Health and Welfare
point out that between 2015 and 2016 cardiovascular diseases were the main
causes of hospitalizations and the incidence in men would represent the majority,
being twice as high as in women. (Australian Institute of Health and Welfare,
2018)
The cause of heart disease is usually a combination of risk factors such as
inadequate diets, physical inactivity, tobacco use and harmful use of alcohol. The
effects of behavioural risk factors can be manifested in individuals through high
blood pressure, high glycemic index, overweight and obesity but it is possible to
prevent most diseases by using strategies to address behavioural risk factors for
the general population.
There are also several underlying determinants that reflect the main forces that
guide social, economic and cultural changes - globalization, urbanization and an
aging population as well as poverty, stress and hereditary factors.
The present work is a study that aimed to analyse the burden of heart disease on
the elderly population and the socioeconomic impact in the health of this group.
This study is concluded with the presentation of suggestions for public health
interventions that can help professionals addressing health issues in the target
population.
1 - Social determinants
The burden of heart disease within the elderly population in Australia
According to research by the Australian bureau of Statistics, the percentage of
heart disease is higher in men than in women, being in the proportion of 5.4% and
men and 4.2% for women. The general numbers increase with old age and in the
age group of 75 years, one in four people has some type of heart disease, with
the highest rates prevailing in the male population. (Australian Bureau of
Statistics, 2018)

The prevalence in the elderly group is justified by considering the physiological
and pathophysiological conditions that differentiate them from other age groups.
Adding this to the socioeconomic status and the increase in life expectancy it
makes them a layer of the population with their own characteristics and needs.
Old age is a stage of life with its own characteristics and values, in which changes
occur in the individual, both in the organic structure, as in the metabolism, in the
biochemical balance, in the immunity, in the nutrition, in the functional
mechanisms, in the intellectual and emotional characteristics and therefore
elderly is more vulnerable to degenerative diseases of insidious onset such as
cardiovascular. Several demographic, socio-cultural and epidemiological factors
contribute to aggravate this situation, such as retirement, loss of workmates,
increase in free time, changes in social norms, impact of age on the individual,
social impact of old age, loss of economic security , rejection by the group, distant
children, increased frequency of certain illnesses, difficulties in accepting new
ideas that clash with traditional models of conduct and modern medicine.
(Oldenburg, Mcguffog, & Turrell, 2000)
Over the years, the cardiovascular system undergoes a series of changes that
tend to compromise cardiac function. Statistics show that the biggest cause of
mortality and morbidity is cardiovascular disease. In addition to age, other risk
factors can be added, such as high blood pressure, diabetes mellitus, smoking,
physical inactivity and obesity. (The Heart Foundation, 2015)
Although we are living longer, heart disease is still the deadliest and the most
expensive for the health system. This demonstrates that better research in
prevention and care is needed. Research shows that in recent years, death rates
related to cardiovascular diseases have not significantly reduced, mainly because
of the high numbers of diabetes and obesity. In addition to heart disease being
the major cause of death, it is also responsible for the poor quality of life of
survivors.(IDI Heart & Institute, 2016)
How the social determinants of health can explain the burden of heart
disease within the elderly
In the first decade of the 21st century, the world moves towards the perspective
of focusing on populations, with actions directed at the societies to which
individuals belong. This pendular movement is driven by the respectable advance
in the study of the relationships between the form of organization and
development of a given society and the health situation of its population. Thus,
the recognition of the inadequacy of health strategies that were not aimed at
attacking the social roots of the disease and well-being gives rise to an emphasis
on the social determinants consolidated by the creation of the WHO Commission
on Social Determinants of Health, in 2005.
The strong and growing evidence of the link between the socioeconomic structure
and people's health status has contributed to the consolidation of the socio-
political and cultural context as generators of poor health and health inequalities.
These factors, also considered structural, are the first to influence the individual's
health. However, this influence is not direct, but occurs through more specific
determinants: General socioeconomic, cultural and environmental conditions,
living and working conditions, social and community networks, behaviours and

lifestyles. (Benach et al., 2010)
Aging is related to the increased risk of having chronic diseases, such as heart
disease, since the increase in longevity naturally leads to a longer period of
exposure to risk factors (Fontana, 2009). However, psychosocial factors,
depression and social situation can also be defined as conditions that potentially
relate psychological phenomena to the social environment (Hemingway &
Marmot, 1999). It is known that these factors do not directly affect cardiac
health, but act fundamentally in behaviour, such as smoking, alcohol
consumption, changes in physical activities that may affect the heart.
For many people, especially the elderly, social networks are the only available
resource to alleviate the burdens of everyday life and those that come from
illness. However, the elderly being weakened tends to decrease the interaction
and affective contacts and to put at risk the social support received, which is
sustained in a reciprocal relationship. Therefore, diseases and disabilities of the
elderly can contribute to social isolation by limiting their participation in the
community. The reduced social network, in turn, can exacerbate the original
disability or impose new limitations on the lifestyle of the elderly.
An intervention to address social determinants of Heart disease for
elderly population
Public Health intervention
The assessment of the burden of chronic diseases in the population represents an
important field in public health and health care planning.
Most studies evaluating preventive services use disease reduction as a result of
specific mortality. In the elderly, there are clearly additional and more pertinent
health results to be considered. Health in the elderly consists of three related
factors: the absence of disease, the maintenance of optimal function, the
presence of adequate support.
An intervention with a Holistic approach and the use of risk assessment as a tool
to direct therapy according to the individual's need is a set of measures that can
help health professionals to address the issue. The holistic approach aims to work
the body, mind and soul of the individual and the collective from the insertion of
segments of medicine and therapies specialized in the constant search for
balance.(Davitt, Madigan, Rantz, & Skemp, 2016)
Holistic occupational therapy in the elderly has a strong role, it should contribute
to promote life and allow them to develop their potential. Anything that paralyses
their performance and development should be considered bad. The objectives of
holistic occupational therapy in geriatrics are based on the physical, psychological
and social needs associated with continuing education, that is, a healthy life.
(Duncan & Cunnington, 2013)
The involvement of other sectors
Community service centres in each region can plan targeted actions. It is

necessary to know how many elderly people live in the territory covered and to
know their different needs. One way to plan care based on these needs is to
classify elderly people according to their functional capacity and the care they
need. These criteria can be identified during home visits and the care plan will be
prepared according to the functional condition of the elderly person identified
from the assessment. The preparation of this plan coordinated and integrated, in
the short, medium and long term, would aim especially at the recovery and / or
maintenance of the functional capacity of the elderly person.
Conclusion
According to the above, it is concluded that social and economic circumstances
determine unequal living and working conditions - with differentiated access to
food, housing, education, among other aspects influencing the construction of
social capital and behaviours and lifestyles, that expose individuals to different
exposures and vulnerabilities. In this line of social health production, the elderly
has health inequalities, which generate greater demands for assistance for the
treatment of chronic diseases and disabilities. For them, equity requires action on
the social determinants of health from the perspective of the "course of life", with
multisectoral actions and at all stages of the life cycle.
References
Australian Bureau of Statistics. (2018). National Health Survey: First Results, 2017-18.
Retrieved March 8, 2020, from
https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~
2017-18~Main%20Features~Heart,%20stroke%20and%20vascular
%20disease~55
Australian Institute of Health and Welfare. (2018). Australia´s Health 2018. Retrieved
from www.aihw.gov.au/reports-
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Simpson, S. (2010). A Conceptual Framework for Action on the Social
Determinants of Health. In World Health Organization Geneva.
Davitt, J. K., Madigan, E. A., Rantz, M., & Skemp, L. (2016). Developing a More Holistic
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Duncan, A., & Cunnington, C. (2013). A holistic approach to managing a patient with
heart failure. Future Cardiology, 9(2), 189–192. https://doi.org/10.2217/fca.13.1
Fontana, L. (2009, October). Modulating human aging and age-associated diseases.
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