menu

Blizard Institute

Teaching menu

SOCIAL DETERMINANTS OF HEALTH (ICM4010)

Level: First year undergraduate (level 4)

Semester: 1

Course credits: 15 ECTS

 

 

Module aims and outline

This module is a compulsory module for the BSc Global Health year 1.

The introduction sets the scene of global health and wellbeing and inequities in global health.  We will explain the multiple interacting factors that determine or influence health at either the individual or the population level.  There will be a strong focus on social determinants of health and the complex ways in which they impact upon health and health inequities. Later lectures and seminar discussions will use particular topics to illustrate the theories, concepts and potential solutions to these issues.  The module aims to explore, with examples, health issues at local, national and international levels. 

Learning outcomes

By the end of the course students will:

  • Have a global perspective with regards to global health and social and health inequities and inequalities
  • Outline the key determinants of health
  • Have considered the importance of treating individuals versus populations
  • Understand the different mechanisms for social factors to influence health outcomes
  • Have an understanding of social inequalities and their impact on health
  • Have a basic understanding of the complex interactions between variables impacting upon health
  • Have a basic understanding of the nature of short and long causal pathways
  • Understand inequity in health across population groups
  • Have some understanding of policies required to reduce health inequities through social change and to be able to apply this in debates on how to address social inequities in health
  • Be able to evaluate and synthesise the public health literature relating to the social determinants of health

Main course readings

We list below, the main core readings and resources for this module. Additional readings that students will be expected to read  in advance of the lectures and seminar will be added to the week-by-week programme as appropriate. 

  • CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health.  Geneva, World Health Organisation.
  • Michael Marmot and Richard Wilkinson (2006). Social Determinants of Health. New York: Oxford University Press.
  • Richard Wilkinson and Kate Pickett (2010). The Spirit Level: Why Equality Is Better for Everyone. London: Penguin Books.
  • The Black Report: Inequalities in Health. Report of a research working group, DHSS 1980
  • The Health Divide: Inequalities in Health in the 1980s. Margaret Whitehead.
  • The Acheson report: Understanding Health Inequalities, (2000), Open University Press
  • The Black report and beyond. What are the issues? Soc. Sci. Med. Vol. 44, No. 6, pp. 723-745, 1997
  • Social determinants of health website of the World Health Organisation. http://www.who.int/social_determinants/en/

Taught sessions

The class will meet every week for two sessions in one day. For example, a one-hour lecture from 9.30am to 10.30am might be followed by a seminar on from 11:00am to 1:00pm. The module lead, or occasionally guest lecturers, will present the lecture. These will be interactive sessions. We would like you to engage actively, ask questions and respond to questions. The seminars give us an opportunity to explore a topic in more depth.  They may occur the same day as the lecture on that topic or later in the programme. The seminars may include: short presentations, debates or discussion of materials brought to the seminar. Please do the required readings and preparation ahead of the seminar or lecture so as to maximise your enjoyment and learning and so the class can get the most of these sessions. The instructions will be put on QMplus ahead of teaching.

This is an example for prospective students-course structure subject to change

Part 1 – weeks 1-4

In the first four weeks we set the scene of global health and wellbeing, inequities in global health and concepts and models that link these with social determinants.  We will explain the multiple interacting factors that determine or influence health at either the individual or the population level.  We will introduce social determinants of health and the complex ways in which they impact upon health and health inequities. We will discuss the nature of evidence and measurement.   

WEEK 1: Introduction to global health and health inequities

Objectives (L1, S1 and S2):

When you have completed the reading and participated in the taught sessions for this topic, you will:

  • Have an overview of this course content and structure
  • Have an understanding of the historic epidemiological and demographic trends in global health
  • Be aware of international differences in health and wellbeing
  • Appreciate the scale of inequities between and within countries
  • Be able to describe definitions of health and the differences between health inequalities and health inequities

In these sessions we will introduce global health.  We look at historic trends in global health.  We consider what is health and what are health inequities and demonstrate stark health inequities between and within countries. Is this an issue of social justice? What are some of the key ways in which these should be addressed?  

Seminar 1 (S1): Introduction to global health and Health inequities I

In this first seminar we will seminar will ask the questions:

  • What is health?
  • What do we understand by health inequities?

You will also have the opportunity to ask any questions about the course content and structure.

Preparation for the seminar: 

  • Read the essential reading for week 1.
  • Bring an example from the news of a health issue of your interest from any country. Be prepared to describe the article in 2-3 minutes to the rest of the group including:  a) Why does this interest you b) What is the main health issue described? c) What groups in society are more likely to exprience this health issue?

Compulsory Reading:

  • Course outline on QMplus
  • Commission for the Social Determinants of Health, 2008. Chapters 1, 2 and 3.
  • Others to be advised

WEEK 2: What causes health and ill health? (determinants)

Objectives (L2, S3):

When you have completed the reading and participated in the taught sessions for this topic, you will:

  • Be able to describe broad determinants of health
  • Have a understanding of the historic and global context of ill health
  • Consider individual vs population approaches

In these sessions we introduce models, such as Dahlgren and Whitehead, that outline the key determinants of health. We will introduce what is included in the social determinants and the “causes of the causes”.  We will discuss some of the historic context that contributes to the different patterns of disease globally.

Seminar 2: Introduction to global health and Health inequities II

The seminar will be used to further our understanding of this topic. It may take the form of a debate about international inequities in health.  Further detail will be given ahead of the seminar, please prepare as requested. Have fun exploring: http://www.gapminder.org/ 

Compulsory Reading:

  • The Acheson report: Part 1
  • “The Black report and Beyond” by Macintyre
  • Others to be advised

Week 3: Explaining social determinants and links to health and health inequities (pathways)

Objectives (L3, S5):

When you have completed the reading and participated in the taught sessions for this topic, you will:

  • Understand the different mechanisms or pathways for social factors to influence health outcomes
  • Begin to understand the complexity of interactions between factors
  • Understand definitions of social status
  • Understand the social gradient in health

In these sessions we deepen our understanding of what is meant by social determinants. We then explore the mechanisms, theories and pathways for social factors to influence health.  These include, for example, the impact of material deprivation and psychosocial factors.  We will begin to see that there is complex interaction between the different factors

Seminar 3: What causes health and ill health? (determinants)

The seminar coincides with World Mental Health Day . Read the compulsory readings. Bring your stories and experience re mental health and wellbeing and notice campaigns.  We will discuss some of the determinants that are linked to mental health and wellbeing. 

Compulsory Readings

  • To be advised

Week 4: Measurement, information and evidence

Objectives (L4, S4):

When you have completed the reading and participated in the taught sessions for this topic, you will:

  • Understand the approaches to evidence and measurement in describing health inequity and determinants of health
  • Appreciate the importance but limitations of measurement and evidence

Measurement and evidence are important to further understanding of this field and inform policy.  However there are challenges.  In these sessions we will discuss aproaches to measuring determinants and their impact on health and health equity. 

Seminar 4: Mini project with Epidemiolgy & Stats (Measurement)

Social determinants/Epi&Stats Joint Mini-Project: This uses the concept of this week (Measurement, information and evidence) together with those of Lecture and Practical 2 (Ecological studies) of Epi&Stats.  The task will be given today and the time of the seminar today will be allocated to getting started with the task. The students will then be expected to work in pairs to the task over the next 10 days and give a 5 minutes slide presentation during the Epi&Stats Practical 5 (SDH/Epi&Stats Mini Project presentation) on Tuesday October 28th.  

Compulsory Reading:

  • To be advised

 

Part 2: weeks 5 to 11

Studies of selected social determinants of health

These later weeks we will explore particular topics in more depth.  This aims to further illustrate the concepts of the first four weeks and give an exposure to some key topics in global health. In addition to the specific objectives for each week, these sessions aim to further your understanding of:

  • the different mechanisms for social factors to influence health outcomes and the complexities of these interactions
  • potential policies required to reduce health inequities through social change and enable you to apply this in debates on how to address social inequities in health
  • measurement and evidence and how to evaluate and synthesise the public health literature relating to the social determinants of health
  • a global perspective with regards to global health and social and health inequities

Week 5: Work, unemployment and income

Objectives (L5 and S6):

When you have completed the reading and participated in the taught sessions for this topic you will be able to:

  • Give examples of the impact of employment, unemployment and income on health equity
  • Understand the impact of absolute and relative income on health
  • Understand the link with other social determinants eg education

These sessions explore the fundamental issues of employment (including positive and negative attributes) and unemployment .  The impacts of relative and absolute income and social status as determinants of health are also further discussed.  Teachings from earlier in the course on the measurement of socio-economic status and the social gradient in health wil be further developed.  We will critique key literature and consider policy solutions.

Seminar 5: Explaining social determinants and links to health and health inequities (pathways)

The seminar will be used to further our understanding of pathways including their policy implications.  Further detail will be given ahead of the seminar, please prepare as requested.

Compulsory Reading:

To be advised.

Week 6: Health inequities between population groups.

Objectives (L6, S8):

When you have completed the reading and participated in the taught sessions for this topic, you will:

  • Understand inequity in health across population groups

These sessions highlight the inequities in health outcomes between different populations.  We explore examples and multi-factorial explanations for these differences. Gender and ethinicty are key and other examples are: socio-economic status (covered throughout the course), disability and sexual orientation.

Seminar 6: Work, Unemployment and income

The seminar will be used to further our understanding of “work, unemployment and income” The seminar will be based upon a critique of the Spirit Level and its implications for policy. Key chapters of the Spirit Level to be read ahead of the seminar.  Further detail will be given ahead of the seminar, please prepare as requested.

Compulsory Reading:

To be advised.

Week 7: Reading week

There are no taught sessions for for this course during the reading week. The reading week is intended as an opportunity for you as students to complete outstanding coursework, to revise the readings, and to work on your essay. 

Week 8: Social capital

Objectives (L8 and S8):

When you have completed the reading and participated in the taught sessions for this topic you will be able to: 

  • Describe and explain the main mechanisms linking social relationships and social capital to health and health inequity
  • Relate social relationships and social capital to other social determinants of health.
  • Critically evaluate policy to promote social capital.

In this lecture, we examine to what extent, why, and how a range of different social relationships (i.e., family, friends, and social clubs and organisations) influences health and health inequities. In addition to the structure of social relationships, we discuss how the quality or content of social relationships affects health inequalities. Also, we scrutinize the debate over the beneficial impact of ‘social capital’, which is a high density and high quality of social relationships in communities. Does social capital indeed lead to better health and smaller health inequity, and if so, how can governments promote social capital? Finally, we examine the link between social relationships, social capital, and other social determinants of health (e.g., education). 

Seminar 8: Social Capital

The seminar will be used to further our understanding of this topic (Social Capital) and the previous lecture (Health Inequities Between Population Groups).  Further detail will be given ahead of the seminar, please prepare as requested.

Compulsory Reading:

  • To be advised

Week 9:  Early life and childhood development

Objective (L9 and S9):

When you have completed the reading and participated in the taught sessions for this topic you will be able to:

  • Understand the importance of early life and childhood development as a determinant of health
  • Appreciate the complexity of interacting factors
  • Give examples of short and long causal pathways influencing health inequities

In these sessions we will study how during early life (at conception, and/or during fetal life, infancy and early childhood), the environment induces changes in development that have long term impact on later health and disease risk.  We will use the seminar to study broader social determinants of health relating to early life.  An international programme, Families and Schools Together (FAST), will demonstrate how some of these issues may be tackled to improve health and social outcomes. We hope to be joined by Professor Seif Shaheen and Professor Lynn McDonald. 

Seminar 9: 

The seminar will be based upon a discussion of key readings and study of the FAST programme.  Details to follow.

Compulsory Reading:

To be advised

Additional reading:

Explore the website of the Developmental Origins of Health and Disease (DOHAD) at http://www.mrc-leu.soton.ac.uk/dohad/index.asp 

Explore the website of Family and Schools Together (FAST) at http://www.familiesandschools.org/programs

Week 10: Physical environment and housing

Objectives:

When you have completed the reading and participated in the taught sessions for this topic, you will:

  • Be able to explain key factors in the physical environment that impact upon health and health inequalities

 Seminar: Physical environment and housing

The seminar will be used to further our understanding of this topic based on the lecture and key readings. In addition we hope to have a guest speaker Dr Jin Lim who has led work across London on “Healthy High Streets”.  Further detail will be given ahead of the seminar, please prepare as requested.

Compulsory Reading:

To be advised.

Week 11: What next?

Objectives (L11 and S11):

When you have completed the reading and participated in the taught sessions for this topic you will be able to:

  • Meet all the objectives of this course
  • Understand some of the global context that facilitates or works against addressing social determinants and reducing inequities in health
  • Give examples of approaches to addressing social determinants and reducing inequities in health at international, national or local levels

This session will re-enforce some of the key messages from this course. We will see the complex and cross cutting nature of the social determinants of health and some of the challenges of this field. We will explore some additional approaches to addressing social determinants and reducing health inequities and discuss some of the context in which these would be operating.

Seminar 11: Course overview and question and answer

Structured and facilitated question and answer session for the whole class on course content.

Introduce to action based learning and action groups eg MEDACT!

Compulsory reading:

  • To be advised

 

Part 3: Week 12

Week 12: Exam

 December

There is no lecture or seminar for this course in week 12. Instead, the students will take a written exam.  Further details (see above) and to advised. 

Return to top