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Social Determinants of Health: Focus on the Individual

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‘Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.’ This a quote from the prominent professor, Sir Michael Marmot, who was commissioned by the then health minister, to propose, evidence-based, cost effectiveness strategy’s, to reduce inequalities in health.

In 2010, the Marmot review ‘Fair society, healthy lives, was released. Within the review, Professor Marmot, argued that inequalities in health are predominantly preventable. To achieve improved health and well being for everyone, the Marmot review set out two goals, ‘to create a society that enabled individuals to maximize individual and community potential and that social justice, sustainability and health must be at the centre of all policies’ (Marmot, 2010).

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This review has become an issue of great importance recently since there is a greater increase in the divide between the affluent and deprived areas of the UK. Social determinants of health shows that there is a link between an individual’s health and their socio–economic status. The research proves that an individual’s health and their risk of illness, are significantly influenced by economic, environmental and social inequalities.A model widely used, to show the links, is the Dahlgren and Whitehead (1991) model of health determinants this is still one of the most effective illustrations of health determinants, and has had widespread impact in research on health inequality.

This literature review will focus on one individual, with a long-term health condition, and how the social determinants of health have impacted on them, their illness, and the treatment they receive. It will for the purposes of this literature review and to uphold confidentiality, no real names will be used, the patient used in this literature review will be called ‘Mr. E’.

‘Mr. E’ is a 67-year-old gentleman, who is a former sheet metal worker, former smoker, and a recovering alcoholic, and at the time of this literature review, ‘Mr. E’ has not drunk for four years. The ‘Mr. E’ was born in Kent in 1953, to Scottish parents, a merchant sailor and a housewife. At the age of three, ‘Mr. E’ and his parents to moved to a small industrious town, on the outskirts of London. There he would have a humble upbringing, leaving school at the age of fifteen and embarking on a career in manual labor.

The man in question presents with a condition of deep vein thrombosis (DVT). A DVT is a blood clot that has formed, generally in the lower limbs, if this blood clot was to break free, it would eventually become a pulmonary embolism (PE), which would be fatal . As of the close nature of DVTs and pulmonary embolisms (PE), the term venous thromboembolism (VTE) is usually used to cover both conditions. Venous thromboembolism (VTE) is the most common vascular disease after acute myocardial infarction and stroke.

As with all conditions, there are several risk factors associated with VTE , at the time of diagnosis ‘Mr. E’, was sixty-two years old, heavy smoker, who was overweight and had a family history of VTE. As a result of this condition, ‘Mr. E’ is now on oral anticoagulant therapy.

So how have the social determinants (social, environmental, economic, political and cultural factors) of health (SDOH), influenced a gentleman with this condition? To explain this, the review will need to break down each risk factor for VTE, and see if there is any correlation, between those and the social determinants of health.

This literature review will be broken down into four sections, the first section will try to explain the determinants of health that contribute to the health beliefs and health needs of individuals and families in a variety of settings. Then it will utilize literature that highlights Person Centred Care (PCC). It will then try to explain the bio-psychosocial determinants of health, of DVT’s and finally, it will describe how nursing care is delivered across different sectors.

As previously mentioned, the Dahlgren and whitehead model of health determinants, is a tool often used when discussing the social determinants of health, the first section of the model is known as the personal characteristics, (sometimes these are called non-modifiable risk factors) this is someone age, sex, their ethnic group and finally hereditary factors. This section is important for the case of ‘Mr. E’ as his DVT, is hereditary. According to Hosseini et al DVT’s can occur without any underlying cause, this is known as idiopathic thrombosis. Hosseini et al go on to state that this could be a direct result, of a preexisting inherited risk factor.

According to Virchows Triad,Venous thromboembolism (VTE), is associated with Virchows Triad, or triad of Virchow. These are the three branches of factors that are thought to contribute to thrombosis. The three branches are Endothelial damage, hypercoagulability and stasis.

It is universally known that smoking, increases the risk for several chronic conditions, ‘Mr., E’ had been a smoker from a very young age, both parents smoked, as did most people, when he was growing up.

So, in conclusion, it is widely regarded that the social determinants of health, can play a key part in an individual’s life. 

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