What Are Social Determinants of Health

Introduction

The social determinants of health can be understood as, “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” (World Health Organisation, 2019). From this we can understand that Social Determinants of Health focus on an individual’s state of health and well-being. Social determinants of health are often referred to as layers, the Dahlgren and Whitehead’s Model (1991) helps explains this. The pair have attempted to map out the relationship between the individual, their environment and disease.

In the model it is clear to see the different social factors which all influence health. The centre of the model contains the individual and their fixed genes i.e. age, sex and other constitutional factors – these are surrounded by a set of different influences. Such as the individual’s lifestyle factors, community influences, living and working conditions, followed by more general social conditions. All which can have profound effects on the person, from before birth right through to adulthood. The model shows all the factors separated, even though all of the determinants link together, and will often affect each other, for example; if a person receives no education, then they are more likely to find it harder to gain a sustainable job than someone with a high level of education, thus effecting their income therefore having a further affect on their housing situation etc. This essay looks at the social determinants of health, highlighting specifically the effects that housing can have on a person, examining how it impacts the health of the individual, family and community physically and mentally.

Benefits of housing

Housing is a fundamental human right and can be a very influential factor on an individual’s health. Having safe and warm housing can help stop preventable diseases, increase one’s quality of life, reduce poverty and more.

Although people face many problems with in trying to sustain a safe and warm home for themselves and their families, there are understandably many benefits to having affordable, dry and warm homes as they play a significant role within improving health and wellbeing.

Although housing costs are rising there is help available for people for example; housing benefits, money to help with housing costs for people on low income.

The Housing (Scotland) Act 2014 contains provisions intended to support social landlords to allocate and manage their housing in a way which balances the variety of housing needs in their area and gives local communities a greater say in who gets priority for housing. (Scottish Government, 2015 pg. 62)

Inadequate housing

Throughout Scotland 1 in 10 households are affected by condensation/dampness or both along with 613,000 households facing fuel poverty, (Scottish Government, 2017). All these issues can make a household unsafe and inhabitable, but families can’t afford safer housing, thus making it their only option. Individuals living in dwellings containing mould and damp are more likely to face problems relating to respiratory infections, asthma, and allergies, furthermore it can increase difficulties with the immune system. The allergens, toxic substances and irritants within the mould are what cause the physical health issues for the family with the house, such as; sneezing, allergic reactions and in some cases even asthma attacks, which can be fatal, (NHS UK, 2018).

For families living in these houses it can have physiological effects on each member and may cause breakdowns within relationships. Parents may feel guilty for not being able to provide their children with a safe habitable home, they may also become anxious and/or paranoid about their loved ones developing respiratory diseases and falling ill.

• Unsafe structuring
• 3% of Scottish households are overcrowded (Scottish Government, 2017).

Homelessness

“Homelessness is both the consequence and cause of poverty and social and health inequality.” (Hertherington,K. Hamlet.N, 2018, pg. 195). This statement suggests that homelessness and poverty are interrelated with social and health inequalities, meaning that a lack of money or housing can create severe problems for an individual’s health both physically and mentally, in extreme cases homelessness can lead to death, according to (Morrison, 2009, pg. 195) homeless people in Glasgow are 4.5 times more likely to die than individuals who are housed.

From a health audit completed within England it was shown that “45% of homeless people have diagnosed mental health problems compared to 25% of the general population” and “41% of homeless people are likely to have long term physically health problems compared to 28% of the general population.” (NHS Health Scotland, 2019). These physical problems could be respiratory illnesses due to the fact they are likely to face a weakened immune system and from a lack of warmth, leading to issues such as hypothermia. As stated in the audit 45% of homeless people are diagnosed with mental health problems, these could be illnesses such as depression, anxiety disorders, schizophrenia and more. It can be terrifying for anyone who lives on the streets but for someone suffering from schizophrenia it can be even more daunting as they experience symptoms such as hallucinations and delusions. This can also be challenging for their family members as another symptom of schizophrenia is withdrawal, meaning the individual may not contact their family or friends possibly leaving the family worrying and the individual feeling lonely.

Usually the homeless are living in extreme poverty and don’t have another choice, thus making crime more attractive, as potential punishments unfortunately don’t tend to overpower the expected benefits (Becker, 1968). This has a negative effect on the community as homelessness increases crime rates, therefore creating barriers with in the community as individuals and families may feel unsafe and possibly anxious in the area.

Stress of Housing

According to the Scottish Government statistics in 2018-19 a total of 29,245 notice of proceedings were issued leading to 1,440 homes abandoned or evicted. Eviction and/or fear eviction can lead to an individual’s mental health and well-being deteriorating drastically. The stress of losing a home puts a major strain on a person’s health and can have serious consequences mentally, for example it can cause a person to feel fearful, distressed and invaluable, it can also lead to more serious mental health problems such as depression and anxiety. Not only will stress affect a person’s mental health but can also affect someone physically causing catastophic damages to the individual, such as a heart attack and suffering a stroke.

Housing can also cause stress for other family members, who live within the home as a house in disrepair can cause embarrassment and make the family ashamed of where they live, this can affect the social aspect of their lives as they may not feel confident nor proud enough to have friends over, making them feel lonely. For children this can raise stress levels due to them finding it harder to make friendships and create strong bonds which is an important part of child development.

An increase of 52% in average Scottish house prices from £113,280 in 2004 to £172,779 in 2017 and a 72% increase from £42.64 in 2004-2005 to £74.44 in 2016-2017 in the average weekly rent, according to (Shelter Scotland, 2016-2017). This increase in prices will affect both individuals/families and communities, with rising pressure to produce the money, stress levels also rise. With increasing house prices some communities could feel increasing stress levels due to their need for services in the community to be used in order to remain sustainable and with the increasing prices, houses are likely to become unaffordable therefore unoccupied, causing distress on the community.

Housing Situation

Regular exercise improves physical and mental health, cognition, and general academic performance, reduces anxiety and depression and adds to quality of life (Lee et al, 2012). This statement makes it clear of the benefits to exercise, however, housing can affect the amount of exercise an individual par takes in. Within a community if there is a lack of green space and parks it will decrease the community’s likelihood to exercise, especially the children that live within the setting as they don’t have an appealing and/or safe place to play. In more affluent areas there tends to be more and a larger variety of facilities i.e. gyms, swimming pools and other places to complete physical activity, this will have a positive impact on those with in the area however the lack of these facilities will negatively affect both the adults and children within the community as they may not be able to access services in other communities, it may even lead to an increase in the levels of both mental and physical health issues. Through increasing green areas and places to play there will be increases in social interaction and physical activity, thus boosting physical and mental well-being and boosting the quality of lives.

The situation of a dwelling can determine an individual’s access to health services or medical treatment, this can be understood as ‘postcode lottery’, this will affect everyone with in different communities some may benefit from this system where as others suffer. Living with in Scotland’s most deprived areas means you have 50% more chance of dying early or living with a life-limiting condition than those in more affluent places, (Freeman, 2018). This may be since in deprived areas there are longer waiting lists to see general practitioners and other health care professionals, if we look back to 2010/2011, in the more affluent areas of Scotland there were 28 consultations per 1,000 patients for anxiety, however there were 62 consultations per 1,000 patients in the more deprived areas, making it twice as likely for you to see a doctor about anxiety, (NHS Health Scotland, 2017).

Death in childhood is rare but mortality rates for children are nearly twice as high in the most deprived sectors of the community compared to more affluent areas.

Teenage girls who live in areas of deprivation are three times more likely to become pregnant. Because terminations are less likely in poorer areas they are ten times more likely to become teenage mothers. (Scottish Executive, 2007)