Geography Reference
In-Depth Information
13.5.5
Economic Determinants
Many investigators, from the nineteenth century social commentators to the present
(Adler and Ostrove
1999
), have shown that people living in disadvantaged socio-
economic circumstances suffer more ill-health and earlier death rates than others.
However the adoption of the 'care and cure' medical approach has tended to blame
some health problems on life-style choices, rather than the wider structural circum-
stances of their life in the socio-economic environment that negatively affect their
health. These components of disadvantage are now usually labelled as the social de-
terminants of health, with Wilkinson and Marmot (
1999
,
2003
) using empirical re-
search results to identify ten significant factors in causing ill-health, summarized as:
the social gradient, unemployment, work conditions, food, stress, early life, social
exclusion, social support, addictions and transport. But it does seem useful to sepa-
rate the factors into what amount to economic and social factors, rather than having
one long list, while the addictions and transport factors have already been dealt with
in the previous discussions on life-style and man-made environment respectively.
One of the most powerful explanations of ill-health among the economic deter-
minants is described by Wilkinson and Marmot (
1999
) as the 'social gradient'. This
means that people who are in the lowest income brackets have shorter lives than
people in higher income brackets, as seen in the Canadian example in Fig.
13.2
,
features that also apply to more ill-health. The pattern is much more pronounced in
less developed countries. Less money for food, heating, adequate clothing, ability
to pay for and access to medical care, knowledge of how to look after oneself, are
all contributory factors, but the lack of education and hence ability to improve one's
position in the social hierarchy is also a major contributing factor to this general
trend. Populations that have higher levels of educational and occupational quali-
fications tend to have lower levels of dementia, indicating that there is some kind
of cognitive reserve that counteracts the effect of this neuro-degeneration (Prince
and Acosti et al.
2012
). However, it was previously noted that the modification
of other life-style factors, such as physical inactivity, could drastically reduce the
incidence of the disease (Norton et al.
2014
). Another powerful social determinant
of ill-health is the
unemployment rate,
as is limited
work satisfaction
and difficult
work conditions. In general, people at the lower end of the social gradient also have
longer periods of poorer health in their later years due to various causes. Rates of
various mental diseases are also higher in cities.
The level of
nutrition
is also critical in improving health. The increasing num-
bers of food additives, such as excessive salt, sugar and food preservatives found in
many products in supermarkets and fast food outlets, have led to higher incidences
of heart diseases and obesity in particular. Certainly some of these issues are a
result of poor life-style choices by disadvantaged people, but they often lack local
sources of healthy food. A good diet, with a variety of vegetables and fruit, and
adequate amounts of each, is essential to maintaining health, for malnutrition leads
to ill-health and also vitamin deficiencies which can lead to diseases. There is still
controversy over these issues, but a meta-analysis of research findings confirmed
a linear relationship between stroke risk and low fruit and vegetable consumption,
