Geography Reference
In-Depth Information
of these needs can be addressed by municipal actions, for example: in shelter by
subsidized housing or community based non-profit housing agencies; in nutrition,
through organizations providing food banks for those in need; or through planning
decisions that take the health impact of a displaced population into account. How-
ever, the most fundamental changes are probably still made by national or state
policy through taxation, welfare, social provisions and ecological regulations to
remove the structural disadvantage of those at the low end of the social gradient that
are created by societal not personal factors.
13.5.6
Social Determinants of Health
A series of interacting factors that may be described as the lived-experiences of peo-
ple are usually called the social determinants of health. A key factor is the presence
of
strong supportive networks of family or friends
, which are correlated with better
health. The opposite applies to those who are subject to
social isolation
, which may
be by choice, but more likely a result of the absence of friends or family, perhaps
due to age, poverty, disability, poor self-esteem. Poorer health is also found in those
suffering
social exclusion
, especially discrimination on ethnic or religious grounds.
Indeed, loneliness and social isolation—which is different to depression—has been
shown to increase the propensity to functional decline and ill-health, as well as
increasing the chances of earlier mortality (Cacioppo and Patrick
2009
; Perissino-
tto et al.
2012
). In addition, there is the problem of
stress
, which comes from the
workplace as well as in homes and neighbourhoods, and is now accepted as having
a biological effect.
Hormones associated with the chronic stress burden protect the body in the short run and
promote adaptation (allostasis), but in the long run, the burden of chronic stress causes
changes in the brain and body that can lead to disease (allostatic load and overload). Brain
circuits are plastic and remodelled by stress to change the balance between anxiety, mood
control, memory, and decision making. Such changes may have adaptive value in particular
contexts, but their persistence and lack of reversibility can be maladaptive. (McEwen
2012
,
p. 1)
These social determinants create a poorer quality of life, with lower self-esteem and
well-being. But others exist. For example, it is also being recognised that a healthier
life is more likely when there are high levels of positive
nurturing
, such as when
children are given a more supportive start to life through good education, nutri-
tion and a caring environment with limited exposure to stress or violent behaviour
(Brooks-Gunn et al.
1993
). This means helping mothers as well as their children
to develop in such environments. In later life, worries about
safety,
let alone actual
physical violence, are also important contributory factors in ill-health. In addition,
some
beliefs and values
, such as refusal to accept certain types of medical care be-
cause of religious beliefs/prejudices, are additional negative factors.
The extent to which there are
supportive facilities
in an area, from quality
schools, to churches and community associations or the provision of home-help,
can also create more caring social environments in an area, creating the social capi-
