Social Class and Health Inequalities, Annotated Bibliography Example

Introduction

Social determinants of health relate to the socio-economic conditions influencing distribution of health care services within a community. It exposes the individual and group disparities in health status due to apparent inequities.  Risk factors associated with social determinants of health include one’s living and working conditions, distribution of income, wealth, influence, and power.

As it pertains to this presentation the writer posits that individual biological factors do not influence social determinants of health; rather it is a person’s access to quality health care that makes the remarkable difference in determination factors. The critical question is how should Canadian government address the social determinants of health?

Why is it an issue?

• Healthcare in Canada is a mix model of public funding and private execution of services.
• There is universal insurance coverage for Canadian citizens and legal residents.
• Public sector health care is not responsible for delivery.
• Public sector health care does not monitor service accessibility to the every citizen or legal residents
• Even though health care is free it is not accessible due to private sector dominance in delivery.
• Many citizens cannot afford private delivery due to co-payment issues
• It is a relevant health care issue because many Canadians cannot access quality health care.
• Public sector negligence in assessing inequities of service delivery creates disparities among classes

Who does the issue involve?

• Children, elderly and women are mostly affected by the social determinants of health care services in Canada
• Public health administration oversees that Canadians have access to health care but does not decide on the quality nor equity.
• Private hospital management operates as a for-profit entity with public funds
• Public sector funding agencies allow private sector health care to charge according to their budget demands rather than what an individuals can afford.

Evidence to Support Argument

Buchanan, D. (1998). Beyond positivism: humanistic perspectives on theory and research in health education. Health Education Research. 13(3), 439-450.

In this article the author presented seven functions of a theory namely, prediction, explanation, making assumptions explicit, understanding, sense-making, sensitization and critique. The first two concepts he described as being associated with positivism while others were linked to humanities. Arguments advanced in this research related to alternative views of positivism, which are beneficial to health education practice. One of the issues intensifying social determinants inequities in Canada is the privilege of health education across social classes

Canada Health Act (2012). Department of Justice. Retrieved Nov 9th, 2012 from http://laws-lois.justice.gc.ca/eng/acts/C-6/

Canada Health Act (CHA) refers to a Canadian federal legislation, designed in 1984, stipulating conditions and criteria under which provincial and territorial health insurance programs must be eligible to receive transfer payments from public funds to private health care entities. These requirements embody universal coverage for every ensured person to entitle him/her for medical services such as seeing doctors, specialists; nursing home referrals, and other services deemed to be medical (Canada Health Act, 2012).  This appears to be as a social determinant of health care in Canada, but with many Canadians do not access quality health care.

Coburn, D (2004). Beyond the income inequality hypothesis: class,neo-liberalism,and health Inequalities. Social Science & Medicine 58 (2004), 41–56

Coburn contends that global and national socio-political-economic trends have increased the power of business classes and lowered working class participation in the social structure. Hence, there is a significant income inequality accompanied by unequal access to health care services. This income disparity then becomes a social determinant of healthcare. If gaps are to be narrowed or closed these disparities ought to be addressed by  Canadian social services department.

Coburn, D., & E. Coburn (2007).Health and health inequalities in a neo-liberal global world. London. Cambridge University Press.

In yet another article teaming up with his wife they advance that neoliberal doctrines influence social inequalities relevant to health inequities.  However, this should initiate action towards resolving these inequities in society. Ironically, they are not addressed in the Canadian social services arena. The question remains how government should intervene.

Raphael, D (2002). Poverty, Income Inequality,and Health in Canada. Toronto. The CSJ Foundation for Research and Education.

The author discusses the impact of poverty and income inequality on Canadian’s health care system. He advanced that poverty and income inequality are detrimental to the health of low income earners. As such, categories of Canadians are affected and it is reflected in weakening of social infrastructure and the destruction of social cohesion. If this is the actual outcome of health care delivery through the mix model intervention changes must occur to address income inequality as a social determinant of health in Canada.

Raphael, D (2000). Health inequalities in Canada: current discourses and implications for public health action. Critical Public Health, 10 (2). 194-204

This researcher explored the consequences of increasing inequality among Canadians and effects on their health status. He acknowledged that the subject has become a Canadian tradition still to be adequately addressed as a public health issue. Public health as an institution is limited in its response to the dilemma. In concluding the analyst cited misinformation or lack of it as being a major factor for silence on the issue.

Madore, O., & Tiedmann, M. (2005). Private Health Care Funding and Delivery under the Canada Health Act. Parliamentary and Information Services.

Analysts cited that many hospitals in Canada function as private not-for-profit entities run by community boards of trustees, voluntary organizations or municipalities.  Services such as pharmacies, food preparation, and facilities maintenance within hospital management are distinctly provided by a mix of private for-profit, private not-for-profit and public sectors

Muntaner, C. Ng, E., & Chung, H (2012). Better Health.  Ontario. Canadian Health Services Research Foundation and Canadian nurses association.

These authors embraced a study indicating the important role nurses play in narrowing health inequalities in their respective communities and functions. The authors conducted a scoping review to assess the empirical associations connecting social determinants and health outcomes. This was a deliberate attempt to expose public polices implicit in political activities aimed at influencing health inequality within the Canadian Health Care system.

Discussion and Implications

• Canadian Healthcare system needs to address inequities in health care delivery
• More women, elderly and children ought to be included in special health care delivery programs
• Social services department ought to make recommendation for improving accessibility to quality health care for citizens.
• Public sector health care should not only monitor private sector funding, but conduct financial assets intervention regarding the intangible health care delivery asset
• Implications are that life expectancy of Canadians will fall
• Human resource is the greatest in any nation and this will be depleted
• Social structures will collapse and the nation will crumble financially.

Conclusion

• Make recommendations to agencies responsible for social services development in Canada
• Organize social action
• Encourage interest group participation in peaceful protest demonstrations
• Empower minority groups by education

Individual biological factors do not influence social determinants of health; rather it is a person’s access to quality health care that makes the remarkable difference in determination factors.

References

Buchanan, D. (1998). Beyond positivism: humanistic perspectives on theory and research in health education. Health Education Research. 13(3), 439-450.

Canada Health Act (2012). Department of Justice. Retrieved Nov 9th, 2012 from http://laws-lois.justice.gc.ca/eng/acts/C-6/

Coburn, D (2004). Beyond the income inequality hypothesis: class, neo-liberalism, and health Inequalities. Social Science & Medicine 58 (2004), 41–56

Coburn, D., & E. Coburn (2007).Health and health inequalities in a neo-liberal global world. London. Cambridge University Press.

Madore, O., & Tiedmann, M. (2005). Private Health Care Funding and Deliver under the Canada Health Act. Parliamentary and Information Services.

Muntaner, C. Ng, E., & Chung, H (2012). Better Health.  Ontario. Canadian Health Services Research Foundation and Canadian nurses association

Raphael, D (2002). Poverty, Income Inequality,and Health in Canada. Toronto. The CSJ Foundation for Research and Education.

Raphael, D (2000). Health inequalities in Canada: current discourses and implications for public health action. Critical Public Health, 10 (2). 194-204