The Determinants of Health

In this class we will do three essays, each of which will explore a topic covered in the sessions in greater depth. They will also explore 3 broad thematic areas:
• The determinants of health
o Most acknowledge where we spend most of our money (illness care) is really only a very small proportion of health (10 to 20 percent).
o The bigger piece is the determinants of health.
o These can be behavioral (individual responsibility, like smoking) or structural (state responsibility, like pollution).
o Canada was an early leader here (Lalonde Report)
• Economic or health inequalities (they are not the same thing)
o There is much research on links between income and health (economic inequalities)
o There is also much research on differences in health outcomes (health inequalities).
§ This can be due to a number of factors, geography for example – people in certain areas live longer.
§ Health can be stratified according to occupation (Whitehall I and II in the UK)
§ Britain has done much work here (Black, Whitehead, Acheson Reports, Marmot Review.
• Solutions
o Sovereign wealth funds (paying a public dividend) o Adequate minimum wage
o Basic income
o Pensions (specifically defined benefit plans)o Universal child care o School lunches
Topic: The determinants of health
Background: When we talk about health it’s usually about dealing with individual health and at that dealing with illness. However, this is actually only a very small part of health. The bigger part is the opposite to this, namely public health, population health, the health of societies, of which the determinants of health are a major part.
The determinants of health are many things. We have dealt with them in part in Session 1. However some of them are more important than others. For example income is a very important part of heath. Here we are getting into things like an adequate minimum wage, or job security, or good working conditions. Or good benefits, like pensions, especially a defined benefits pension plan.
There is another aspect to the determinants of health and that has to do with empowering the individual, having the individual be an integral part of setting health policy.
And, if we want to go this route how do we empower the individual? Universities can play a crucial role here. They can not only teach people like you, but also get their information out to the public. How do you think they can do this?
Format
Recall the format we have talked about in class, which might be helpful:
• State what you are going to do. This should be short – a few sentences should
suffice.
• Provide some background to the topic you have chosen
• Provide analysis, look at it critically. With the benefit of hindsight are there improvements you can suggest to how it was done at the time.
• Have a conclusion. In light of your background and analysis this comes to some resolve.
A Word on Citations
An important part of academic essays are citations. Your citations must be traceable. To list author, title and year, of a multipage article or book is largely meaningless. You need to include a page number whenever possible. This is sometimes not possible on electronic articles but most often is if you download the PDF version.
The reason for this is academic knowledge is built on a foundation; its an aggregate. People constantly want to delve further into ideas or references that catch their eye to help tease out their own ideas. You have to make it easy for them to do so.
Assignment-1
2
This is even important at the undergraduate level. Never think that just because you are writing at this level your work is unimportant. The contrary is true. You are just as able as anyone to come up with groundbreaking ideas.
An Alternative Topic
If some of you want to choose and explore a topic of your own in the area of health care that you find particularly interesting or engaging, you are free to do so.
Additional Resources For This Essay:
In addition to the lectures and the readings, some of the other resources mentioned in the syllabus might be helpful.
There are some other recent publications that might be helpful.
• One is by the Institute for Competitiveness and Prosperity and is called
Modernizing Medicare.
• There is also an article in the journal Foreign Affairs which a number of libraries at the U of T (including the Graham Library) have. The citation is: Nicolas Colin and Bruno Palier, “The Next Safety Net: Social Policy for a Digital Age”, Foreign Affairs, vol. 94, no. 4, July-August 2015.
• The Commonwealth Fund has useful information on the healthcare systems of a number of countries.
o From its website: The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.