Social Determinants

Background: The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theory-based evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. Methods: A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. Results: The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP's success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion: The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory. Implications for policy makers • Program theory-based evaluation provides an approach to evaluate the process and longer term outcomes (through a predictive chain-of-logic approach) of complex inter-sectoral policy processes. • Developing the evaluation framework through a participatory and iterative process enables the involvement of policy actors and facilitates co-production of knowledge. • This approach to evaluation can account for the changing political and bureaucratic environments that are part of the reality of policy-making. • Program theory-based evaluation is currently the best approach to determine, prospectively, the health impacts of policy. Implications for the public Public policy shapes the social, economic and environmental conditions of everyday living. These conditions influence the health and wellbeing of individuals and populations. Action to improve health requires multiple policy sectors and policy-makers to work together to achieve improved health and ensure that benefits are distributed equitably across the population. Despite the importance of such inter-sectoral work it has been difficult to evaluate given the complexity of the task, the wide range of sectors and people involved, and the difficulties of attributing long-term outcomes to policy changes. This paper describes development of a framework for evaluation that allows examination of both the policy-making processes and the health outcomes of the resulting policies.

In the last few decades there has been a resurgence of interest in the social causes of health inequities among and between individuals and populations. This ‘social determinants’ perspective focuses on the myriad demographic and societal factors that shape health and well-being. Heeding calls for the mainstreaming of two very specific health determinants - sex and gender - we incorporate both into our analysis of the health gap experienced by girls and women in Canada. However, we take an intersectional approach in that we argue that a comprehensive picture of health inequities must, in addition to considering sex and gender, include a context sensitive analysis of all the major dimensions of social stratification. In the case of the current worldwide economic downturn, and the uniquely diverse Canadian population spread over a vast territory, this means thinking carefully about how socioeconomic status, race, ethnicity, immigrant status, employment status and geography uniquely sh...

Organizations in the twenty-first century continuously adapt their mindsets and look for new ways to reawaken employees' talent toward innovation and competitiveness. In this regard, they fulfill new environment requirements together with more effective and interactive competitive strategies such as: fostering cooperation, promoting relationships of resource/competencies exchange, and developing networks through communication platforms and virtualization. There is a constant transformation of administrative processes from isolated into interactive processes. Consequently, a more psychological and social approach is needed to understand the real value and combined outcomes experienced through value co-creation activities. For a better understanding, organizational studies should consider a holistic view of stakeholders and their context as co-creators of the key-value needed to excel and be competitive.

This Research Topic for Frontiers in Psychology brings together a set of contributions related to social and psychological determinants of value co-creation for organizations and individuals.

Argentina and Brazil report the highest incidence of the fear of crime across Latin America. Although the spread of crime and victimization may explain these trends initially, the focus in this paper is on the significance of non-criminal factors in explaining the fear of crime, such as socioeconomic vulnerability, educational level and trust in people and institutions, as well as exposure to violence at one's place of residence. Using a subset of data from the 2017 edition of the Latinobarómetro survey (n = 2400), a regression analysis was conducted showing that the fear of crime is radically different between the two countries. In Argentina, as in certain European countries, people's fears of crime are positively associated with socioeconomic vulnerability and in turn negatively associated with statedriven violence. The latter has a protective effect on Argentinians' feelings of insecurity, while in Brazil the fear of crime is to a greater extent a consequence of previous victimization and a general distrust in other people. Despite this key difference, our results shed light on the problem of social cohesion in both countries, suggesting that the fear of crime is a social rather than criminal issue.

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12-18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, men...

Social capital is essential for the successful development of young people. The current study examines direct measures of social capital in young people in five urban global contexts. The Well-Being of Adolescents in Vulnerable Environments is a global study of young people aged 15-19 years living in disadvantaged, urban settings. Respondent-driven sampling was used to recruit approximately 500 participants from each site. The sample included 2,339 young people (mean age 16.7 years; 47.5% female). We examined the associations between social capital in four domains-family, school, peers, and neighborhood and demographic characteristics-using gender-stratified ordinary least-squares regression. We also examined associations between self-reported health and the four social capital domains, which was minimal. School enrollment was positively associated with social capital for young women in Baltimore, Delhi, and Shanghai; the association was less consistent for young men. The same patte...

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect

Background Latinos comprise 14% of the United States (US) population, and approximately 75% of Latinos in the US are immigrants or children of immigrants. Urban Latino men face a distinct set of structural barriers that may influence their health and well-being. The collapse of the automobile industry in Detroit, Michigan, contributed to increased rates of racially stratified unemployment. Method Through semi-structured interviews and ethnography, we present a case study of nine Latino men who face decreasing opportunities for formal ...

To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n=679) was collected in 2002. Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have phy...

In the past few decades, a particular need for a child-centered perspective has emerged, based on evidence that children are more susceptible to environmental and social risks, and that they have different needs than adults do. This article examines issues affecting children in existing measurements and presents conceptual considerations for future work toward defining and measuring child poverty. Current definitions

In the last few decades there has been a resurgence of interest in the social causes of health inequities among and between individuals and populations. This ‘social determinants’ perspective focuses on the myriad demographic and societal factors that shape health and well-being. Heeding calls for the mainstreaming of two very specific health determinants - sex and gender - we incorporate both into our analysis of the health gap experienced by girls and women in Canada. However, we take an intersectional approach in that we argue that a comprehensive picture of health inequities must, in addition to considering sex and gender, include a context sensitive analysis of all the major dimensions of social stratification. In the case of the current worldwide economic downturn, and the uniquely diverse Canadian population spread over a vast territory, this means thinking carefully about how socioeconomic status, race, ethnicity, immigrant status, employment status and geography uniquely sh...

Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men's and women's attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. We used data from the RESPECT study, a randomized controlled trial that evaluated an intervention to prevent sexually transmitted infections in a cohort of young Tanzanian men and women, to examine the relationship between couples' attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women's reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline. Over time, participants' attitudes tended to become more equitable and women's reports of IPV declined substantially. Multivariable logistic regression analyses suggested that inequitable attitudes and couple discordance were associated with higher risk of IPV. Our find...

Mendes FM, Braga MM, Oliveira LB, Antunes JLF, Ardenghi TM, Bönecker M. Discriminant validity of the International Caries Detection and Assessment System (ICDAS) and comparability with World Health Organization criteria in a cross-sectional study. Community Dent Oral Epidemiol 2010; 38: 398–407. © 2010 John Wiley & Sons A/SAbstract –  Objectives:  The aim of this cross-sectional study in preschool children was to assess the ability of International Caries Detection and Assessment System (ICDAS) in discriminating socioeconomic factors associated with the presence of caries lesions at both noncavitated and cavitated thresholds and to compare with the standard World Health Organization (WHO) criteria.Methods:  The study was carried out in Amparo, Brazil, during the National Day of Children’s Vaccination including 252 children aged 36–59 months. The same child was independently examined by two calibrated examiners, one using the ICDAS and the other using WHO criteria. Socioeconomic information was also recorded. Associations between socioeconomic factors and presence of caries assessed as binary (caries prevalence) and count outcome (actual dmfs values) obtained by WHO criteria and by ICDAS at noncavitated and cavitated thresholds were evaluated by Poisson regression analysis with robust variance.Results:  Some covariates were significantly associated with the presence of caries evaluated by the WHO criteria and by ICDAS (using score 3 as cut-off point). When noncavitated scores of ICDAS were used to calculate the presence of caries, the discriminant power decreased. When dmfs values were used as outcome, no differences in the associations were observed between two systems or using noncavitated caries lesions.Conclusion:  Cavitated scores of ICDAS present similar discriminant validity compared with WHO criteria when presence of caries is used as outcome; however, when actual dmfs values are used, no differences are observed in using noncavitated or cavitated caries lesions.

Individual behaviour change interventions and technological approaches to HIV prevention can only be effective over time if the broader social environment in which health-related decisions are made facilitate their uptake. People need to be not only willing but also able to take up and maintain preventive behaviours, seek testing, treatment and care for HIV. This paper presents findings and recommendations of the Social Drivers Working Group of the aids2031 initiative, which focus on how to ensure that efforts to address the root causes of HIV vulnerability are integrated into AIDS responses at the national level. Specific guidance is given on how to operationalise a structural approach.