⇨ Case Summary Module 2022
➔ Case 1: SES, work, health and lifestyle in general
1. Components of SES and how they affect health inequalities and lifestyle:
Main components of SES:
- Education: Higher levels of education are associated with better health outcomes.
Individuals with more education tend to make healthier choices, have greater health
literacy, and access higher-paying jobs with better healthcare benefits. Conversely, those
with lower levels of education may have limited access to information about health and
face occupational and environmental risks that can adversely affect their health.
- Occupation: People in high-status jobs often have more control over their work
environment, experience lower stress, and have better access to healthcare benefits.
Conversely, individuals in low-paying and high-stress occupations may face health
disparities due to workplace-related factors.
- Income: People with higher incomes often have better access to healthcare, can afford
healthier lifestyles, and live in more favorable environments. Conversely, individuals
with lower incomes may face barriers to healthcare, experience higher stress levels, and
have limited access to resources for maintaining good health.
SES health inequalities:
- Several factors explain the socioeconomic inequalities in health, such as behavior and the
living and working environment.
- Lifestyle factors strongly intertwine with work factors. Workers with unfavorable
working conditions are more likely to have an unhealthy lifestyle.
- Work factors seem to particularly contribute to socioeconomic inequalities in self-related
health.
- 2 main hypothesis for the role of lifestyle behaviors and the living and working
environment in explaining socioeconomic inequalities in health exist:
1. People with a low SES have a less healthy lifestyle and live and work
in more disadvantaged conditions than people with a high SES
(mediation effect)
- Material factors, such as housing and physical work factors,
explained the largest part of the relation between socioeconomic
position (i,e, income, occupational class, and education) and self
related health. This was followed by behavioral factors, such as
smoking and physical inactivity, and psychosocial factors, such as
lack of social support.
- Work factors mediate the relation between income,
occupational class, and education and health outcomes (e.g.
cvds, self-related health, low-back pain)
, 2. The effects of unhealthy lifestyle and living and working conditions
- It was found that material factors which include occupational factors, contribute
more to these inequalities than factors within the behavioral pathway such as
lifestyle.
- Important aspects:
1. Contribution of physical and psychosocial work factors to health inequalities
and
2. The importance of the contribution of work factors relative to the contribution
of lifestyle factors.
- Contribution of work factors to explaining these health inequalities
might be larger than the contribution of lifestyle factors. These
findings have important implications for public and occupational
health policy and the development of interventions. It emphasizes
the importance to focus on work factors, besides lifestyle factors,
in order to reduce socioeconomic inequalities in self-related health
2. How do work and lifestyle Characteristics affect health (job exposures/job
demands):
Lifestyle/work and health + role of SES:
- Behavior-related modifiable health risk factors, such as smoking are major
contributions to the non communicable disease burden and mortality around the
world. These factors tend to cluster at the population level, with some people
having multiple health risk factors (an overall unhealthy lifestyle) and others
having multiple health-promoting factors (an overall healthy lifestyle), the causes
of this clustering are not well underwood.
- SES directly affect health through mechanisms such as material well-being and
psychosocial stress, there is also the role of SES on behaviors.
1. SES as a predisposing determinant of behavior: The perspective on SES as a
determinant of behavior related to health would suggest first that environments
shape behavior from early childhood onward.
2. SES as an enabling determinant of behavior: Socioeconomic standing also
confers capabilities and resources that enable the predisposed behaviors to be
carried out, for better or for worse. With higher standing come more resources and
the associated education and training that endow individuals and families with
enabling judgements and resources.
3. SES as a reinforcing determinant of behavior: SES can contribute to the
availability or reinforcements by putting people into association with other people
and environments that are more likely to produce satisfaction with behaviors.
, Behavioral determinants of health:
- Some health behaviors are single, discrete actions that can have lasting
effects for health (e.g. getting a vaccine, or a mosquito net to reduce
malaria exposure)
- Much of today's growing chronic disease burden relates more to complex
repeated behaviors, sometimes referred to as a habit or lifestyle.
- “Complex behavior” refers to combinations of interrelated practices and
their environmental contexts, reflecting patterns of living influenced by
the family and social history of individuals and communities, their
environmental and socioeconomic circumstances, and their exposure to
cultures and communications.
- Behavior itself is considered a risk factor for
various diseases. As the figure above shows,
the broad array of actions people take,
consciously or unconsciously, can have an
immediate or cumulative effect on their health
status. The effect on health may be intended
(health directed) or unintended (health-related),
but the behavior is nevertheless direct in its
effect.
- Behavior can also be a determinant of other
risk factors.
- Behavior can also be a consequences of
cognitions, environments and genetics
3. What is the precede-proceed model:
- The precede-proceed model provides an eight-phase framework for practitioners to
determine, develop, implement and evaluate health promotion programmes, including the
application of health promotion theories systematically within such programmes.
- The different PRECEDE phases aim to map educational “diagnosis” and planning.
- Precede- proceed leads health promoters through the layers of a socio-ecological model,
from individual characteristics to broad socio-political conditions.
- The PROCEDE phases guide socio-ecological assessment and planning.
Five important and defining approaches of precede-proceed are that it is:
1. Socio-ecological with particular emphasis on the impact of physical, social and political
environments on population health
2. Population- centered, rather than focused on individuals, as such it is arguably a public
health theoretical framework, with health behavior change embedded within it.
, 3. Participatory, involving citizens in identifying, assessing and addressing their
community’s health and quality of life issues.
4. Quality of life focused, rather than behavior change or even health oriented
5. Grounded on experience from the field with ongoing revisions and refinements
- The precede- proceed model is a framework that invites and guides health promoters to
choose the theories they feel will best guide them in each phase of their work: (summary
of the model by Gielen et al):
- Precede-proceed can be thought of as a road map and behavior change as the specific
directions to a destination. The road map presents all the possible avenues, whereas the
theory suggests certain avenues to follow. The main purpose of the precede-proceed
model is not to predict or explain the relationship among factors to be associated with an
outcome of interest. Its main purpose is to provide a structure for applying theories and
concepts systematically for planning and evaluating health behavior change programmes.
Critiques of the model:
- It was called very theoretical - as
theory cannot always predict or
explain the actual relationship among
some factors
Precede has four assessment and planning stages to guide the health promotion
partners in selecting what problem to address, examining its underlying causes and
planning an intervention.
Proceed on the other hand includes four implementation and evaluation phases:
Phase 1:
- The social assessment and situation analysis, identifies and assesses potential areas for
health action. By engaging the community in this using both objective and subjective
information from multiple sources, the goal is to identify the population’s priorities in
Phase 2:
- The epidemiological assessment identifies and prioritizes health issues and sets change
