The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.
Poverty and poor health are inseparably linked. Poverty has many dimensions – material deprivation (of food, shelter, sanitation, and safe drinking water), social exclusion, lack of education, unemployment, and low income – that all work together to reduce opportunities, limit choices, undermine hope, and, as a result, threaten health. Poverty has been linked to higher prevalence of many health conditions, including increased risk of chronic disease, injury, deprived infant development, stress, anxiety, depression, and premature death. These health conditions of poverty most burden vulnerable groups such as women, children, ethnic minorities, and disabled people. Social determinants of health – like child development, education, living and working conditions, and healthcare- are of special importance to the impoverished.
Socioeconomic factors that affect impoverished populations such as education, income inequality, and occupation, represent the strongest and most consistent predictors of health and mortality. The inequalities in the apparent circumstances of individual's lives, like individuals' access to health care, schools, their conditions of work and leisure, households, communities, towns, or cities, affect people's ability to lead a flourishing life and maintain health. The inequitable distribution of health-harmful living conditions, experiences, and structures, is not by any means natural, "but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics". Therefore, the conditions of individual's daily life are responsible for the social determinants of health and a major part of health inequities between and within countries. Along with these social conditions, "Gender, education, occupation, income, ethnicity, and place of residence are all closely linked to people's access to, experiences of, and benefits from health care." Social determinants of disease can be attributed to broad social forces such as racism, gender inequality, poverty, violence, and war. This is important because health quality, health distribution, and social protection of health in a population affect the development status of a nation. Since health has been considered a fundamental human right, one author suggests the social determinants of health determine the distribution of human dignity.
Definitions and measurements Social determinants of health in poverty reveal inequalities in health. Health is defined "as feeling sound, well, vigorous, and physically able to do things that most people ordinarily can do". Measurements of health take several forms including subjective health reports completed by individuals and surveys that measure physical impairment, vitality and well-being, diagnosis of serious chronic disease, and expected life longevity.
The World Health Organization defines the social determinants of health as "the conditions in which people are born, grow, live, work and age" , conditions that are determined by the distribution of money, power, and resources at global, national, and local levels. There are two main determinants of health: structural and proximal determinants. Structural determinants include societal divisions between social, economic, and political contexts, and lead to differences in power, status, and privilege within society. Proximal determinants are immediate factors present in daily life such as family and household relationships, peer and work relationships, and educational environments. Proximal determinants are influenced by the social stratification caused by structural determinants. Social determinants of health include early child development, globalization, health systems, measurement and evidence, urbanization, employment conditions, social exclusion, public health conditions, and women and gender equality. Different exposures and vulnerabilities to disease and injury determined by social, occupational, and physical environments and conditions, result in more or less vulnerability to poor health.
Social determinants of health have a huge impact on the lives of many individuals. It impacts their job likelihood, success, health, and future. For instance, those who come from lower socioeconomic status are more likely to develop health conditions such as cardiovascular disease. Some factors that affect these individuals and their health are food insecurity, financial stability, and healthcare access. Those who are from lower socioeconomic status backgrounds are likely to have adverse cardiovascular outcomes when compared to higher-income populations who may also be benefiting from curative and preventative strategies.
Social position
Poverty gradient and severity Within the impoverished population exists a wide range of real income, from less than US$2 a day, to the United States poverty threshold, which is $22,350 in a year for a family of four. Within impoverished populations, being relatively versus absolutely impoverished can determine health outcomes, in their severity and type of ailment. The poorest of all, globally, are the least healthy. Those in the lowest economic distribution of health, marginalized and excluded, and countries whose historical exploitation and inequality in global institutions of power and policy-making, have the worst health outcomes. As such, two broad categories distinguish between relative severity of poverty. Absolute poverty is the severe deprivation of basic human needs such as food, safe drinking water and shelter, and is used as a minimum standard below which no one should fall regardless of where they live. It is measured in relation to the 'poverty line' or the lowest amount of money needed to sustain human life. Relative poverty is "the inability to afford the goods, services, and activities needed to fully participate in a given society." Relative poverty still results in bad health outcomes because of the diminished agency of the impoverished.
Certain personal, household factors, such as living conditions, are more or less unstable in the lives of the impoverished and represent the determining factors for health amongst the poverty gradient. These factors prove challenging to individuals in poverty and are responsible for health deficits amongst the general impoverished population. Having sufficient access to a minimum amount of food that is nutritious and sanitary plays an important part in building health and reducing disease transmission. Access to sufficient amounts of quality water for drinking, bathing, and food preparation determines health and exposure to disease. Clothing that provides appropriate climatic protection and resources to wash clothes and bedding appropriately to prevent irritation, rashes, and parasitic life are also important to health.Housing, including size, quality, ventilation, crowding, sanitation, and separation, prove paramount in determining health and spread of disease. Availability of fuel for adequate sterilizing of eating utensils and food and the preservation of food proves necessary to promote health. Transportation, which provides access to medical care, shopping, and employment, proves absolutely essential. Hygienic and preventative care, including soap and insecticides, and vitamins and contraceptives, are necessary for maintaining health. Differential access to these life essentials depending on ability to afford with a given income results in differential health.
Gender Gender can determine health inequity in general health and particular diseases, and is especially magnified in poverty. Socioeconomic inequality is often cited as the fundamental cause for differential health outcomes among men and women. The health gap between the impoverished and other populations will only be closed if the lives of women are improved and gender inequalities are solved. Therefore, gender empowerment is key in achieving fair distribution of health. The rate at which girls and women die relative to men is higher in low- and middle-income countries than in high-income countries.
"Globally, girls missing at birth and deaths from excess female mortality after birth add up to 6 million women a year, 3.9 million below the age of 60. Of the 6 million, one-fifth is never born, one-tenth dies in early childhood, one- fifth in the reproductive years, and two-fifths at older ages. Excess female deaths have persisted and even increased in countries immensely affected by the HIV/AIDS epidemic, like South Africa. In South Africa, excess female mortality between 10 and 50 years of age rose from close to zero to 74,000 deaths per year in 2008. In impoverished populations, there are pronounced differences in the types of illnesses and injuries men and women contract. According to Ward, poor women have more heart disease, diabetes, cancer, and infant mortality. Poor women also have significant comorbidity, or existence of two ailments, such as psychiatric disorders with psychoactive substance use. They are also at greater risk for contracting endemic conditions like tuberculosis, diabetes, and heart disease. Women of low socioeconomic status in urban areas are more liable to contract sexually transmitted diseases and have unplanned pregnancies. Global studies demonstrate that risk for contracting cervical cancer, exclusive to women, increases as socioeconomic status decreases."
Household causes Health of poor women is impacted by gender inequalities through discriminating distribution of household goods, domestic violence, lack of agency, and unfair distribution of work, leisure, and opportunities between each gender. The way in which resources such as income, nourishment, and emotional support are traded in the household influences women's psychosocial health, nutrition, wellness, access to healthcare services, and threat of violence. The exchange of these elements in a home mediates in the impacts of geographical, cultural, and household patterns that result in inequality in health status and outcomes. Health-related behaviors, access and use of healthcare, stress, and psychosocial resources like social ties, coping, and spirituality all serve as factors that mediate health inequality. Household discrimination causes missing girls at birth, and the persistence of discrimination and poor service delivery perpetuates high female mortality.
Societal causes