What social and cultural factors have shaped your perspective?
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the role of health systems and health behaviors in explaining the U.S. health disadvantage, but health is also deeply influenced by “social determinants,” such as income and wealth, education, occupation, and experiences based on racial or ethnic identification. These factors have been shown to contribute to large health disparities in the United States and other countries and should be considered in efforts to explain disparities in health among countries. Although the science of the social determinants of health is still evolving, a growing body of biological, epidemiological, and social science research has revealed pervasive and strong links between a range of social factors that shape living and working conditions and a wide array of health outcomes. A rapidly accumulating literature also is elucidating the biological processes that may account for these health effects (Adler and Stewart, 2010; Braveman et al., 2011b; Commission on the Social Determinants of Health, 2008).
Following widespread convention, we use the term “social” to refer to economic as well as psychosocial factors. Access to, and the quality of, medical care are clearly influenced by social policies, such as the legislation creating Medicare and Medicaid in 1965 and the Affordable Care Act in 2010. Generally, however, and in this report, the terms “social factors” and “social determinants of health” refer to factors outside the domain of public health and health care, which are covered in Chapter 4.
As discussed above, the terms “upstream” and “downstream” are often used to denote relative positions of a given health determinant on plausible causal chains. Upstream factors are closer to the fundamental cause and often farther (“distal”) from the observed health outcome; downstream
the role of answer is chapter 4 ka matter
