patient journey: structural inequalities in health

• Social structures are the policies, economic systems and other institutions (judicial system, schools, work hours, transportation, housing, childcare, etc.) that have produced and maintain modern social inequities as well as health disparities, often along the lines of social categories such as race, class, gender and sexuality.
• Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way … The arrangements are structural because they are embedded in the political and economic organisation of our social world; they are violent because they cause injury to people.
• Structural vulnerability is the risk that an individual experiences as a result of structural violence - including their location in multiple socioeconomic hierarchies. Structural vulnerability is not caused by, nor can it be repaired solely by, individual agency or behaviours. 
• Naturalising inequality refers to the process when inequality and structural violence are justified by, or go unacknowledged due to, nonstructural explanations for structurally mediated harms/inequities. These nonstructural explanations - which often emphasise individual behaviours, “cultural” characteristics or biologised racial categories - help preserve social inequities by giving the impression that the status quo is “natural”, in the sense of not being primarily social or structural in origin.
• Discuss how environmental and occupational factors contribute to health and disease (part 1)

  1. Air Quality: Poor air quality, due to pollutants (particulate matter, nitrogen dioxide, sulfur dioxide, ozone) lead to respiratory diseases (asthma, COPD, cardiovascular). Long-term exposure linked to lung cancer and premature death.
  2. Water Quality: Contaminated sources harbor pathogens and toxins causing diseases (cholera, dysentery). Chemical pollutants lead to long-term health problems like cancer and neurological disorders.
• Discuss how environmental and occupational factors contribute to health and disease

  1. Climate Change: impacts environmental factors like temperature, precipitation patterns, extreme weather events, exacerbate spread of infectious diseases, alter distribution of vector-borne diseases (malaria, dengue fever).
• Discuss how environmental and occupational factors contribute to health and disease.

  1. Occupational Hazards: hazardous substances - chemicals, asbestos, silica, heavy metals - risk of occupational diseases (occupational asthma, dermatitis, pneumoconiosis, cancers). Unsafe working conditions, ergonomic stressors, psychological factors -> work-related injuries and mental health disorders.
• Discuss how environmental and occupational factors contribute to health and disease.


  Occupational Hazards: Workers exposed to hazardous substances, such as chemicals, asbestos, silica, and heavy metals, are at risk of developing occupational diseases like occupational asthma, dermatitis, pneumoconiosis, and certain cancers. Unsafe working conditions, ergonomic stressors, and psychological factors can also contribute to work-related injuries and mental health disorders.
• Discuss how environmental and occupational factors contribute to health and disease.

  1. Noise Pollution : Prolonged exposure to high levels of noise, whether in occupational settings (e.g., factories, construction sites) or urban environments (e.g., traffic noise), can lead to hearing loss, sleep disturbances, cardiovascular problems, and increased stress levels.
• Discuss how environmental and occupational factors contribute to health and disease.Radiation Exposure: Occupational exposure to ionizing radiation, such as in nuclear power plants or medical facilities, can increase the risk of cancer, genetic mutations, and other adverse health effects. Non-ionizing radiation from sources like UV rays and electromagnetic fields also poses health risks, including skin cancer and electromagnetic hypersensitivity.
• Discuss how environmental and occupational factors contribute to health and disease.

  
  

  Built Environment: Urban planning and design can influence physical activity levels, access to healthy foods, and exposure to environmental hazards. Poorly designed neighborhoods with limited green spaces, inadequate infrastructure for walking and cycling, and high levels of pollution can contribute to obesity, cardiovascular diseases, and respiratory ailments.
• Discuss how environmental and occupational factors contribute to health and disease.

  Vector-Borne Diseases: Environmental factors like temperature, humidity, and rainfall influence the distribution and abundance of disease vectors such as mosquitoes, ticks, and fleas. Changes in these factors due to climate change and habitat destruction can lead to the spread of vector-borne diseases like malaria, Lyme disease, and Zika virus.
• Describe how health behaviours and outcomes are affected by diversity of socioeconomic status.Access to Healthcare: higher SES backgrounds -> better access to healthcare services (preventive care, screenings, treatments). More likely to have health insurance coverage and afford out-of-pocket expenses. In contrast, those from lower SES backgrounds may face barriers such as lack of insurance, transportation issues, and limited availability of healthcare providers, leading to delayed diagnosis and treatment of health conditions.
• Describe how health behaviours and outcomes are affected by diversity of socioeconomic status.

  Health Behaviours : Higher SES engage in healthier behaviours (regular exercise, nutritious diets, abstaining from smoking/excessive alcohol consumption). They have greater access to recreational facilities, healthy food options, information about healthy lifestyle choices. Conversely, individuals from lower SES backgrounds have limited access to healthy foods, safe recreational spaces, health education, -> higher rates of smoking, poor dietary habits, sedentary lifestyles, substance abuse.
• Describe how health behaviours and outcomes are affected by diversity of socioeconomic status.

  Stress and Mental Health: Socioeconomic disparities contribute to differences in stress levels and mental health outcomes. Lower SES backgrounds often face chronic stressors related to financial strain, unemployment, housing instability, discrimination. Chronic stress -> negatively impact mental health -> depression, anxiety disorders. Moreover, limited access to mental health services and stigma surrounding mental illness further exacerbate disparities in mental health outcomes.
• Describe how health behaviours and outcomes are affected by diversity of socioeconomic status.

  Environmental Exposures: SES influences exposure to environmental hazards such as air and water pollution, lead contamination, and hazardous working conditions. Individuals from lower SES backgrounds are more likely to reside in neighborhoods with poor environmental quality, including proximity to industrial sites, traffic congestion, and inadequate sanitation. These environmental exposures increase the risk of respiratory diseases, cardiovascular problems, and other adverse health outcomes.
• Describe how health behaviours and outcomes are affected by diversity of socioeconomic status.

  Nutritional Status: Socioeconomic disparities affect nutritional status and food security. Higher SES individuals -> access to fresh, nutritious foods, afford a diverse and rich diet. In contrast, individuals from lower SES backgrounds may rely on low-cost, energy-dense foods that are high in sugar, fat, and sodium. Limited access to healthy foods contributes to higher rates of obesity, malnutrition, and diet-related chronic diseases such as diabetes and cardiovascular disease.