Socio-Economic and Population Health (for

SPH)
Instructional
After CompletingObjectives
this unit the learner is able to:
• Define health
• Describe socio-cultural determinants of health
• Describe economic determinants of health
• Understand and explain how the status of women
determines their health and health of their children
• Explain how place of residence affects health
• Explain the basic concept (definition) of globalization
• Describe direct and indirect human health care costs
Part I: Introduction
Basic concepts of health
• World Health Organization (1948) definition:
• as “Health is a state of complete physical,
mental, social and emotional well-being of
human population and not merely the
absence of disease.
• According to WHO, health is an ability of
human being to lead a “socially and
economically productive life”.
 Socio-economic determinants of health
Part II. Social determinant of health

Socio-cultural factors
1. Culture
A person who is conservative and with a traditional culture may
not attend modern medical care services and visit physicians.
Such traditional culture enforces the society to intensively use
traditional drugs than to go to modern health centers.
Moreover, societies in the traditional cultural settings strongly
attached to the social and economic values of children.
Thus, this dominant traditional culture negatively influences
and affects the health care status of inhabitants mainly
mothers and children.
2. Religion
• Religion is another social factor, which influences the
contraceptive behavior of women. Religion and
intensity of religious feeling appears to influence the
actual contraceptive use and family size. In this case,
contraceptive use, fertility, mortality and the general
health situation of the society vary across different
religious groups due to once religion.
• In addition, it is highly expected that those women who
regularly attend religious church services are less likely
to use contraceptive commodities (items) than those
who do not regularly attend church services. Thus,
religion by itself is a social determinant factor of human
health.
3. Ethnicity
• Ethnicity is one of the major determinant factors of the
way of life. Age group specific logistic regression models of
South Africa show that despite strong state, family
planning program was targeting to the black women.
These women were less likely than non-blacks to practice
modern contraception before and after independence
(population council or studies in family planning, 1994).
• Among the ethnic groups, Chinese women have the
highest proportion of contraceptive use (60 percent),
followed by Indians (54 percent), and the Malaysia (29
percent) (Idris, 1981).
• Thus, this indirectly indicates that the health care status of
the people varies across ethnic groups.
4. Gender difference and role
• When compared with wife’s socio-economic status,
husbands’ socio-economic status (education and work
status) may be important determinant factor influencing i.e.
encourage or discourage women’s contraceptive use.
• In some societies, the husbands views carry more weight
than the wife’s in determining whether contraceptive will be
used.
• According to some studies, women who want no more
children may go on having more additional children
because of their husbands’ desire more children.
• Disapproval of family planning on the part of husbands’
may be a barrier to women’s contraceptive use and thereby
may cause a negative impact on women’s health situation.
• For instance, in Uganda, Demographic and Health
Survey (DHS) report indicates that 19.8 percent of
currently married women reported that their
husbands disapprove the use of family planning
methods, and a great proportion of women had
little family planning communications with their
partners (UDHS, 1995: 68).
• This indicates that the effect of husband’s education
and work status is stronger than that of the wife’s
socio-economic status.
• Thus, such Gender view and role may have a
negative impact on the health care status of
mothers and their children.
 5. Status of women
• Because of gender inequality, the social life and
economic participation of women in the society
(mainly in developing countries) is very low. This is
reflected by the low participation in formal
education and the high illiteracy rate among
females.
• Low status of women is also reflected by their poor
participation in the labour force. Even when they
are employed, most of them perform non-
professional duties.
• In addition, some cultural practices allowed marriage
to take place at earlier ages.
• This is one of the factors that contribute not only to
high fertility but also to high maternal, infant and
child morbidity.
• Unwanted pregnancy is also a serious problem
leading to high maternal morbidity and mortality.
• This is again one of the factors that contribute not
only to high fertility but also to high maternal, infant
and child morbidity.
• Generally, high fertility is usually associated with
high maternal, infant and child mortality rates.
• Short birth intervals, pregnancies under the age of
20 and above 35 are some of the causes for high
maternal, infant and child moralities aggravated
by high prevalence of infectious and
communicable diseases and malnutrition.
• However, when the status of women is better, i.e.
when their educational status, their independent
income level and their decision making power in
the family are better, the general health status of
them will be better.
6. Educational status
• Education and training are the primary opportunity
for improving women’s status. It is the fact that
better educated women have broader knowledge
and higher socio-economic status as well as better
health status than do less educated women.
• Education also expands women’s employment
possibilities and their ability to secure their own
economic resources.
• Thus, educational and training status of women
will be one of the major determinants of health
care status of them and their children.
Part III. Economic factors
7. Unemployment

• Rapid Population Growth causes shortage of

food supply, which challenges adequately
feeding the population.
• In a society with rapid population growth, it is
difficult to create sustainable job opportunities.
• This is because the number of economic
establishments is too few to absorb the large
proportion of the economically active
population.
• E.g. when unemployed population increase:
- Rate of unemployment has increased;
- Carrying capacity of the environment has declined;
- Which creates demand for more resources and thereby
the available resources are highly exploited;
- The land with forest cover has been devastated at an
alarming rate;
- The demand for fuel wood and construction materials
increased with increase in the size and growth of population;
- Air and water pollution has increased;
- Soil erosion and environmental degradation has increased;
- Shortage of transportation and communication provisions
(services) has aggravated.
8. Poverty
Poverty refers to lack, deficiency and scarcity of income
per head in the country.
With poverty, health situation of the community will be
exposed to infectious diseases and nutritional
deficiencies, low level of education, inadequate access
to clean water supply, shortage of sanitary facilities and
poor access to health facilities have contributed to the
poor health status of the society at large.
In general, with the prevalence of poverty:
• The proportion of people who suffer from hunger will
be significantly increase;
• Gender disparity or inequality in primary and
secondary education preferably will increase;
• The quantity and quality of health and educational
facilities or infrastructures will be poor;
• Maternal, infant and child health care situation
declines and thereby their morbidity as well as
mortality rates will significantly increase;
• The prevalence of HIV/ADIS, Malaria and other
diseases will drastically increase;
• Environmental degradation or deterioration will be
aggravated.
 9. Income Inequality
• When we think of the nations or countries of the world,
they are separated by greater income inequality.
Broadly speaking, the world is divided between the two
extremes.
• In the world, there are the rich and the poor.
• There are the hungry and the well fed.
• There are also the sheltered and the homeless.
• For example, take the two different countries of Britain
and Bangladesh.
• In Britain, the average family enjoys a relatively high
standard of living. The average family in this country has
sufficient regular income to get more than the basic needs
such as food, housing and clothing. In addition, the family
can have different kinds of home comforts, furnishings,
electrical goods, leisure time and diverse facilities.
• Essential services such as a clean water supply, sanitation,
energy supply, education, medical care are also common
in Britain as compared to Bangladesh.
• This indicates that a society with greater income level
may have better health care situation as compared to a
society with lower income level.
• Thus, income inequality is one of the economic factors,
which determines health care situation of the community.
10. Assets or wealth
• Assets or wealth means better income per head in a country.
• In a general sense, there is positive association between asset
or wealth or income and the health status of the society.
• For instance, there is:
• Positive relationship between income and life expectancy
• Positive relationship between income and health/nutritional
status
• Positive relationship between income and education
• Positive relationship between income and environment
(quality of housing, clean water supply, etc).
•Another way to look at the relationship between asset or
development and mortality in terms of life expectancy
(average number of years members of a given population are
expected to live).
•According to statistics of 1989, in developing countries with
fewer assets or wealth as a whole, life expectancy at birth was
about 57 years while contrary in developed countries, it was
about 72 years.
•As the table below also indicates, children born in 1980’s in
the poorest countries could expect to live only 53 years on
average, while children born in the same period in the richest
countries were likely to live 75 years on average.
•In general, the relationship between asset or income and
health status of a community is positive.
• For instance, see the table below.
Table 1. Life expectancy at birth by income
group, 1983.
Income group Life expectancy
<$ 300 53
$ 300-500 64
$ 500-1000 55
$1000-2000 64
$ 2000-5000 68
$ > 5000 75

In general tems, the relationship between income and health

situation of a community is positive.
11. Economic growth and development
• There is a big difference between economic
growth and development.
• Economic growth means quantitative change i.e.
increase of existing production.
• However, development means qualitative and
holistic change in which new forms of economic
activities are created.
• Thus, it is agreed that development implies more
than just a rise in real national income.
• In order to measure objectively the degree of
development of a country compared with others, we use
development indicators. These indicators may be
concerned with economic, social and even political
development.
• The concept of development nowadays, refers to the
whole societal change including cultural, social,
(education and health), economic and technological
changes.
• The term development covers all aspects of the economic
and social life or wellbeing of a society
•Development is movement of the whole system upward.
Development generally involves progress in:
- Economic growth
- Reduction of both morbidity and mortality rates
- Better technological change
- Welfare/well-being or change of social services
- Modernization
- flourish of democracy and good governance, etc.
•Thus, simple economic growth may not bring a significant or
positive impact on human health situation, but socio-
economic development brings a significant or positive impact
on human health care status in the given community.
 Part IV. Place of residence
12. Our home

• Internal housing characteristics where we live can

have relevant effects for health outcomes,
especially for children. Housing conditions,
including temperature and humidity can generate
or aggravate respiratory health problems.
Children’s physical health particularly depends on
the characteristics of the home in which they live.
• Health can be adversely affected by poor air and
polluted water supply in our home
13. Neighborhood or locality (Environment)
• Just as conditions with our homes,
neighborhood or locality (environment) has
important implications for our health. Conditions
in the neighborhood or localities surrounding our
homes can have also major health effects. Social
and economic features or characteristics of
neighborhoods (environments) have been linked
with mortality, mental health and general
health status of the surrounding community.
• If physical and social environments in the surrounding
localities is not conducive, it can be obviously hazardous
for human health. They can also severely limit the
choices and resources available to individuals.
• Social and economic conditions in neighborhoods
(environments) can also influence human health by
affecting access to employment opportunities and
public resources including efficient transportation,
efficient health services, good schools, etc.
• Strong ties and trust or reliance among people within
neighborhoods have also been associated with better
health. However, not all neighborhoods (environments)
enjoy these opportunities and resources equally.
• The physical environment where people live
can have relevant impacts on their well-
being, and particularly on health. People are
more likely to be physically active when they
live in neighborhoods (environments) with
better resources for exercise such as parks
and walking or running tracks and so on.
Thus, neighborhood (vicinity or locality) has its
own positive or negative impacts on the
health care status of the given community.
14. Globalization
•“Globalization” refers to interconnectedness of states across
the world in social, cultural, economic and technological and
political aspects.
•In other words, Globalization is social, economic and political
ties among countries of the world.
•Because of globalization, currently health policy of countries is
directed by different technological advances and innovatives.
•Through globalization, health related knowledge and skill,
ideas, technologies as well as innovative can be shared by
countries.
•Therefore, these are the fruits of globalization. Such situations
are important to address solutions of health care related
problems of the community, too.
• However, globalization has its own negative impacts
on health care status of the population in a given
country.
• For instance, due to interconnectedness of
globalization, there is greater international travel and
tourism activity in the world wide. Such greater
international travel and tourism activity causes for
the circulation of different communicable and
sexually transmitted diseases from country to
country.
• E.g. HIV/ADIS, Ebola, Zika virus and other
communicable diseases.
15. Health care cost
• Normally, there are direct and indirect health
care costs.
a) Direct health care costs
• The direct health care costs include:
- expenditures for medical care
- expenditures for drugs
- expenditures for funeral ceremonies, and
- other medical care expenses.
b) Indirect health care costs
• In direct health care costs include:
- lost time due to illness or be out of the role of
productive force due to illness,
- recruitment and training costs to replace sick
workers,
- care of patients and orphans.
• In this connection, if costs are financed out of
saving, then the reduction in investment could lead
to a significant reduction in economic growth in
household and national level at large.
16. Guiding study questions
1. What is health?
2. Describe socio-cultural determinants of health.
3. Describe economic determinants of health.
4. Explain the relationship between socio-economic status
of women and their health care situation.
5. How place of residence affects health?
6. What is the basic concept or definition of
globalization?
7. Describe direct and indirect health care costs.