Introduction
Studies carried out by different people and institutions in different countries have for a long time determined that prevailing social circumstances have an influence on peoples’ health. These social determinants may either be found at an individual level, group or community level, depending on a person’s lifestyle. Most governments and other stakeholders have thus engaged in serious research programs to determine the exact social issues that influence human health, how these issues lead to health problems and how they can be overcome. in order to minimize their negative impact on people’s health.
Different policies have also been put forth to mitigate the effects of these social issues on peoples’ health to ensure that they remain in considerably good health conditions. When people are not in good health status, they are not productive and this affects the general development of their groups, communities and institutions, and as a result the general development of their countries. Most stakeholders have found it better to deal with the underlying social causes of health problems before they fully culminate into health problems as it has been found to be easier to prevent the health problems, as opposed to curing them when they are at an already advanced stage. It is important to note that these social issues do not discriminate on countries depending on their resource endowment but affect all countries, whether they are already developed or developing.
Health is in many cases considered as a human right to every individual whose provision creates social equity on the part of all the people as it is availed to everyone in the society despite their social status or economic position. But in a majority of countries, people pay for their health services meaning that the provision of these services is not equitable as only those who can afford the services have them at their discretion (Barkaway, 2009, p. 90-91).
Social Determinants of Health
According to Raphael (2004, p. 1), Social Determinants of Health refer to those social and economic circumstances that impact individuals and communities in general health. They determine whether people fall sick and to what extent they do so, or whether they remain in good health. These social factors also establish whether or not an individual is well enough to accomplish what he is meant to accomplish in terms of his aspirations, personal and societal needs. Some of the most common social determinants of health include education, social exclusion, housing, employment, social gradient, stress, early life and work among others. Over the years, many countries have witnessed disparities in the health status of different people either within or outside the countries in question. These differences were largely attributed to the disparities that exist in the conditions within which different people live which in turn affected the peoples’ ability to lead lives characterized by healthy living conditions. These disparities were found to be either unjust meaning that they were possible to avoid, or they were unavoidable since they were natural occurring phenomena or biological occurrences (World Regional Office, 2008, p. 12).
The understanding of the social determinants of health can be enhanced by looking at the determinants as an issue that affects the whole society as opposed to a single individual and his/her genetic or biological makeup. Thereby the social determinants of health look at changes that occur in the society and the policies that have been put into place either by the government or other stakeholders to combat these issues, which include differences in the general income levels of individuals and the levels of poverty and or wealth in the society. This social approach follows a different path compared to that taken by the biological and physiological factors model which suggests that health problems occurring in people are a result of their physical and biological makeup as well as the behaviors of individuals (Barkway, 2008, p. 88).
In this paper, I will focus on stress as a social determinant of health and show the different factors that lead to stress among people and come up with recommendations that can be used to counter the health problems associated with stress. This is because there has been a consistent increase in the number of people having to be treated for stress related illnesses in the recent past and as such something needs to be done to counter this rise and return it to manageable levels as well as to prevent further complications from occurring thereby saving different countries funds in terms of health care costs from preventable diseases.
Stress as a Social Determinant of Health
Stress is the resultant problem caused by the failure of human beings to act in response to different threats that have been leveled against them either physically or emotionally. Stress is not necessarily a problem as it can work both ways depending on a person’s ability to handle it. This means that if a person can be able to handle the demand brought upon him by specific factors and make good out of the situation, then the stress can be said to be positive. But if the person cannot handle such demands and they end up bringing him or her problems, then stress is said to be negative (Fontana, 1989, p. 3). According to Wilkinson & Marmot (2003, p. 12), circumstances that result in stressful conditions for people lead to worry and anxiety thereby making them unable to deal with the issues at hand thereby harming them as far as their health is concerned.
Stress has been identified as one of the Social Determinants of Health, and it can be caused by either social or psychological factors. These factors include work-related issues, low self-esteem, anxiety, problems at home as well as insecurity. These kinds of issues are in most cases associated with people from lower levels of the social hierarchy but have also been found to occur among people on the higher hierarchies. It is the biological process behind the stress that leads to health problems such as high blood pressure, depression, diabetes, stroke and heart attacks (Wilkinson & Marmot, 2003, p. 13). This happens when psychological and social issues occur over a prolonged period of time. When a person is faced with either a physical or emotional threat, the nervous system together with the body hormones react in such a way as to both cause the person to flee or stay on and fight the issue causing the problem. This results in increased heart rates which release stored energy redirecting one’s blood into the muscles, thereby increasing the level of alertness in the person. When such energy is redirected elsewhere, it means that it is not used in the areas it was supposed to be used before which are necessary to maintain good health in humans thereby leading to health problems in the individual due to the impact on his or her immune and cardiovascular systems (Wilkinson & Marmot, 2003, p. 13).
According to Raphael (2004, p. 6), the British Working group which was given the mandate of coming up with social factors which determined peoples’ health are the ones who came up with stress as being a determinant of peoples’ health. Stress as outlined before can be caused by a number of issues which are as follows:
Work Related Issues
Work related stress occurs when employees are required to meet demands that are at times out of their reach because they do not match with their abilities, skills or knowledge. These demands may be quantitative, physical, psychological or emotional depending on the job and as such employees are unable to cope with them leading to health problems which are associated with some of the diseases mentioned above. Most of the demands associated with workplaces are as a result of the rising requirements associated with dynamism due to the global influences in the workplaces (European Foundation for the Improvement of Living and Working Conditions, 2007, p. 2).
Low Self Esteem
This refers to the level of worth a person attaches to him or herself and encompasses both emotional factors as well as one’s beliefs. People with low self esteem, therefore, see themselves as of little worth and do not believe they are good enough. This in most cases results in continued stress which in turn leads to health-related issues.
Anxiety
Anxiety in most cases results from extreme worry and fear about different issues related to one’s life such as shortage of money, families, health, work and school. Continued anxiety consumes individuals so much so that they can no longer function normally in their daily duties, whether individual or social duties. Such anxiety is detrimental to peoples’ health as it leads to stress which in turn leads to health problems.
Insecurity
Insecurity is a situation characterised by feelings of nervousness and general unease leading to lack of confidence on oneself. An insecure person in most cases thinks that the prevailing positive situation is temporary and will soon come to and end thereby portraying him as a failure in the eyes of other people. It comes about as a result of one perceiving him/herself as being worthless and inadequate.
Home and Family Related Issues
These are those issues that a family undergoes in their day-to-day lives. They are determined by factors such as the level of income the family earns collectively, the types of jobs family members hold, the behaviour of different family members among other things.
All these psychological and emotional factors mentioned above end up causing stress which in turn causes health problems. These factors are in most cases associated with one prevailing social circumstances, especially if they are negative. But they can be overcome in order to improve peoples’ lives and also minimize and completely eliminate their negative impact on peoples’ health.
Stress is also known to lead to unhealthy behaviors which also result in various health problems as mentioned earlier.
Stress and Human Behavior
Human behaviour culminates into two types of health-related behaviors, which are either positive behaviours as well as risky behaviours. Risky health behaviors in most cases result in diseases or injuries on the part of people while the positive health behaviors in most cases include those actions taken by people to prevent diseases and at the same time enhance one’s health (Fink, 2000, p. 322). Though not all risky health behaviors are associated with stress, in most cases stress plays a major role in facilitating such risky behaviors. Some of them may include drinking alcohol, taking drugs and smoking cigarettes.
As a social determinant of health, stress plays a major role in the diseases that occur among people and therefore it is necessary that all the stakeholders involved come up with ways of minimizing the causes of stress in order to reduce the health problems associated with it as well as the level of vulnerability it causes for the individuals thereby making them susceptible to various diseases. In order to counter the stress associated problems, governments and other stakeholders such as schools, organisations, places of work and other institutions from the health sector have come up with various policies outlined as follows:
Peoples’ Living Conditions
It is true to say that peoples’ living conditions affect a lot of things such as their behaviour, the levels of insecurity they have, anxiety levels as well as their self esteem. If people are from places characterized by poor living conditions, then it is more than obvious that their self-esteem will be negatively affected, their feelings of insecurity heightened among other things (World Health Organisation Commission on Social Determinants of Health, 2008. p. 2). This is most likely to lead to increased stress levels on their part and as such make them vulnerable to certain stress-related illnesses. As such, their living conditions should be made bearable, not only in their homes but also in their place of work. For example in their places of work, employees should be given work that is in line with their skills, knowledge and abilities to reduce their chances of becoming stressed and thereby getting health complications. At school, students and other members of staff should be given work up to the extent which they can handle so that they have time to engage in other activities that will help reduce their levels of anxiety and insecurity, while at the same time enhancing their self esteem in order to encourage positive health behaviour.
Distribution of Resources
Most country’s resources are not equitably distributed and as such those who enjoy the majority of such resources are those from the higher hierarchy levels (World Health Organisation Commission on Social Determinants of Health, 2008. p. 2). As such, those who are left to suffer are those from the lower social hierarchies. Such suffering when continued for a long time results in the factors that cause stress and as such make the people of society vulnerable to stress-related complications and in turn to health problems. To ensure that this does not happen, those charged with ensuring a country’s or regions resources are distributed in a manner depicting equity should do so and reduce the disparities between the wealthy and the poor thereby enabling them to provide for themselves and as such reduce cases of insecurity, anxiety and self-esteem among others meaning that they will be able to avoid stress and as such health complications.
Measuring and Understanding the Problem
Most countries and major stakeholders more often that not deny the existence of problems such as inequity and disparities among different members of the society and even when they acknowledge these issues exist, little is done to mitigate them(World Health Organisation Commission on Social Determinants of Health, 2008. p. 2). As such, those who are on the losing end of such situations end up experiencing continued levels of stress leading to health complications such as high blood pressure and diabetes. Governments and other stakeholders should therefore acknowledge the existence of such problems and take the necessary action to get rid of them and thereby restore a situation that allows for equity on the part of the community and as such minimize the stress and the problems associated with it. This can be done by carrying out major research, analyzing key findings of the area and as such coming up with solutions that will encourage positive health behaviors.
Home and Family Related Issues
People develop stress as a result of issues associated with their families as well as their individual issues. For example, if they are not able to provide fully for their families and as such this makes them vulnerable to stress-related health complications. It is up to stakeholders in different fields associated with the improvement of peoples’ lives to ensure that this happens so as to reduce the negativities they cause on people and in effect their health. Stress can also lead to the worsening of already existing medical conditions and as such should be avoided at all costs.
Community Empowerment
According to Laverack, community empowerment involves making those who are poor more powerful so that they can be able to fend for themselves as opposed to relying on others to provide for them all the time (2004, p. 12). Community empowerment can be done by providing members of communities with relevant information regarding how they can live their lives without the pressures associated with stress and how they can handle stressful situations as well as to encourage them to practice positive health-related behavior so as to prevent themselves from contracting stress-related diseases. Community empowerment can either be s way through which set goals can be achieved while at the same time, empowering members of communities may be the objective itself. It is important to note that different people take health to mean different things and as such those seeking to empower communities should make clear to the people what they mean by health and how the policies they are suggesting will help reduce peoples’ stress levels and in effect improve their general health.
Such community empowerment should involve members of the communities in question so as to help them feel like they are part of the process as this will give them a sense of belonging makes them easily embrace the process of healthy living by avoiding stressful behaviors, situations and activities (Laverack, 2004, p. 12).
Government Programs
Of all the stakeholders, the government of any country should play the most major role in ensuring the social welfare of its people is maintained at high levels and in effect the health of the people is made a priority. The government can do this by coming up with programs that address social, economic and psychological factors which are the main causes of stress because when left unattended they lead to insecurity and anxiety, stress and eventually health complications. These programs should seek to encourage members of different target communities to further their education and skills, encourage the communities participation in different development projects, minimize financial and economic disparities among the people in order to reduce financial insecurity, rehabilitate different members of the community and as such encourage them to engage in different coping mechanisms that will help them avoid stress (Wilkinson & Marmot, 2003, p. 13).
These policies and others if implemented to the letter will work in favor of the people in that they will help prevent those factors that lead to stress from taking their toll on individuals and also communities and as such the health issues related to stress. It is however important to note that in some cases it is not possible to completely avoid stress and as such people should be equipped with ways in which to deal with stress so as to avoid it from leading to mental and cardiovascular related diseases.
According to Barraclough & Gardener (2008, p. 13), policy creation and implementation as a process of eliminating stress and its related complications should be taken seriously as this process will determine whether or not the policies will work ant o accomplish the goals which they were set out to accomplish in the first place. The policy makers should thus take several factors into consideration, such as whether they are directly related to the problem at hand and whether they recommend the best possible solution to the problem at hand.
Conclusion
From the information gathered above it is fair to conclude that stress forms a major determinant of health. If stress levels are not managed properly then there is a greater chance of people contracting stress-related diseases. A lot has been invested in research to show how stress impacts the health of people and how other social factors also impact peoples’ health. The findings should thus be relayed to the people so that this information can act as a guideline for them so that they may know how to protect themselves from those issues that are likely to undermine their health.
The government compared to all other stakeholders has the largest role to play in terms of ensuring that the disparities and inequalities found in their respective countries are kept at their lowest levels so that one portion of the population is not left to suffer at the expense of the other. Once these disparities are eliminated or minimized, people will not live their lives under constant worry, insecurity, anxiety and fear and as such their stress levels will also be kept at a minimum meaning that diseases such as heart attacks, stroke, diabetes, aggression, high blood pressure and depression among others will be maintained at controllable levels. This will mean that resources used in treating such diseases will go down and individuals and societies at large will be able to work efficiently and effectively thereby leading to the general development of nations.
Reference List
Barkway, P. (2009). Psychology for Health Professionals. Australia: Elsevier Publishers.
Barraclough, S. & Gardener, H. (2008). Analyzing Health Policy: A Problem-Oriented Approach. Australia: Elsevier Publishers.
European Foundation for the Improvement of Living and Working Conditions. (2007). “Work-Related Stress”. Web.
Fink, G. (2000). Encyclopedia of Stress. Volume 2. London: Academic Press.
Fontana, D. (1989). Managing Stress. London: Routledge Publishers.
Laverack, G. (2004). Health Promotion Practice: Power and Empowerment. London: Sage Publications.
Raphael, D. (2004). Social Determinants of Health: Canadian Perspectives. Ontario: Canadian Scholars’ Press Inc.
Wilkinson, R., & Marmot, M. (2003). Social Determinants of Health: The Solid Facts. 2nd Edition. Denmark: World Health Organisation.
World Health Organisation Commission on Social Determinants of Health. (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Denmark: World Health Organisation.
World Regional Office for the Eastern Medi. (2008). Social Determinants of Health in Countries in Conflict: A Perspective from the Eastern Mediterranean. Eastern Mediterranean: World Health Organisation.