澳大利亚公共卫生英语课程作业辅导-A Global Perspective on the Social Determin

澳大利亚公共卫生英语课程作业辅导-A Global Perspective on the Social Determinants of Health

 

 

The WHO (World Health Organization) and UNICEF (United Nations International Children’s Emergency Fund) conducted a total of seven related meetings after two and a half years of preparation and planning, trying to seek the way of improving international health care. On September 6-12, 1978, delegates from 134 countries and 67 delegates of the specialized agencies and non-governmental organizations which had officially contacted to the WHO and UNICEF came to Alma-Ata, the capital of the former Soviet Republic of Kazakhstan (the Republic of Kazakhstan now) and participated in the international conference on primary health care.WHO（世界卫生组织）和联合国儿童基金会（联合国国际儿童紧急基金）共进行了7个相关会议，经过2年半的准备和规划，努力寻求改善国际卫生保健的方式。于1978年9月6-12日，来自134个国家和67个专门机构和非政府组织的代表，代表已正式接触世界卫生组织和联合国儿童基金会来到阿拉木图，前苏联哈萨克斯坦共和国（在资本现在哈萨克斯坦共和国​​）和参与初级卫生保健的国际会议。

 

 

The purposes of this conference are:

First, promoting all countries’ understanding of the primary health care. Second, communicating the experience of the development of primary health care and exchanging information. Third, valuating health status and health care all over the world and its relationship with the primary health care, and exploring an approach to improve health conditions through a primary health care. Forth, it tries to identify the principles of primary health care and the methods of operations. Fifth, the conference means to determine the significant roles of the governments, governmental organizations and international organizations in the cooperation of health technology and the support of primary health care. Last, it aims to putting forward relevant Suggestions on primary health care.

 

 

At the opening ceremony, Dr. Houghdan Mahler, the director-general of the WHO, put forward eight content of primary health care to delegates. After full discussion, the assembly gradually presented a brand new way for most representatives which was designed, practiced and had been yielded positive results in some developing countries. Primary health care shows a great prospect to improve the people's health level.

 

 

Under the joint efforts of the delegates, Dr Mahler and Mr. La Bois, the director of UNICEF executive committee jointly drafted a meeting document as long as 49 pages titled "primary health care", which was the outline of the Declaration of Alma-Ata. The document was further abbreviated and amended into the Declaration with only 1000 words and ten clauses were listed in it in accordance with the terms of the treaty form. At the closing ceremony, a representative from Sierra Leone announced the Declaration of Alma-Ata. And with the unanimous agreement of all delegates and their warm applause, a file was born which symbolized the milestone in the history of international health development. Moreover, Alma-Ata made clear the concept of primary health care and it is explicitly pointed out in the Declaration of Alma-Ata that primary health care is the key and the basic way of achieving the goal of "health for all in 2000". 马勒博士和香格里拉布瓦先生，联合国儿童基金会执行委员会主任与会代表的共同努力下，共同起草了一份会议文件，只要49页题为“初级卫生保健”，这是“阿拉木图宣言”的轮廓。文件进一步简化和修改成只有1000字，10个条款，按照条约形式的条款被列入“宣言”。在闭幕式上，来自塞拉利昂的代表宣布了“阿拉木图宣言”。并与所有与会代表的一致同意和他们热烈的掌声中，诞生了一个文件，这标志着在国际卫生发展的历史里程碑。此外，阿拉木图明确初级卫生保健的概念，并明确指出在“阿拉木图宣言”，初级卫生保健是关键，所有在2000年实现这一目标的“健康”的基本途径。

 

 

The Declaration of Alma-Ata illustrates the necessity for all governments and health-care workers to take measures to guarantee and improve all people’s health. Important aspects about health are involved in these ten terms. In this declaration, Health is regarded as “a most important world-wide social goal” which needs the joint efforts of social and economic sectors as well as health sector. Besides, it points out the health inequality, government’s responsibility for health, the importance of economic and social development and people’s rights and duty for health care. Most importantly, it explains the content of primary health care, which is “essential health care”, and identifies its key points and important aspects.

 

However, in fact, according to the WHO (2007), the world health agenda is anything but easy to be achieved for there are many obstacles coming in its way. 

 

 

First of all, the negative influence of economic and social development upon health. We all know that with the economic and social development, the health care can be promoted, our medical conditions be improved and the better health care services provided. Moreover, people can live longer with a lower rate of death. Meanwhile, as people say, economy is a double-edged sword. The economic and social development can exert negative influence upon health. For one thing, the development of economy would necessarily accelerate the pace of industrialization. People are setting up a number of plants which can cause environmental pollution and increase the latent risks of people’s illness. For example, the plants for papermaking, printing and dyeing, electroplating and building materials are those which do serious harm to our environment and our health. At any cost the one-sided pursuit of economic development, people abuse the natural resources such as air, water, land, forest which have caused serious damages. And environmental pollution has brought damage to the national health. In 2007, the number of new liver cancer patients has increased to 667000 worldwide. 

 

 

For another, Relative to the environmental pollution, economic development has had adverse influence on the health by changing people's life style, the impact of which is more concealed and more likely to be overlooked. People’s life standard has rose with the development of social economy and the working conditions are considerably improved (they can complete all work sitting in front of the computer all day).  People’s life style has changed a lot, causing excess nutrients and exercising less, which are further degraded into modern civilized diseases such as obesity, high blood pressure, diabetes, etc. Take China for an example. The rising level of economic development has led to the increase of people's living standard, which has changed the way of people's diet structure and behavior, made a growth of the overweight and obese population. At the same time, the population of high blood pressure, blood fat, high cholesterol, and high blood sugar increased, resulting in a series of the increase of chronic diseases. Meat and fat consumption of residents in China increased significantly. And the growth of that of rural residents is also significantly faster than the urban. According to Fang et al. (2010), from 1982 to 2002, China's urban residents per capita consumption of meat a day increased by 69% (from 62 to 62 grams). At the same time, rural residents' consumption has increased by two times (from 23 to 69 grams). The growth rate is almost three times that of the city. During the same period, China's urban residents per capita daily fat intake increased by 25% (from 68 to 68 grams). And daily fat intake per capita of rural residents has increased by 69% (from 40 to 73 grams). And the growth rate was close to the three times of the city. The high ratio of fat in residents’ calorie sources is directly connected with many chronic diseases. 

 

 

What’s more, people’s bad behaviors have increased with the social and economic development, such as gambling, drug use and virtuous sexual behavior, etc. with the high pace of work in the modern society, people are having more complex social network and they need to deal with much more incidents than they do before. Thus people get pressured mentally. With the improvement of the economic development, competitive pressures and work greatly speed up the pace of life and the social and living risks also increased. Due to the cost of living rises ceaselessly and the income increase slowly, residents are working under significantly higher labor intensity and more pressure. Especially in the developing countries, the working conditions are not quickly improved with a low level of health care and security, the medical conditions are still not positive. Most of low-income workers are still having hard lives struck with sharp polarization of income distribution. Under the influence of these factors, sub-health population increased significantly and all sorts of mental health problems also begin to increase numerously. Take America for an example. It is reported that there are about 30% of Americans are suffering from illness. And due to bad sexual behavior, there are over 40,000 Americans who are infected with HIV virus each year.#p#分页标题#e#

On the contrary, in the underdeveloped areas, the life expectancy is much lower than that in the developed areas. It is the same case in terms of the national population growth rate. And the death rate is much higher. There is a large gap in health status of people between the developed areas and the underdeveloped areas. Such a gap exists between different countries as well as between different areas in the same country for their differentiated economic development.  

 

 

According to the definition of health given by the WHO, the health not only refers to the absence of disease, it also includes the complete state of physical, psychological and social adaptation ability. Personal health status can be regarded as a certain point in the three- dimensional space composed of physiology, psychology and society. Everyone occupies a certain position in the three dimensional space. Thus the unequal health system is shaped by the health status of different social individual. Health inequality means that there exists a systematic differentiated health level among the individual or group the different social and economic status. For some scholars, the disadvantaged groups such as the poor, minorities and women groups may suffer more health risks and social inequality than other social groups. In essence, health inequality is a form of social inequality.

　　　

 

The social rank is another key factor which has affected the health and impeded the process of health for all. Earlier in the study of social stratification in the 1980s, scholars pay more attention to the aspects such as the inequality of economy, culture and social capital. (Solar & Irwin, 2007) The health inequality is involved in very few researches. In 1977, the British Department of Health and Social Security Ministry set up the health inequality research committee specializing in the research of health differences between groups of different social and economic status. The commission in 1980 issued a "health inequality research report", pointing out that the British upper class group was significantly lower than the lower social group in terms of morbidity and mortality. This report aroused widespread controversy since published and it also broke the fairytale of the biomedicine. Biomedical technology can’t eliminate health inequalities. On the contrary, it widened the social health inequalities between the upper and lower class. Then some studies in the other European countries and the United States also found a similar trend. So health, as the core issue of the biomedical research, is concerned by social science researchers, especially social stratification researchers. And gradually cross-disciplinary biomedical and social sciences are built up, such as social medicine, medical sociology, etc.

 

 

Social rank is the most decisive factor which affects one's health and life expectancy. According to the data from the related studies of the WHO, Health status, health behavior, the accessibility of health services and health services utilization are closely related with the social and economic status, such as education, income and occupation, and have obvious statistical significance.

 

 

As the basis of social stratification factor, the occupational status determines the risk factors, work pressure related to occupation and the income level which are exposed to different groups. Different occupations have influence on the health and risk factors of different groups, accessibility of medical services and the health of the residents. Besides, the close connection between occupation and health also lies in whether people can get enough income to sustain their own health. Else, residents’ income and the accessibility of health and medical services are closely related. The factor affecting health is not only a low-income itself; what’s more important is the unfairness of income distribution in a community. (Karlsson et al., 2009) The negative impact of low-income on health is embodied in: the body function, lack of good living conditions, psychological effects and behavioral effects. Meanwhile, education everyone in the society to accept is closely related with its social and economic status. Education is the basic building blocks of the social status which influences the health. Higher education can reduce a lot of unhealthy or dangerous risks. And the health benefit of education is not limited to a certain age which can be expanded through the entire life period. 

 

 

Different healthy social policy carried out between developed countries and developing countries lead to the health inequality between them. Inequality in health is broadly defined as socially-patterned variability in indicators of health status such as disease, disability, and mortality. (Lindsay & Kenneth, 2012) Due to the different economic power and social system, the healthy system built up in developed countries and developing countries are totally different. Among the developing countries, the healthy system in British, German and America are commonly regarded as very complete and advanced system. Take the health system in German for instance. Germany is the world's first country to implement the social security system equipped with relatively developed and perfect insurance system. In terms of health insurance, the German health insurance is composed of the statutory health insurance and private insurance. Citizens have rights to choose between the statutory health insurance and private health insurance considering how much they can earn after taking jobs.

Therefore, we can see that the insurance premium paid by the German statutory health insurance policy-holder mainly depends on their income, while they are enjoying the same medical insurance service regardless of how much they have paid. This is their social medical insurance that they are pride of. That is, "high income to help low income, the rich help the poor and fairness is embodied in mutual help". And it’s a different case in the developing countries. The same health system mode can’t be built up in these countries for its rather laggard economic and social development. However, there are still some developing countries building up their perfect medical system such as Mexico, Brazil and Thailand. But due to the limits of economic development, many developing countries don’t build up proper medical system just right for their national conditions for some good reasons. First, they are lack of the support from their government and capitals. Else, they are poor in building up the system of management and supervision.

 

 

Different food safety standards in different countries lead to some misunderstanding of food safety which is a key factor of health. (Trienekens & Zuurbier, 2008) The supposed safe food in this country may be harmful for people in another country for they have different food traditions. As the old saying put it, disease enters by the mouth. We can see that the food safety is very important for health. However, the food safety standards are so different from country to country, people are often confused whether the food they eat is safe or not. 

 

 

In conclusion, three important factors of health including economic development, social ranks and different health system are thoroughly illustrated in this paper. They are all playing significant roles in causing the health inequality among different groups, especially between the developing countries and developed countries. Else, the different food safety standards which caused people’s confusion about food are simply pointed out. And they all have some influence upon the individual health and the health of different groups more or less, thereby obstructing the goal of “Health for All” which should be paid more attention to.

 

 

 

References

Fang, Pengqian; Dong, Siping; Xiao, Jingjing; Liu, Chaojie; Wang, Yiping, (2010), Regional inequality in health and its determinants: Evidence from China. Healthy Policy. No.1, pp 14-25

Henson, Spencer; Humphrey, John, (2009), The Impacts of Private Food Safety Standards on the Food Chain and on Public Standard-Setting Processes. Joint FAO/WHO food standards programme. No.32.

Karlsson, Martin; Nilsson, Therese; Lyttkens, Carl Hampus; Leeson, George, 2009, Income Inequality andhttp://www.ukassignment.org/ Health: Importance of a Cross-Country Perspective. Publications of Darmstadt Technical University, Institute of Economics.

Lindsay A. Rinaldo, Kenneth F. Ferraro, (2012), Inequality, health. Wiley-Blackwell Encyclopedia of Globalization.

Solar O, Irwin A. (2007), A Conceptual Framework for Action on the Social Determinants of Health. Discussion paper for CSDH. Geneva, WHO.

Trienekens, Jacques; Zuurbier, Peter, (2008), Quality and safety standards in the food industry, developments and challenges. International Journal of Production Economics. No.113, pp107-122.

World Health Organization, (2007), Achieving Health Equity: form root causes to fair outcomes. The Interim Statement of the Commission on Social Determinants of Health. Geneva: WHO.