Socioeconomic determinants

Kawachi, I. and Kennedy B. P. (1997), Socioeconomic determinants of health Health and social cohesion why care about income inequality , British Medical Journal, 314, 1037 -1040. Kawachi, I., Kennedy, B. P., Lochner, K. and Prothrow-Stith, D. (1997), Social capital, income inequality, and mortality , American Journal of Public Health, 87, 1491 -1498. 

Wilkinson, R. G. (1997), Socioeconomic determinants of health Health inequalities relative of absolute material standards , British Medical Journal, 314, 591-595. 

An important consideration is due to certain factors which have been identified in the causation of these disorders and which are often neglected by commentators, namely the socioeconomic determinants of chronic respiratory disorders (AO, 42, 43). Differences of large magnitude underscore much higher mortality for the lower soclo-economical classes, in respect to better economy groups, in men and women. Morbidity figures are similarly affected, with disproportlonal frequencies encountered... 

The degree to which the authors appear to accept racially and socioeconomically determined opportunity structures, both fortunate and not, is hardly reassuring if we are seeking to maximize opportunity for all Americans. 

The results regarding socioeconomic gradients undermines the hypothesis that the principal social class influence on health is material deprivation. In fact, the social class gradient in health cuts deeply into the affluent middle classes. The implication is that the conditions under which people live can affect human health directly, and not only through material deprivation. Early childhood experience, one s place in the social environment, and the experiences of daily life must be powerful determinants of the length and healthfulness of life (Kelly et al., 1997, p. 438). 

In sum, Wilkinson focuses his explanatory hypothesis on social anxiety. He links social anxiety to shame, depression and violence, and emphasizes that social anxiety has its roots in perceptions of inferiority, unattractiveness, failure or rejection. This helps explain why health is so closely related to lack of friends, low social status, violence and poor early emotional attachment, all of which are associated with similar patterns of raised basal cortisol levels and attenuated responses to experimental stressors. He concludes, therefore, that social anxiety is a very plausible central source of the chronic anxiety that depresses health standards and feeds into the socioeconomic gradient in health. As he puts it, the most important psychosocial determinant of population health is the levels of the various forms of social anxiety in the population, and these in turn are determined by income distribution, early childhood and social networks (Wilkinson, 1999, p. 60). Thus, social anxiety is suggested as an explanation for the links between health and friendship, health and early emotional development, health and the direct psychosocial effects of low social status, the patterning of violence and health in relation to inequality, and health and social cohesion (Wilkinson, 1999, p. 61). 

Martikainen, P. T., and M. G. Marmot. Socioeconomic differences in weight gain and determinants and consequences of coronary risk factors. American Journal of Clinical Nutrition 69(4)( 1999) 719-726. 

Recently we published data that even in countries with excellent food sources and availability, insufficient vitamin A supply will occur (Schulz et ah, 2007). The aim of this trial was to analyze vitamin A and p-carotene status and investigate the contribution of nutrition to vitamin A and p-carotene supply in mother-infant pairs of multiparous births or births within short birth rates. Twenty-nine volimteers aged between 21 and 36 years were evaluated for 48 hours after delivery. In order to establish overall supply, retinol and p-carotene were determined in maternal plasma, cord blood, and colostrum via HPLC analysis. A food frequency protocol was obtained from all participants. Regardless of the high-to-moderate socioeconomic background, 27.6% of participants showed plasma retinol levels below 1.4 pmol/liter, which can be taken as borderline deficiency. In addition, 46.4% showed retinol intake <66% of RDA and 50.0% did not consume liver at all, although liver contributes as a main source for preformed retinol. Despite a high total carotenoid intake of 6.9 3.9mg/day, 20.7% of mothers showed plasma levels <0.5 pmol/liter p-carotene. 

Multiple factors determine patterns of tobacco use among racial and ethnic minority groups in the United States socioeconomic status, cultural characteristics, degree of assimilation into American culture, stress, biological elements, targeted advertising, price of tobacco products, and the varying capacity of communities to mount effective tobacco control initiatives. 

Although developmental age is a critical element in determining children s activity patterns, other factors, such as geography, climate, culture, socioeconomic status, sex, season of the year, and areas (i.e. urban versus rural), can also have an important impact on activities and exposure. Thus, there is a need for caution when data about activity patterns generated in one region are used to estimate exposures in another region. 

Lopez-Carrillo L, Torres-Sanchez L, Garrido F, Papaqui-Hernandez J, Palazuelos-Rendon E, Lopez-Cervantes M (1996) Prevalence and determinants of lead intoxication in Mexican children of low socioeconomic status. Environ Health Perspect, 104(11) 1208-1211. 

Article 56). Articles containing an Annex XIV substance may be imported to the EU without authorisation.16 Authorisation is to be granted by the Commission on a case-by-case basis for a specified period and under conditions subject to review, if the risks to health and the environment arising from the listed intrinsic properties of a substance are adequately controlled (Article 60, as defined in Annex I). However, the adequate control route is closed for a SVHC that has the properties PBT or vPvB or that is a CMR for which a threshold cannot be determined (Article 60). For such substances, or when control is not adequate, authorisation requires that socioeconomic benefits outweigh risks and that there are no substitutes available (Article 64). These aspects must be considered by a Committee for Risk Assessment and a Committee for Socioeconomic Analysis before the Commission can take a decision on an application, which must include a socio-economic analysis according to Annex XVI. 

They emphasized the social determinants of disease - the health consequences of poverty, stress, and the social isolation created by artificial hierarchies based on race, income, wealth, and class - combined with poor nutrition, insufficient recreational opportunities, inadequate health care, and exposure to toxicants. They thus broke down the barrier -which had been created in the original National Environmental Policy Act of 1969 - between environmental issues and socioeconomic issues. 

Several risk factors determine the toxic outcome of in utero alcohol exposure. Risk factors suggested include genetic predisposition, marital status, smoking, use of prescribed or over-the-counter drugs and medications, concomitant usage of other drugs of abuse, occupational or environmental exposure to chemicals, socioeconomic status, and adequate nutrition. 

Hsiao and Salmon reported that patients beliefs about the benefits of diabetes therapy are important in determining whether they obtain and use medication. In general, the more severe the patient s disease and the greater the perceived susceptibility to complications, the more likely the patient is to be adherent. Patients must be convinced of the seriousness of their disease and empowered to monitor themselves for diabetic complications. Patients with diabetes who were at high risk for nonadherence included older people, men, and those with low socioeconomic status. 

Forastiere F, Agabiti N, Corbo GM, et al Socioeconomic status, number of siblings, and respiratory infections in early life as determinants of atopy in children. Epidemiology 1997 8 566-570. von Mutius E, llli S, Hirsch T, et al Frequency of infections and risk of asthma, atopy and airway hyperresponsiveness in children. Eur Respir J 1999 14 4-11. 

---