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Introduction
According to Mikkonen, and Raphael (2010), the main factors that shape and determine the health status of people in Canada are not lifestyles or medical interventions, but the living conditions of individuals and groups of people across the country. These factors are the social determinants of health.
The Canadian policy documents developed by the national government have focused on these factors since mid-1970s (Mikkonen & Raphael, 2010). The contributions to the improvement of the social determinants of health has been extensive, making the country achieve the title “health promotion powerhouse” (Mikkonen & Raphael, 2010).
Nevertheless, the impact of the social determinants of health on the health status of Canadians remains strong. Diseases affecting the modern communities, especially those related to lifestyle, are good examples of the effect the determinants of health can have on the lives of people. Stroke is a key example of these diseases. In this paper, the social determinists of health are discussed as they relate to stroke in minority societies such as the Canadian Aborigines, women, people of colour and the immigrants.
Identification of the health issue/disease: Stroke
Stroke is a disease that affects and interferes with brain functioning (Bornstein, 2009). It occurs when blood cannot flow to a section of a person’s brain. Blood transports vital nutrients, which nourish the brain. Consequently, a certain part of the body will not function well, depending on the part of the brain that is damaged. For example, a person may feel numbness of the hand if the part of the brain that controls the hand is damaged (Bornstein, 2009). This disease is abrupt and the impacts on the body are instant.
Stressful circumstances in life have been linked to increased risk of getting a stroke. Stressful circumstances may be caused by having to deal with issues of low income, social exclusion, and frustrations of not advancing in education. Continuous stress causes responses that exhaust the body. Studies show that chronic stress weakens the immune system. Therefore the body is prone to diseases such as cardiovascular diseases (Louis, 2009).
Income
Income is a significant factor that influences the quality of health. Some Research has claimed that state of health rises with the level of income. The income earned determines the living standards, influences psychological functions, and affects health issues such as food quality and physical exercise (Wilkinson & Marmot, 2003).
Equal income distribution has demonstrated to be the best predictor of a healthy nation (Wilkinson & Marmot, 2003). Income is particularly crucial in countries that give few vital services and benefits to its citizens. According to Wilkinson and Marmot (2003), people living in wealthy environs live longer, but people living in poorer environs have low life span.
Statistics indicate that people from minority ethnic groups in the US have high chances of developing the condition, especially due to the low levels of income associated with certain ethnic groups. In particular, the American Indians, the Hispanics and the blacks are likely to develop stroke compared to other groups.
According to (), Alaska is one of the states with the highest prevalence of stroke in the country. The Alaskan natives have the highest prevalence of the disease, with more than 2,300 deaths per annum. Statistics indicate that Alaska has the highest prevalence of death due to stroke, with more than 2,340 cases reported per year.
It is followed by South Dakota (1780 cases) North Dakota (1650 cases) Michigan (1300 cases) and California (1130 cases). Poverty and low income are major aspects that contribute to the increased rates of stroke among the American Indians. Statistics indicate that more than 36% of those who die of heart attack are people aged above 65 and living in poverty or from low income families.
People with high income worry less because they have enough money to pay bills, take their children to good schools, and participate in cultural and social activities. Social activities are good for health because they promote self-esteem and reduce amount of stress.
The health consequences begin when people feel that their income cannot meet their daily needs and those of their family. The anxiety created is harmful to health because it is linked to chronic diseases such as stroke (Davidson, 2014). Feeling of anxiety triggers negative emotions in the body.
Education
Education is a key aspect that influences health. People who are more educated are healthier than those who are less educated (Mikkonen & Raphael, 2010). There are various reasons that explain the relationship between education and quality of health.
Finally, education improves knowledge and understanding of issues that affects one health and the actions needed to be taken to promote a healthy lifestyle (Mikkonen & Raphael, 2010).With advanced education, individuals acquire refined skills that help them assess how certain behaviors are helpful or damaging to their health. They acquire better skills and new resources to achieve healthier lifestyles.
However, it is crucial to know that lack of education is not the main issue leading to health problems (Wilkinson & Marmot, 2003). The way that education affects a nation’s population depends on public policies. For example, if provision of medical services was made affordable to everyone and there was enough income, then effects of education to health would be reduced.
Social exclusion
Social exclusion portrays biased relations among people in society, which leads to differences in accessing financial, political, and educational facilities. People more likely to experience social exclusion include the disabled, people of a different race, and women (Davidson, 2014).
Social exclusion increases the chances of stroke
The level of employment is continuously being formed along racial backgrounds with low-income jobs being taken by the excluded group in the country (Mikkonen & Raphael, 2010).
Social exclusion is due to the increasing cases of job instability and that these unstable jobs are being taken by the socially excluded. Statistics indicate that socially excluded people are at a higher risk of developing diseases such as the Aborigines have a 32% probability of developing stroke compared to the Caucasoid groups that have less than 22% risk of developing the same condition.
Social exclusion forms countless educational and societal problems. It further creates helplessness and hopelessness among its victims. As a result, the likelihood of inclusion in a community becomes minimal (Davidson, 2014). The impact of social exclusion to health is great. Research has shown that the excluded persons in the society are prone to stroke (Bornstein, 2009).
How do income, social exclusion and education interact to influence stroke?
People who are socially excluded have limited access to health and social services and ways of advancing their education. Most of these secluded people have no jobs or earn less income. These groups have less impact on decisions passed by the government.
Socially excluded people such as immigrants are denied participation in civil issues. As a result, they are restricted from practicing their professions because of these laws and policies. Limiting social resources such as education, shelter, and health services are widespread among the socially excluded groups (Wilkinson & Marmot, 2003).
In addition, they lack access to communal and cultural activities. This is because they lack enough finances to facilitate these activities. One reason is that education allows people to climb the career ladder therefore getting better access to financial resources. Therefore, with good financial resources they can fulfill their financial obligations and accumulate wealth. As a result, chances of diseases caused by stressful conditions such as stroke are highly reduced.
In most cases, multiple social health determinants interact with each other to produce significant and complex influences on the health status of individuals. In people suffering from or prone to get stroke, multiple social determinants of health interact to yield a common influence on the health of the patient or patient groups. In particular, the level of education, income and social exclusion are important factors that interact to determine the health status of stroke patients (Wilkinson & Marmot, 2003).
First, social exclusion in Canada is defined by the denial of the opportunity to participate in the active public life Davidson, A. (2014). In Canada, the Aborigines, people of colour, recently immigrated people, women and individuals with disabilities are likely to experience social exclusion for a number of reasons Davidson, A. (2014).
For example, immigrants are unable to participate in the cultural and social activities of the Canadian life because they do not have the appropriate papers to reside in the country, language barriers and the feeling of being foreign (Davidson, A. (2014). Therefore, they are denied the opportunity to obtain decent employment (Wilkinson & Marmot, 2003).
In this way, they are denied the opportunity to obtain the appropriate education and awareness about stroke, the management of the disease as well as the appropriate methods of mitigating the risks to the development and progress of the disease. Since the opportunities for obtaining a decent income are limited, the individuals’ access to healthcare and health information regarding the management of stroke is limited. This means that this group of people is unable to obtain health education as well as general education about stroke, stroke management and mitigation of risks associated with the development of the condition.
Davidson, A. (2014) has shown that the immigrants and other minority groups at higher risks of developing stroke than other groups, including the risk of developing stroke (Wilkinson & Marmot, 2003). In addition, poor information and education about disease management is caused by poor access to healthcare and healthcare facilities, which is a product of poverty and poor income.
The Canadian Aborigines, immigrants, people of colour and other minority ethnic groups form another major group that indicates evidence of the interaction between the level of income, social exclusion and level of education and the impact of this interaction on the development of stroke (Davidson, 2014). It has been shown that blacks have a significantly higher likelihood (34%) of developing cardiac problems than the Caucasoid group (22%) (Wilkinson & Marmot, 2003).
In particular, their level of income and opportunities of employment are relatively low (Wilkinson & Marmot, 2003). This means that the access to quality healthcare and healthcare information regarding stroke is limited. In addition, the level of general and healthcare education has been linked to higher risks of development and inappropriate management of stroke. Aborigines, immigrants and the people of colour have a relatively low level of income and limited access to healthcare information and education about diseases, which means that the prevalence of stroke is relatively high.
Moreover, the low-income groups, especially the Aborigines, immigrants and the people of colour, tend to be socially isolated from participating in the social development, which increase the limitations of earning a decent income as well as access to better healthcare. For instance, studies have shown that more than 46% of Aboriginal families live under the poverty line due to low income contributed by poor education levels (Wilkinson & Marmot, 2003).
A Prevention strategy to address these issues
One of the most important methods of reducing the impact of low income, poor health education and social exclusion on personal health in regards to stroke is to ensure effective access of information as well as near-universal healthcare services. Healthcare services, especially for the management of serious conditions such as stroke, should be easily accessible to all groups (Wilkinson & Marmot, 2003). The provision of healthcare and relevant information about stress should not be based on the level of income.
Rather, healthcare insurance should be made accessible to every group of people, regardless of the immigration or citizenship statuses. In addition, the role of nurses within the communities should be enhanced in order to ensure that nurses interact with people within their neighbourhoods and educate them about the need to mitigate the risks of developing stroke as well as the appropriate lifestyles and methods of managing the condition (Spence, 2006).
In addition, nurses should be involved in providing home-based care for the affected individuals, especially the elderly. In this way, it is possible to reduce the limitations of access to healthcare and information about stroke management that are caused by low income, poverty, social exclusion and low level of health education.
Conclusion
Social determinants of health play a significant role in the development of stroke. This study shows that a strong link exists between the occurrence of stroke and a number of socioeconomic issues. First, it indicates that the level of education determines the level of knowledge about stroke and lifestyle. Low level of education means little knowledge and a high probability of stroke. Secondly, it indicates that low income is a product of low level of education.
Societies with low level of education tend to have low levels of income. Low income levels mean poor lifestyles, a major factor that contributes to stroke. Socially isolated communities such as the Aborigines show a high likelihood of stroke. They tend to be excluded from participating in socioeconomic activities, which increases the poverty levels and poor education status. Thus, they are likely to develop stroke.
References
Bornstein, N. (2009). Stroke: Practical Guide for Clinicians. London: Karger Medical and Scientific Publishers.
Davidson, A. (2014). Social Determinants of Health: A Comparative Approach. UK: Oxford University Press.
Louis, R. (2009). Caplan’s Stroke: A Clinical Approach. UK: Caplan Elsevier Health Sciences.
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian facts. Toronto: York University School of Healthy Policy and Management.
Spence, D. (2006). How to Prevent Your Stroke. Tennessee: Vanderbilt University Press.
Wilkinson, R., & Marmot, M. (2003). Social determinants of health: The solid facts Denmark: WHO Library Cataloguing in Publishing Data.
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