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Global Perspectives On Social Determinants Of Health

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Question:

Write about the Global Perspectives on Social Determinants of Health.

 

Answer:

The social determinants of health are the social and economic conditions, based on which, people are born, grow, live and work. The distribution of these conditions is not same throughout the population, which influence gaps or differences among groups and individual regarding their health status. These are considered as the health promoting factors in living and working conditions, rather than the risk factors, promoting the risk for disease development or vulnerability to disease. Dev and Venkatanarayana (2011) claimed that distribution of social determinants is shaped by public policies, reflecting the influence of prevailing political principles of those governing jurisdiction. Social determinants of health are related to the globalization and health issues. There are several SDHs, within which “unemployment” would be discussed here along with how it is affecting the health status of selected population.

Unemployment is one of the key social determinants affecting health status of global population. However, the effect is not equal; rather there is a widespread difference among the health effects due to unemployment from communities to communities. Creating new jobs is a vital aspect and it has a significant contribution in country’s economy. Drop in financial market affect the job market, which in turn develops unemployment. For instance, recession is a significant example of economic downturn, creating a vast unemployment. Unemployment rate is measured by the prevalence of unemployment and calculated as the percentage by dividing the unemployed individuals by all individuals in the workforce. Unemployment puts a significant health risk it has been reported that the effect and risk is higher in places where unemployment is widespread. Mitra and Verick (2013) claimed that although other factors are in place, unemployed people and their family have a high risk of premature death and the effects are linked with psychological consequences as well as financial problem  

When people understand that their job is threatened, the insecurity leads to the development of anxiety, beginning of the negative health consequences of unemployment. In this context, to analyze the health effects of unemployment, the population within 22-30 years living in Delhi, India has been selected. India consist of the largest population of youth throughout the world, which include approximately 66 % of population under 35 years , thus, it is the country where the downturn of financial market hits the employment opportunities worst (Mazumdar, 2011). Moreover, the other social determinants also contributes in unemployment in India like poverty, limited access of skill based education, work experience along with other social factors. Delhi is India’s capital, where a sharp rise in unemployment has been seen. In terms of the selected population, Delhi lags behind the national average unemployment rate.

The effects of unemployment created a health risk in this vulnerable population selected in this assignment. In addition to the health risk of unemployed population, the health effects are also present in the family members of the unemployed youth, which is due to the result of insecurity of life. The insecurity of employment is detrimental to health, as it leads to emotional and mental health issues including stress, anxiety and depression. In addition several literatures supported the relation of heart disease with insecurity of unemployment (Sunitha & Gururaj, 2014). Some reports suggested that job quality can also leads to mental or physical health issues. During 19990s, economic changes in the labour market led to many industrialized countries with high rate of job insecurity. The unemployment and job insecurity played the role of chronic stressor, effect of which grew with the length of exposure; increasing sickness absence and health service use.

As the psychological needs, which is the basic needs for survival, according to Maslow’s hierarchy of needs, are not met due to unemployment, unemployed population are at high risk of mental and physical health issues. In a Finland based study, researchers found that people who had been unemployed in previous years, consisted a higher rate of mortality compared to people who never undergone the phase of unemployment. In another study conducted in UK revealed a strong link between increased long-term mortality with unemployment of youth. Schmitz (2011) reported that unemployed people are more likely to consist of poor health habits like drinking alcohol, smoking, lack of socialization, lack of activities with a sedentary lifestyle.

Milner, Pagee and Lamontagne (2014) suggested that insecurity leads to enhanced cholesterol level. A Sweden study revealed that over 24 years old, previously unemployed individuals are related to high rates of suicide, cardiovascular disease, accidents and cancer, indicating unemployment as potentially dangerous life events. Another literature found that followed by 18 years of age, previous unemployment is related to a significant increase in acute myocardial infarction. Moreover, it has been revealed that the longer the employment is, the greater the cumulative risk. Research also suggested that the health risk associated with unemployment is approximately of same magnitude like smoking, diabetes and hypertension. In US, unemployed youth have shown to have a worse physical well being compared to employed adults. Moreover, it has been found that unemployed youth with college degrees have the lowest physical well being (14 %), which is followed by secondary education (27 %) and primary education (28 %) respectively (Viner et al., 2012). Another finding revealed that unemployment is harder to bear, in absence of family support. For instance, in Delhi, India, the majority of Generation program students are living with a number of their family members; only 1 % are living by themselves, whereas 45% lives with 6 or more with their households. Unemployed youth living with their families do not have as much pressure for earning, as faced by unemployed youth living alone; as there are others members, who are earning for them.  In case of selected population, it has been revealed that youth who are previously unemployed are at less risk of fatal consequences compared to youth who have been unemployed upon undergoing unsatisfied employment (Viner et al., 2012).

Mental health and Unemployment

Figure: Mental health and Unemployment

(Source: Butterworth et al., 2012)

Mental issues or psychological issues, which have been significantly affecting unemployed youth’s health, include lack of self-esteem, obsessive compulsive disorder, depression, anxiety, behavioural issues, agitation, impaired thought process an suicidal motives. Further increased depression with prolonged unemployment and lack of primary financial resource leads to physiological issues like loss of appetite, sleep disturbance, loss of sexual interest, weight gain and obesity. It has also been revealed that young people getting more family and peer support have better skills to cope with their psychological and physical symptoms. In addition to these factors, unemployment is also associated with high rate of social isolation and loneliness. Fear of getting bullied or harassed by the same age peers, who are employed, unemployed youth usually have been seen to be isolated, deny meeting family and friends directly or through social network, which in turn affects their psychological well being along with identity crisis. Butterworth et al., (2012) revealed that people who are employed are more likely to contribute towards the healthy society as they have a higher self-esteem.

In addition to the psychological effects, physiological effects related to stress, anxiety and depression include cardiovascular issues, myocardial infarction and hypertension, high blood sugar, high cholesterol, sleep disturbance, and AIDS. The life style changes related to unemployment, which affects health significantly, include increased smoking, alcohol consumption as well as drug abuse. These in turn increase the health risk of lung cancer, liver and kidney damage and HIV/AIDS. For instance, unemployment during 1990 to 1992 due to recession, the rate of schizophrenia increased significantly, 88 % in 1990 to 96% in 1996 (Mazumdar, 2011). Studies have also shown that long term unemployment in one hand promote the suicidal behaviour and on other hand it promotes youth violence and criminal behaviour, which are also the results of frustration and depression. Finally, ILO has warned of a ‘scarred generation’ and social instability resulting from long term youth unemployment in India.

If the problem related to unemployment is mitigated, it will promote the development of the country. With 1.20 billion populations, unemployment rate is significantly increasing. To cope with the health effects of unemployment as an SDH, it is important to mitigate the unemployment issue, which in turn would be able to lower the risk of health issues related to this SDH (Schmitz, 2011). To mitigate the health issues related to unemployment in Indian youth, government should set three mandatory goals including prevention of unemployment and job insecurity, to reduce the hardship suffered by the unemployed population and to restore people to secure jobs.

One of the key causes of unemployment in India is less industrialization and increasing population. Thus, the initial step government should undertake is motivating citizens to have small families. The second reason that should be addressed is enhancing the quality of education provided in the public schools for creating a skilled labour force. A committee can be selected to look after the adequacy of the education system. The education system should include skill based studies according to the current requirement of the industries. More training based study should be empowered in universities (Mitra & Verick, 2013). On the other hand, it has been revealed that there is a significant gap within the employment status of rural and urban population, in case of selected population. Thus, government should encourage and develop agriculture based industries in rural areas to mitigate unemployed issues in the rural areas. Most importantly a rapid industrialization is required, which can be supported with more investment in industrialization and providing the foreign companies the opportunity to the market and exploring the huge labour force in the country. Corruption is another significant cause of unemployment in India, for which a strict system should be employed, which would ensure the elimination of corruption, thereby enhancing the scope of employment.

Government should engage more staffs in campaigns and spreading awareness related to the strategies to cope with unemployment. For instance, occupational health sector and career counselling can help to cope with stress and other psychological effects of unemployment. In the rural areas, unemployed p=youth should get more access to the heath care services. Counselling can have a significant impact upon motivating unemployed people to modify their negative health behaviour (Schmitz, 2011). In case of NGOs, they should engage collectively in policy advocacy on youth employment for more training and enhanced industrialization to mitigate the issues.

According to World Health Organization, the unequal distribution of health affecting experiences is resulting from the toxic combination of poor social policies, unfair economic and political arrangements; rather than a natural phenomenon. In this context, unemployment has significant negative health consequences upon the young generation, which should be mitigated as soon as possible to make India as a healthy and developing country. 

 

Reference List

Butterworth, P., Leach, L. S., Pirkis, J., & Kelaher, M. (2012). Poor mental health influences risk and duration of unemployment: a prospective study. Social psychiatry and psychiatric epidemiology, 47(6), 1013-1021.

Dev, S. M., & Venkatanarayana, M. (2011). Youth employment and unemployment in India. Indira Gandhi Institute of Development Research, Mumbay.

Mazumdar, I. (2011). Gender dimensions: employment trends in India, 1993-94 to 2009-10.

Milner, A., Page, A., & Lamontagne, A. D. (2014). Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review. Psychological medicine, 44(05), 909-917.

Mitra, A., & Verick, S. (2013). Youth employment and unemployment: an Indian perspective. ILO.

Schmitz, H. (2011). Why are the unemployed in worse health? The causal effect of unemployment on health. Labour Economics, 18(1), 71-78.

Sunitha, S., & Gururaj, G. (2014). Health behaviours & problems among young people in India: Cause for concern & call for action. Indian journal of medical research, 140(2), 185.

Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. The lancet, 379(9826), 1641-1652.

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