OBJECTIVES: This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. OBSERVATIONS: Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. CONCLUSION: Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use. Language: en

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Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration.

https://www.isr.umich.edu/williams/All%20Publications/DRW%20pubs%202000/social%20inequalities,%20stressors,%20and%20self%20reported%20health%20status.pdf

Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area.

with a Few Basic Principles There is no single definition of health promotion, notwithstanding the World Health Organization's (WHO) attempt to describe it as "the process of enabling people to increase control over and to improve their health."1 For some, health promotion remains wedded to disease prevention. For others, it is about the "big stuff' of unhealthy social practices and conditions such as poverty, pollution and power inequalities. There is abundant evidence of both sets of practices, and some consensus on basic practice principles. Baum2,3 identified a number of these, based upon the Ottawa Charter.

Population health and health promotion: what do they have to say to each other?

A spatial analysis of the determinants of pneumonia and influenza hospitalizations in Ontario (1992-2001)

The difficult economic times that Cuba has had to face have taken a considerable toll on its urban ecosystems, with data suggesting that indicators of health, the environment, and social services have been deteriorating. This has been particularly evident in Centro Habana, a municipality with the highest population density in the country. More than half the population was without daily access to potable water, waste disposal was insufficient, overcrowding was serious, disease vectors were prevalent, and rates of various infectious as well as noncommunicable diseases and injuries were highest in the country. To improve the situation, the municipality requested help from the National Institute for Hygiene Epidemiology and Microbiology (INHEM) to determine the best use of scarce resources to improve health. INHEM performed an ecological descriptive study and conducted focus groups in five communities to assess perceptions of health, social, and environmental factors, followed by a household survey. INHEM then engaged collaborators at the University of Manitoba to assist in developing a framework, analyzing the data, and planning and undertaking the evaluation requested. Maximum likelihood factor analysis was used to reduce the dimensionality of the data. The perception data were then merged with the ecological level health and environmental data to ascertain the relationship between these two data sources and determine which indicators might be useful for an intervention analysis. The perception results indicated that the greatest community concern was quality of housing, but that the risk perception results were independent of ecological data on morbidity, mortality, and basic sanitation indicators. Based on this conclusion, it was decided to use a combined qualitative and quantitative approach to evaluate actual and potential interventions, using the driving force-pressure-state-exposure-effects-action (DPSEEA) framework. It was also decided to adopt an ecosystem approach that fully involves the community in developing a set of ecosystem human health indicators. Data from repeat focus groups and household surveys are planned, with these data to again be integrated with ecological data including environmental, socioeconomic, and health outcome information, using a pre- versus postintervention with concurrent control design. Our findings in this first phase indicated that an ecosystem framework is invaluable in ascertaining determinants of health and prioritizing and evaluating interventions to improve the health of communities.

R. G. Evans

Papers

8. The Determinants of a Population's Health: What Can Be Done to Improve a Democratic Nation's Health Status?