23/09/2017

عنوان

Review of Literature on Structural ...
 

Abstract

Background and object: during recent years social determinants of health had been the most complex subject on the domain of health policy. The social determinants of health.

Are social condition that people live and work and they affect the personal health, community health and social health and even the health pattern? The main object of this study is to review the studies witch related to the status of four structural social determinants of health including income, gender, education and ethnicity during 1379-1385 in Iran and the documentation of the result of these studies are according world health organization model.

Material and methods: In this descriptive study (review), studies had been searched with 28 keywords and those 124392 titles were collected. After passing several stages of screening, information of 267 researches in 3 category of physical health, sociomental health and both of them were classified and described in this research. R. M, Excel & Spss software were used.

Results: The majority of studies were article (165 studies). 63.7 percent of studies were published by the University Medical Science and 12.7 % by non-medical universities. Related studies mostly was performed in 1385 (23.2%) and the lowest documents were for 1381 (8.6%). The type of more studies was cross-sectional (53.6%) and most of them had been done in cities or urban areas (60.3%). The sampling method of 41.9% was probable and 21.3% was census. 66.2% of studies were on general population and 34.5% were on inpatient or out patient. 39% of peoples who had been studied were adults and 21% were children, 38.4 were children and adults. 21.7% studies were on women and 74.5% were for both gender. 47.2% of studies were about physical health and 22.8% were about sociomental health. 160 studies had gender determinant, 149 studies had education determinant, 98 document income determinant and 15 documents were about ethnicity determinant.

In the class of gender and health in childhood, the difference between two genders about weight and height of newborn, infant mortality, low birth weight and malnutrition was observed, but in dental caries, impaired vision and hearing, the deference was not significant, about women the life expectancy index was more, quality of life was low and there was more malnutrition but in men the death was more about driving accidents. The incidence of infarction in men was more, but women referred to treatment centers later and the risk of early death after stroke was higher in them. The result of studies about difference between two genders in risk factors of cardiovascular disease, hypertension, infectious and parasites disease, respiratory and eye were not similar. About mental health, mental disease and disorders also the result of studies were not similar but suicide attempting in woman was more reported.

In the income determinant almost all the studies showed the more frequency in health problems is in the groups with lower income and it showed significant relation between income and health status. Showed inverse relation between household income and food consumption pattern and / or household calories consumption also, significant relation between income status and malnutrition and obesity, type of delivery / unwanted pregnancy, space between pregnancies , delivery at the appropriate place and BMI index of pregnancy women , life style related to osteoporosis ,skull youth index, health behavior, understanding the concept of health and control of health , weight of child, neonatal mortality and rate of dmf was observed .Digestive disease and malnutrition was more in groups with lower income .In the studies of mental health and income also the frequency of symptoms and mental disorders in low income groups and significant relationship between mental health and income was observed. The frequency of attempted suicide in low income groups was higher and the relationship was significant.

In education determinant class , almost all educational interventions were effective .About literacy and reproductive health , the result of studies showed that with increasing in maternal education , the chance of postpartum care ,appropriate place for delivery , delivery with the help of appropriate person , the number of care during pregnancy , caesarian and using forceps and desire to breastfeeding increased and  natural delivery , pregnancy of third child and above ,unwanted pregnancy and pregnancy under 18 years reduced. Also prevalence of LBW neonate of mothers with lower education was higher there is a significant relation between maternal education and child weight. Unwanted pregnancy, time to start secondary meals, maternal nutrition status and cytomegalovirus infection in mothers was observed. Between father education and third child and unwanted pregnancy was also significant relationship. However statistical significant relationship between maternal education and the period of breastfeeding and menopause featured was not found. The result of studies showed inverse statistical significant relationship between level of education (parents) and child malnutrition, overweight and obesity but in elderly the relationship between high education level and obesity was direct and significant. Statistical significant relationship between father education and child obesity was also shown. The result of studies about cardiovascular disease showed that frequency of people with low educational level in death due to acute heart infarction, delay in referring patient to hospital, the higher blood pressure was more and statistical difference was significant. In parasitic infections there was inverse statistical relation between level of education (parents) and hair pediculus, entrobiosis, helicobacter infection, bacterial vaginosis and also prevalence of amebas in high education was less reported. Ascaris infection was common in illiterate people but there was not a significant relationship. The relationship between education level and trauma was significant and reverse therefore penetrating trauma in the lower education and blunt trauma in higher education was more. Results of studies about mental health and education were not similar but the frequency of attempted suicide in the group with lower education was higher.

In ethnicity determinant , there was a little studies and the result were showed the ethnicity difference in weight and height of neonate cloven lips and palate , malformation of neurotic tube in neonate ,diarrhea ,the marriage pattern behavior of reproductive health , health behavior in workers ,hypertension and leishmaniosis.

Conclusion: studies related to structural social determinants of health in the studied period were more descriptive and frequency of some demographic variables mentioned instead of measure of relation and analysis of causality. Also the health difference between two genders, the different income, educational level and different ethnicity observed.

Keywords: Social determinants of health, Gender, Income, Education, Ethnicity 

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