Welcome to Module 4 Course 2, Social Determinants of Health for Families of Young Children. My name is Wendy Looman, and I'm a professor in the School of Nursing at the University of Minnesota. This module has three parts, with an overview of how social determinants affect the health of young children. A case study to examine how social determinants influence a family's ability to promote child health. And some policy based strategies for improving outcomes for families of young children. Be sure to review the module information and read the assigned articles for a broader understanding of this content. In Part 1, we'll explore how systems thinking can help us understand the influence of social determinants on the health of young children. You may recall from an earlier course in this specialization that systems thinking can help us understand influences on health at multiple levels. Systems thinking forces us to consider context by asking, what is this a part of in order to see how things fit into larger holes? One example of this is the notion that a child is part of a family and a family is part of a community which is nested in the broader socio-political context, and all of these systems are part of the whole planet. In this module, we'll be using systems thinking to explore how social determinants are relevant to child health. Recall that according to the World Health Organization, social determinants are defined as the conditions in which we are born, grow up, work, and live. This is true for adults and children. Children experience many socioeconomic circumstances that come from their parents, the household in the neighborhood in which they live. One way to visualize the social determinants for children is through the Rainbow Model, which is described in the article by Pearce and colleagues. The Rainbow Model is just another way of viewing the child as part of a nested system. In the rainbow model, social determinants of help are depicted as concentric layers of influence around the child. These factors are interrelated and they all contribute to health and health outcomes. While there are certain fixed characteristics at the child level, such as age, sex, and ethnicity, the characteristics in each of the layers around the child are largely modifiable. The innermost layer around the child includes the determinants that are most proximal to individual health, such as child health behaviors and parenting interactions. In the next layer is the health and behaviors of the parents and caregivers themselves. Caregivers such as grandparents or other family members might also be included in this layer of influence. At the household level, there are influences such as housing quality and employment. The influences at the household level are also include the structure of the family and the roles and relationships of members in the family. The next are community and social networks. Characteristics such as the walk ability of the neighborhood, social connections, and services that are available in the local area around the family's household. Beyond the community level are what are considered structural influences. These include living and working conditions, and the macro level political, cultural, and commercial and economic conditions. These structural conditions influence the child directly and indirectly through the family. For example, childcare and schools influence the child directly. Whereas workplace policies around parental leave and flexibility for absences are conditions that influence the child's health indirectly through the family. It's important to understand that the social determinants of health are socially distributed. As Pearce and colleagues note, there are a number of pathways through which a child's and family's social circumstances influence the child's health, leading to health inequalities. It is the unequal distribution of the social determinants of health that leads to health inequalities, the pathways through which this happens, our behavioral material, psychosocial, and structural. Material living conditions are one pathway through which a family circumstances influence health. These conditions include food, clothing, and characteristics of the physical home environment, such as home size and access to gardens and clean air. All of these factors are extremely important for health, and when there is material hardship, a family has less control over these conditions. The psychosocial pathway is another way that a family's circumstances lead to health inequalities. Some of these circumstances include feelings of lack of control due to inequalities, and stressors related to living in a socially disadvantaged circumstance. Parent behaviours such as feeding and child rearing practices have important direct consequences on child health. This actually tends to be our first instinct as a place to intervene to influence child health. But it's important to not place too much emphasis on the behavioral pathway in isolation because it has been criticized as being too simplistic. Research shows that parent behaviours alone are not sufficient to account for health inequities between the rich and the poor. Many of these behaviors are structurally determined and influenced by the psychosocial and material pathways and the wider social determinants. This is one example of the importance of systems thinking. Recall that systems thinking requires us to make distinctions, understand parts and holes, and to recognize that multiple interacting systems and relationships influence health. As a systems thinker, you can recognize that simply asking parents to make good food choices for their child is not enough to fix health inequalities, especially when there are structural material and psychosocial factors at play. Structural determinants of health are depicted in the outer layers of the Rainbow model. These structures influence the control and distribution of resources and services. Intervening at this level by addressing the structural forces behind the unequal distribution of resources is thought to be the most effective way to eradicate health inequities. Here are some key points to remember about how social determinants affect the health of young children. Children experience many socioeconomic circumstances that come from their parents, the household, and the neighborhood in which they live. Social determinants contribute to the health and health outcomes for families and children, and many of these circumstances are modifiable. Structural conditions such as neighborhood factors, schools, and workplace policies are important as they influence the child directly and indirectly through the family. Finally, the most effective way to address health inequities for families with young children is through addressing the structural forces behind the unequal distribution of resources. As you think about families that you may work with, consider how each of these areas might represent social determinants of a family's ability to raise a healthy child. Thinking about the notion of transforming data to action, what data elements can you identify for each of these areas?