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  <head>
    <title>103-01 Social determinants, inequality, inequity, and population health</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Social determinants and population health">
      <outline text="Determinants and definitions">
        <outline text="Biology interacts with living conditions"/>
        <outline text="Income, education, housing, work, food, transport"/>
        <outline text="Environment, connection, law, discrimination, power"/>
        <outline text="Shape exposure, stress, detection, treatment, recovery"/>
        <outline text="Clinic sees bodies, population health sees distribution"/>
        <outline text="Inequality: any measurable difference"/>
        <outline text="Inequity: avoidable and unjust difference">
          <outline text="Adds a normative claim to make explicit"/>
        </outline>
        <outline text="Equality: same resources"/>
        <outline text="Equity: allocate by need and barriers"/>
      </outline>
      <outline text="Social gradient">
        <outline text="Health improves at each socioeconomic step"/>
        <outline text="Material resources: nutrition, shelter, access"/>
        <outline text="Relative position: autonomy, status, chronic stress"/>
        <outline text="Lifestyle framing mistakes mechanism">
          <outline text="Demands behaviour the environment makes costly"/>
        </outline>
      </outline>
      <outline text="Education and employment">
        <outline text="Education shapes literacy, income, navigation"/>
        <outline text="Health affects education: bidirectionality"/>
        <outline text="Schooling years vary in quality"/>
        <outline text="Attainment may reflect several pathways"/>
        <outline text="Work gives income, identity, structure"/>
        <outline text="Precarious, hazardous, low-control work harms"/>
        <outline text="Leaving dangerous work may improve health"/>
        <outline text="Task, schedule, control matter, not job title"/>
      </outline>
      <outline text="Housing, neighbourhood, food, transport">
        <outline text="Housing: damp, mould, crowding, sleep"/>
        <outline text="Instability disrupts medicines and follow-up"/>
        <outline text="Homelessness is not one uniform state"/>
        <outline text="Ask where people live before advising">
          <outline text="Otherwise a correct plan may be impossible"/>
        </outline>
        <outline text="Neighbourhoods distribute exposures and services"/>
        <outline text="Segregation concentrates advantage and disadvantage"/>
        <outline text="Individual adjustment can remove the pathway"/>
        <outline text="Food insecurity: restriction alternating with availability"/>
        <outline text="Advice assuming money and facilities adds shame"/>
        <outline text="Structural food interventions beyond education"/>
        <outline text="Transport barriers cause missed care"/>
        <outline text="Improvements can displace low-income residents">
          <outline text="Evaluate distribution with average benefit"/>
        </outline>
      </outline>
      <outline text="Connection and discrimination">
        <outline text="Isolation: objective lack of contact"/>
        <outline text="Loneliness: perceived mismatch in connection"/>
        <outline text="Illness causes and results from isolation"/>
        <outline text="Match intervention to the barrier"/>
        <outline text="Discrimination: interpersonal, institutional, structural"/>
        <outline text="Alters access and stress physiology"/>
        <outline text="Racism not a biological property of groups">
          <outline text="Biological effects via unequal treatment, exposure"/>
        </outline>
        <outline text="Race categories cannot replace genotype or experience"/>
        <outline text="Intersectionality: systems combine, not add"/>
        <outline text="Group averages are not individual destiny"/>
      </outline>
      <outline text="Life course and commercial determinants">
        <outline text="Exposures accumulate, cluster, act in sensitive periods"/>
        <outline text="Cumulative disadvantage reduces reserve"/>
        <outline text="Chains of risk, interrupted by protection"/>
        <outline text="History changes probability, not inevitability"/>
        <outline text="Corporate products, practices, political activity"/>
        <outline text="Choice occurs in engineered environments"/>
        <outline text="Regulation changes defaults at scale">
          <outline text="Anticipate substitution, illicit markets, adaptation"/>
        </outline>
      </outline>
      <outline text="Access and inverse care">
        <outline text="Availability, geography, cost, acceptability, quality"/>
        <outline text="Entitlement does not guarantee timely care"/>
        <outline text="Language, hours, digital exclusion, fear"/>
        <outline text="Volume without continuity does not improve outcomes"/>
        <outline text="Unmet need includes the uncounted"/>
        <outline text="Inverse care: least care where need greatest"/>
        <outline text="Equal appointment length can be inequitable"/>
        <outline text="Proportionate universalism scales to disadvantage"/>
      </outline>
      <outline text="Population strategies and data">
        <outline text="High-risk strategy: large benefit, few people">
          <outline text="Depends on detection and engagement"/>
        </outline>
        <outline text="Population strategy shifts whole distribution">
          <outline text="Widens inequality if advantaged adopt first"/>
        </outline>
        <outline text="Combine universal change with targeted support"/>
        <outline text="Absolute and relative gaps can diverge"/>
        <outline text="Missing equity data rarely random"/>
        <outline text="Averages can hide minority decline"/>
      </outline>
      <outline text="Acting on determinants">
        <outline text="Causal candidates, not therapeutic pessimism"/>
        <outline text="Clinicians: barriers, adaptation, connection, advocacy"/>
        <outline text="Policy acts upstream"/>
        <outline text="Neither level substitutes for the other"/>
      </outline>
    </outline>
  </body>
</opml>
