Social and Behavioral Determinants of Health
Reflective Journal Resources
The following web page provides some useful hints and directions:
What is a reflective journal?
A number of courses in Public Health include a reflective journal as one of the assignment
tasks. The reflective journal provides you with the opportunity to reflect on your studies in
light of the knowledge and/or practical skills that have been gained as a result of your
previous experience. In a reflective journal, the central focus is you, as a student, and your
professional development and thinking as you undertake the course. The primary aim of
the journal is to encourage you to engage in active learning from study and experiences,
through critical self-reflection. To quote the above reference, reflective writing �helps you
to develop and clarify connections between what you already know and what you are
learning, between theory and practice and between what you are doing and why you are
doing it. Its purpose is for you to enhance learning through writing and thinking.
There are a number of ways that you might keep a journal and present the reflective
journal assignment. For example, you could keep a regular (e.g. weekly) journal
maintained for a period of time during the course, or you could keep an intensive (over
several weeks) journal with entries made on a daily basis.
Bearing in mind the word limit (1500), you are required:
- to submit the key points of your reflective journal;
- your analysis of these; and
- your reflections on how the journal writing experience has contributed to your
professional awareness and understanding of social and behavioural determinants of
This encourages a process you may use throughout your career in which you consciously
learn from your reflections on your professional experience.
What am I being asked to do?
By drawing on the lectures, readings and perhaps your own experiences, we want you to
write a short piece where you link the course content to prior knowledge, state what you
found interesting, difficult, or contentious in the lectures or readings, what the information
may have added to your knowledge of the field, or how you will think about your working
You have been asked to select three topics from
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� organisational settings for health,
� social determinants
� (or other topic to be negotiated with the Course Convenor).
Some questions you may want consider could include:
- What did I learn through the lectures and/or course readings?
- What did I find interesting/ Why?
- How has the information added to my knowledge in the field?
- How does what I have learnt connect with prior experience and knowledge, prior
assumptions and preconceptions, what I know from other disciplines?
- How has what I have learned relate to my own life/ working practice?
- What did I find puzzling or unexpected/Why?
- What do I disagree with/Why?
- What do I feel about the way I am approaching this topic area?
- What do I need to know more about?
- What other resources interested or inspired me (visuals etc)
- What questions does this topic raise for me?
Determinants of health are the factors that contribute to a person’s health status. The
factors include socioeconomic, physiological, behavioral, psychological and social. My journal
focuses on three topics namely: Gender, Ethnicity and social determinants as social and
behavioral determinants of health. Gender is the socially defined roles, behaviors, attributes and
activities that are considered appropriate for women and men in different societies (WHO, nd).
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Ethnicity is where a group of people are characterized by the social and cultural traditions they
maintain. Social determinants are complex and overlapping structures that contribute to health
inequities and they include: the social environment, health services, physical environment, and
structural and societal factors (CDC, nd). All these factors play an important role in determining
health and attention should be given to each one of them. Clear policies should be developed to
promote health through these determinants.
The topic on gender was very informative and I got a new perspective on some of the
issues. Men and women suffer from different diseases at different ages (WHO) and they also
experience and respond to health programs and their outcomes differently. As a health
determinant, gender refers to the interrelated dimensions between psychological and biological
differences and social experience. The focus on gendered programs is important because women
suffer more from inequalities. Even though women have biological advantages over men, they
have greater social disadvantages. This means that while women have better health practices,
coping skills and self concept that increases their life expectancy, men have better social,
economic, political and cultural advantages which also cancel out the biological advantage of
women. Past experience has shown that women have a longer life expectancy than men. What I
found interesting about this topic was the role of socioeconomic factors in determining women’s
health. Employment is crucial in determining the health status of women, but so many factors
influence women employment such as age at what women can be employed, family
responsibilities, and their social class, what work they can undertake and under what conditions.
Most women are not employed or work part time and do not earn as much as their male
counterparts in many societies. Fewer women are also found in managerial positions compared
to men. This therefore means that they have less money to cater for their health needs such as
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medical care and insurance and may be more prone to illnesses such as stress. This means that as
a health professional, I should be involved in developing policies that work at improving
women’s health through health promotion programs. Areas of interest include reproductive and
sexual health, mental and emotional health, violence and caring (Kehler, 2004). Women are
prone to mental breakdowns due to stress and depression associated with family roles and
employment. Violence against women is also high in many societies, making the woman
vulnerable. Focus should be on investment in health care systems that cater for women and
especially the most vulnerable women in society. Besides genetic disparities sexual orientation
functionalities, ethos and individual trait controls how men and women; boys and girls have
access to health services. According to the world health organization (WHO) this equally
determines how the healthcare systems react to their demands. My new perspective is that
upstream strategies should be employed in research, policy and practice to address the economic,
cultural and social obstacles that prevent women from achieving their potential. Health
promotion should be taken seriously to reduce health inequalities. I would like to know what
more I can do as a health professional to promote women’s health (Egede, 2006).
Ethnicity was an interesting topic because of the many different ethnic groups in our
societies and the effects on health is a significant problem. Evidence shows that ethnic and racial
minorities tend to receive lower quality care than non minorities (Egede, 2006). Ethnicity has an
influence on health status of a person, with most ethnic minorities being at higher risk of disease
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prevalence and mortality rates. Different ethnic groups have different health needs as some are
more predisposed to certain illnesses than others e.g. Afro-Caribbean’s have higher risk of
developing sickle-cell anemia than white Europeans while Europeans have higher risk of
hemophilia. Most ethnic minorities usually settle in areas where there is poverty, deprivation,
and health and social risks. This means that they have low access to health care, insurance, and
other factors that influence health such education, employment, and social class. They also tend
to get risky jobs where chances of getting injury or falling sick are high.
Culture of an ethnic group plays a role in determining their health status e.g. there is high
prevalence of heart diseases among Indians associated with their use of high amounts of ghee
and fats. An interesting aspect is that Indian women and men chew tobacco and consume beetle
nuts which increase their risk of throat and mouth cancer. Culture can have both negative and
positive influence on health. Discrimination has also been linked to factors contributing to ethnic
disparities in healthcare. This results in minorities not receiving preventative services.
By and large, ethnicity is associated with low socioeconomic status. Socioeconomic
factors influence the rates of morbidity and mortality and are considered hand in hand with
ethnicity. In America, black Americans are more likely to suffer from ill health than whites as
their socio economic class is far apart. Whites have better access to good education, resulting in
good and better paying jobs and better access to health services compared to black Americans.
Influence of ethnicity on health is so great that researches have pointed out that in the
United States, some people live 20 more years than others depending on their ethnicity,
socioeconomic status or where they live. Black Americans are noted to have worse health than
Whites. It is even suggested in some studies that for every life saved through medical
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intervention, five lives could be saved if African Americans had the same mortality rates as
whites (North Carolina Institute of Medicine, n.d).
The information gained from this topic will help me deal better with ethnic minorities as I
have understood their problems better. As a health profession, I will be involved in developing
policies that address ethnicity and how we can bridge the gap in health care between minorities
and non minorities. Questions that arise from this topic include: how health systems should be
improved to cater for minorities and how we can reduce the effects of factors influencing
ethnicity and health. I would be interested in learning more about how ethnicity in risk
prevention and patient preferences influence medical decisions and outcomes (Wilkinson &
The study of Social determinants of health is complex and is concerned with people’s
working conditions, living conditions and lifestyles. It is also concerned with the economic and
social policies and their implications on health and how the policies can bring about health
benefits. Social determinants of health are usually shaped by distribution of money, power and
resources. They include: social gradient, work, unemployment, stress, food, transport, social
exclusion, and social support. In social gradient, it is the poor who are at the bottom of the ladder
who suffer more from health issues. Poor social economic status usually affects health
throughout life. It is interesting to learn that the effects of the social gradient do not only apply to
the poor but even in employment where low ranking officers will suffer more health risks than
higher ranking officers. Social disadvantages are also more common among the poor, creating a
chain of misery and ill health. Stress is a condition that can be detrimental to health and can even
lead to death if not checked. It is usually caused by social and psychological factors and is more
common in people of low socioeconomic status. Early life influences adulthood and as such,
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mothers and young children should be supported (Keleher, 2004). Evidence shows that slow
growth and poor emotional support contribute to increased risk of poor health and decreased
physical and cognitive and emotional functioning in adulthood. It is therefore important to
improve access to health services and education to better the life of mothers and children and
create better adults. Poverty, social exclusion and deprivation affect health and even lead to
premature death in some social groups. Exclusion could result from hostility, discrimination,
unemployment and stigmatization. Poverty leads individuals to engage in risky behaviors, which
contribute to death or disability, low income earners also experience barriers to health services or
delayed services. Wealth is what contributes to better health since individuals have assets, can
afford a good life with basic needs and luxury.
Unemployment results meager earnings, scarcity of healthcare facilities and misery and
in turn poor health. People in unemployment may develop low self-esteem and seclude
themselves increasing their risk of stress and ulcers. In worse cases, they could develop
depression and get suicidal. Job security on the other hand creates good health. Good working
environments should also be created to reduce stress developed from at the workplace. Good
nutrition is important for god health. Individuals with high socioeconomic status have better
access to nutritious and fresh foods than poor individuals.
Policies should be developed to reduce unemployment, create job security, reduce stress and
create wealth for individuals across all social economic levels. Good health will only result if
inequalities are reduced and eliminated, education and access to education is improved,
improving housing, reducing unemployment and involving the society in the social, economic
and cultural life of their societies (Kaufer, nd)
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From this topic I have developed a new perspective on the social determinants of health
and how we should handle individuals from all socioeconomic status. My role will be to be
involved in policy development to address these issues.
Health is influenced by gender, ethnicity and social determinants. They all have their roles and
policies should be developed to enhance this role while eliminating the negative aspects in each.
As a health professional, I will be involved in developing and implementation of these policies to
ensure a healthy society.
Egede, E. L. 2006. Race, Ethnicity, Culture and Disparities in Health care. J Gen Intern Med
Vol. 21. No 6: 667-669.