Chapter 17
Social, Economic and Political
Factors That Influence
Occupational Performance
Catherine L. Lysack and Diane E. Adamo
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
1. Distinguish between socioeconomic status, social class,
and social inequalities.
2. Discuss how health is related to an individual’s
position in the social hierarchy.
3. Discuss how individual and community level
socioeconomic factors impact health.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (Continued)
4. Explain how socioeconomic disadvantages experienced in
childhood affect the occupational performance of client
as adults.
5. Describe three actions that occupational therapy
practitioners can take to reduce the negative impact of
social inequalities and health disparities in clients’ lives.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction
• The Bottom Line: Higher socioeconomic status (SES) is
associated with better health
– more opportunities for engagement and benefit
from meaningful occupations
• Socioeconomic factors influence:
– access, participation, and positive outcomes
through OT services; and
– health choices and behaviors of clients and health
care professionals
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction (Continued)
• Lower SES has been linked to:
– chronic stress;
– heart disease;
– Ulcers;
– Diabetes;
– rheumatoid arthritis;
– certain types of cancer; and
– premature aging
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Defining the Social Causes of
Health and Illness
Socioeconomic Status, Class, and Social Mobility
• Socioeconomic status refers to occupational,
educational, and income achievements of individuals or
groups
• Classes groups of people with similar economic means,
ownership and control of property and assets
• Social mobility degrees movement up or down social
ladder
– largely dictated by class status
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Social Inequality and Health Disparities
• Social inequality: Pattern of unequal social status
linked to race, gender and wealth inequalities
• Health disparities: Unfair differences in access to
health care services, treatment provided and health
outcomes
– May be the result of social inequalities or improper
actions by professionals.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intersections of Gender, Ethnicity, Age,
Disability and Sexual Orientation
• Gender inequalities
• Ethnic inequalities
• Age inequalities
• Inequalities due to disability
• Inequalities based on sexual orientation
Many are subject to multiple inequalities by belonging to
several groups experiencing health disparities
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Political Economy of the
Health Care System
• The U.S. health care system is a complex and
fragmented system
• Regulation and reimbursement policies are difficult to
navigate and understand
• Most expensive health care system in the world
• The U.S. ranks low on many health indicators in
comparison to other countries
• Evidence suggests that the system has serious problems
at all levels
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Role of Health Insurance
Access to U.S. health insurance requires employment with
health benefits or independent financial means
• More than 50 million U.S. citizens have no health
insurance
• An additional 50 million are thought to have insufficient
coverage
• Ethnic and racial minorities make up a disproportionate
share of the uninsured
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Role of Health Insurance
• The uninsured and underinsured have:
– reduced access to health care;
– poorer overall health; and
– increased likelihood of premature death
• Medical debt is the leading cause of bankruptcy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mechanisms of Disadvantage Across the
Life Course
Money Matters: Economic Disadvantage and Health
• Poverty—the lack of material resources necessary for
subsistence
– Increases exposure to factors that make people sick
– Decreases chances of having high-quality medical
insurance and care
• Poor social and physical environments may adversely
affect health through physiological stress.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Poverty
• Populations at high risk for poverty include children, older
adults, new immigrants, persons with disabilities and
ethnic minorities
• Working poor: People who work full-time but whose
wages are still below the poverty level
• New poor: People who have fallen into poverty because
of some sudden and/or unexpected circumstance (e.g.
serious illness, divorce or job layoffs)
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Deprivation Across the Life Course
• Foundations of adult health are laid before birth and in
early childhood
– Slow physical growth in infancy is associated with
reduced cardiovascular, respiratory, pancreatic, and
kidney function, increasing the risk of serious illness
in adulthood
– Living in an impoverished home environment can
impede normal development
• Social inequalities over the life course contribute to
occupational performance deficits in adulthood
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Role of OT in Addressing Health
Disparities
What can OTs do about these intractable problems?
•
•
Utilize focused, evidence-based OT interventions early
among vulnerable children
Increase research on effective interventions for
overcoming socioeconomic influences on health
• Engage in reflective practice that includes:
• examination of clients’ socioeconomic status and cultural
factors; and
•
impact on OT services and outcomes
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Role of OT in Addressing Health
Disparities (Continued)
What can OTs do about these intractable problems?
• Become more educated about economic, institutional and
structural barriers to treatment and health outcomes
• Leverage our position in the health care system to
reduce the negative consequences of poor social
conditions on our clients’ health and occupational
performance
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins