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How Global Social and Economic Pressures Affect Medical Practices

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Since the late 1970s, globalization has become a phenomenon that has elicited polarizing responses from scholars, politicians, activists, and the business community. Several scholars and activists, such as labor unions, see globalization as an anti-democratic movement that would weaken the nation-state in favor of the great powers. There is no doubt that globalization, no matter how it is defined, is here to stay, and is causing major changes on the globe. Given the rapid proliferation of advances in technology, communication, means of production, and transportation, globalization is a challenge to health and well-being worldwide. On an international level, the average human lifespan is increasing primarily due to advances in medicine and technology

The trends are a reflection of increasing health care demands along with the technological advances needed to prevent, diagnose, and treat disease (IOM, 1997). Along with this increase in longevity comes the concern of finding commonalities in the treatment of health disparities for all people.

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The World Health Organization (WHO) defines health as not just the absence of disease, but rather in the broad sense of physical, economic, emotional, and social well-being at an individual, family, and community level. Health is thus affected not only by individual risk factors and behaviors, but also by a range of economic and social conditions. These social determinants of health—the circumstances in which people are born, grow up, live, work, and age—are shaped by a variety of economic, social, and political policies and forces. These policies and forces—what the WHO describes as the social determinants of health inequities—in turn determine access to life chances and opportunities for health based on social markers of advantage and disadvantage such as race and ethnicity, class, and gender. In this article I explore some of the mechanisms through which social determinants affect health (and life) outcomes, and describe some policy approaches to improving health by addressing socioeconomic disadvantage. Why is it that the United States has the best health care in the world, but is nowhere near the healthiest country? The County Health Rankings framework developed by the University of Wisconsin School of Medicine and Public Health’s Public Health Institute shows that health outcomes, as measured by length and quality of life, are influenced by a set of four modifiable health factors: health behaviors, clinical care, social and economic factors, and the physical environment. (Genetics, while important, is, at present, functionally non-modifiable, and therefore excluded from the model.) These modifiable health factors are in turn strongly influenced by a broad set of policies and programs

Although this framework is broad and inclusive, our national discussion about improving health outcomes tends to focus on clinical care and on individual responsibility for health behaviors; the other two modifiable health factors, social and economic factors and the physical environment, are generally not included in the conversation. This reflects a widely held belief in the United States that if an individual engages in healthful behaviors (such as exercising, eating healthfully, and not smoking) and goes to the doctor regularly, she will be healthy. However, these two factors, while certainly important, only account for at most half of what determines health outcomes.

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A variety of individual, organisational and environmental factors influence a physician satisfaction and commitment which, in turn, affect quality of medical services. Individual factors include physician’s age, personality, education, capabilities and experience

Organisational factors include working conditions, resources and relationships with co-workers. Environmental factors consist of economic and social influences. Furthermore, the physicians’ subjective attributes, including the priority they give to medical care, would have a moderating influence on the delivery of care. A number of studies have found clear relationships between employee satisfaction, quality of care and patient satisfaction. Satisfied and com mitted employees deliver better care, which results in better outcomes and higher patient satisfaction (Is the professional satisfaction of general internists associated with patient satisfaction? Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA). Good human resource management drives employee satisfaction and loyalty (A study of the relationship between job satisfaction, organizational commitment and turnover intention among hospital employees. Mosadeghrad AM, Ferlie E, Rosenberg D Health Serv Manage Res. 2008). This study showed that physicians burdened with heavy workloads, and poor compensation packages. All of these factors have impeded the delivery of quality medical services particularly in the public health sector. Patient related factors such as socio-demographic variables (e.g., age, race, education, social class and health status), attitudes, and behaviours (e.g., moods, actions and cooperation) may act as facilitators or blockers to quality of received medical services. These findings support previous research (Ditto PH, Moore KA, Hilton JL, Kalish JR (1995). Beliefs about physicians: their role in health care utilization, satisfaction and compliance, Basic and Applied Social Psychology, 17 (1&2): 23–48.).

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All things considered, medical care providers, including nurses, physicians, and others, undergo intensive training in medicine, not in social work, and we believe in the power of medical care to heal, alleviate suffering, and save lives. Nevertheless, the knowledge indicating a crucial role for socioeconomic and related social factors in shaping health has become so compelling that it cannot be ignored insofar as public health and health-care personnel are committed to health

Current knowledge suggests ways to collaborate with others to improve health outcomes for socially disadvantaged populations.138 At a minimum, appreciation of some of the social factors that influence health-related behaviors and health status itself can help clinical providers develop more effective treatment plans.139 Clinical and public health practitioners can strengthen routine procedures to assess and respond to social needs through referrals and/or on-site social and legal services.140–142 Public health workers and clinicians also can develop health-promotion strategies that reach beyond individual clinical and social services to communities, to influence living and working conditions that are generally the strongest determinants of whether people are healthy or become sick in the first place.143 They can participate in or promote research adding to the understanding of the mechanisms by which social factors influence health, and test which strategies appear most effective and efficient. Finally, clinicians and public health practitioners can be key resources for local, state, and national policy makers on the crucial issue of health equity for all Americans, including those facing the greatest social obstacles.

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Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA (2000). Is the professional satisfaction of general internists associated with patient satisfaction? Journal of General Internal Medicine, 15 (2): 122–128.

Hong SC, Goo YJ (2004). A causal model of customer loyalty in professional service firms: an empirical study. International Journal of Management, 21 (4): 531–541.

Mosadeghrad AM, Ferlie E, Rosenberg D. (2008). A study of relationship between job satisfaction, organisational commitment and turnover intention among hospital employees. Health Services Management Research, 21 (4): 211–227.

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