Prioritizing the Determinants of Social-health Inequality in Iran: A Multiple Attribute Decision Making Application

Abstract

Background:One of the main challenges of healthcare systems of developing countries is health inequality. Health inequality means inequality in individuals’ ability and proper functioning, resulting in inequality in social status and living conditions, which thwarts social interventions implemented by the government.Objectives:This study aimed to determine and prioritize the social determinants of health inequality in Iran.Materials and Methods:This was a mixed method study with two phases of qualitative and quantitative research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect qualitative data along with a multiple attribute decision making method for the quantitative phase of the research in which the TOPSIS technique was employed for prioritization. The qualitative findings were entered into NVivo for analysis, as were the quantitative data entered into MATLAB software.Results:The results approved the suitability of the conceptual framework of social determinants of health suggested by the WHO (world health organization) for studying social determinants of health inequality; however, this framework general and theoretical rather than a guideline for practice. Thus, in this study, 15 themes and 31 sub-themes were determined as social determinants of social health inequality in Iran. Based on the findings of the quantitative phase of our research, socioeconomic status, living facilities such as housing, and social integrity had the greatest effect on decreasing health inequality.Conclusions:A major part of the inequality in health distribution is avoidable because they are mostly caused by adjustable factors like economic conditions, educational conditions, employment, living facilities, etc. As in the majority of developing countries the living and health conditions are the same as Iran, the findings of this study may be applicable for other developing countries.

The Social Determinants of Health in Military Forces of Iran: A Qualitative Study

“…The results of Aghapoor and Mesri's study (2012) on the effects of social and cultural factors on the soldiers' quality of life showed that their quality of life was affected by their religious orientation, the duration of the military service, self-esteem, age, education, and housing conditions [ 29 ]. The results of many studies conducted on the civilians' SDH have proven the effects of economic, social, and public policies, as well as the culture and social values on health [ 25 , 30 , 32 , 48 ], which are consistent with the results of the present study.…”

“…The results of Hassanzadeh and colleagues' study (2013) indicated that the prerequisites for health equity were the social factors and the alimentation of inequalities in the social classes [ 31 ]. The results of Zaboli and colleagues' study (2014) confirmed the suitability of using the conceptual framework of social determinants of health, developed by WHO, for investigating the social determinants and health inequalities in Iran [ 32 ]. Most of the recent studies have been conducted on the effects of social determinants of health based on the WHO framework.…”

“…According to the conceptual framework of the CSDH, the identification of social determinants of health is “working beyond the first causes of diseases” [ 23 , 43 ]. What can be inferred from the findings of similar studies in the field of social determinants of health [ 30 , 32 , 44 , 45 ] is that the approach of social determinants of health in Iran is developing. Given the broadness of social determinants and their effects on health, the results of the present study showed that the health of Iranian military forces was affected by the globalization conditions, the economic, social, political, and cultural policies of the society, and the social factors of the military environment.…”

“…The approach of social determinants of health tries to address the inequities in the people's social status and their living and working conditions. Most inequalities can be avoided [ 32 ]. According to the conceptual framework of the CSDH, the identification of social determinants of health is “working beyond the first causes of diseases” [ 23 , 43 ].…”

Macroeconomic policies and increasing social-health inequality in Iran

“…Zaboli and colleagues reviewed and prioritized SDH in Iran. They believe, socio-economic status, living facilities such as housing, and social integrity had the greatest effect on decreasing health inequality in Iran (27). Addressing SDH requires an understanding of the impact of macroeconomic policies and social policies on the health.…”