Social Hierarchy/Social Rank on Health

The consequences are very clear about Social Hierarchy/Social Rank on health. Below is an article that has relevance for all the Healthy Mendocino Project Priority Areas:

http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)30191-5/fulltext

Here are the recommendations of evidence-based strategies to minimize the impact of social hierarchy on health:

Invest in children

• Early childhood development enrichment programs
• Intensive parent support (home visiting) programs
• Enrollment of all children in early childhood education

Get the welfare mix right

• Regulate markets as necessary
• Implement income transfer policies that redistribute resources (ie, progressive tax and benefit regimes)
• Optimize balance between targeted and universal social protection policies through benefit design that minimizes both undercoverage and leakage
• Eliminate child poverty through monetary and non-monetary support for families with dependent children

Provide a safety net

• Provide income support or tax credits
• Provide social housing
• Subsidize childcare
• Provide free access to health care (especially preventive services)

Implement active labor market policies

• Provide job enrichment programs
• Democratize the workplace (involve employees in decision making)
• Provide career development and on-the-job training
• Provide fair financial compensation and intrinsic rewards
• Promote job security
• Discourage casualization of the workforce

Strengthen local communities

• Foster regional economic development
• Promote community development and empowerment
• Encourage civic participation
• Create mixed communities with health-enhancing facilities

Provide wrap-around services for the multiply disadvantaged

• Coordinate services across government and NGOs
• Provide intensive case management when necessary
• Foster engagement of the targeted families and individuals

Promote healthy lifestyles

• Strengthen tobacco control and addiction services
• Improve the diet of poor families (eg, through subsidizing fruit and vegetables, community gardens, purchasing co-ops, school meals)
• Provide green space and subsidized sport and recreation facilities

Ensure universal access to high quality primary health care

• Subsidize practices serving high need populations
• Provide additional nursing and social worker support for practices in disadvantaged areas
• Assist patients with clinic transport and childcare
• Provide services free at point of use
• Provide conditional cash transfers (to increase demand for clinical preventive services)