قابلیت های سلامتی و خود مدیریتی دیابت : تاثیر منابع اقتصادی، اجتماعی و فرهنگی

While the “social determinants of health” view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's “capabilities” framework and its derivative the “health capabilities” (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health.

Health is shaped by the chances or opportunities people have to pursue health and to be healthy, along with the choices they make relative to these chances. Life chances are a function of the resources available to connect them to larger social structures. The association between access to resources and health outcomes is well-documented ( Commission on Social Determinants of Health (CSDH), 2008, Department of Health and Social Security, 1980, Humphries and van Doorslaer, 2000, Mackenbach, 2012, Marmot, 2005, Marmot et al., 1991, Marmot et al., 2010, Phelan et al., 2010, Rabi et al., 2006, Smith et al., 1990, Wilkinson and Pickett, 2006 and Willson, 2009). These resources are more or less convertible to other resources that offer health benefits (e.g., fitness membership, healthy leisure activities, wholesome foods, high quality health care) and are unequally distributed across society. Greater access to resources means greater latitude in translating them into health-relevant resources to improve health and well-being.