is caused by three factors that reduce access. these include socio-demographic factors (such as age, ethnicity, marital status, and education), systematic barriers, and barriers based on lack of knowledge, attitudes and life-styles. several studies show the complex associations between poverty and education, employment, teen births, and the health of the mother and child. in 1985, the world health organization estimated that maternal mortality rates were 150 times higher in developing countries than developed nations. furthermore, increased rates of postpartum depression were found in mothers belonging to low socioeconomic status. differential health for men there also exist differentials in health with respect to men. in many post-transition countries, like the russian federation, excess female mortality is not a problem, but rather there has been an increase in mortality risks for men. evidence suggests that excess male mortality correlates with behavior considered socially acceptable among men, including smoking, binge drinking, and risky activities. according to moss, "women are more likely to experience role strain and overload that occur when familial responsibilities are combined with occupation-related stress." age social determinants can have differential effects on health outcomes based on age group. youth health adolescent health has been proven to be influenced by both structural and proximal determinants, but structural determinants play the more significant role. structural determinants such as national wealth, income inequality, and access to education have been found to affect adolescent health. additionally, proximal determinants such as school and household environments are influenced by stratification created by structural determinants, can also affect adolescent health. access to education was determined to be the most influential structural determinant affecting adolescent health.proximal determinants include household and community factors, such as household environment, familial relationships, peer relationships, access to adequate food, and opportunities for recreation and activity. the most influential proximal determinant has proven to be family affluence. family affluence directly affects food security, which correlates with adolescent nutrition and health. family affluence also influences participation in regular physical activity. while nutrition and physical activity promote physical well-being, both promote psychological health as well. thus family affluence is correlated with reduced psychological stress during adolescence. family affluence also affects access to healthcare services; however, in countries with universal healthcare systems, youth belonging to less-affluent households still display poorer health than adolescents from wealthier families. one study (that followed individuals from childhood to adulthood) showed that housing environment impacted mortality, with the main cause of death being the presence of pollutants in the house. higher rates of chronic diseases such as obesity and diabetes, as well as cigarette smoking were found in adolescents aged 10–21 belonging to low socioeconomic status. infant health poverty during pregnancy has been reported to cause a wide range of disparities in newborns. low maternal socioeconomic status has been correlated with low infant birth weight and preterm delivery, physical complications such as ectopic pregnancy, poorer infant physical condition, compromised immune system and increased susceptibility to illness, and prenatal infant death. sixty percent of children born into poor families have at least one chronic disease. infant mental complications include delayed cognitive development, poor academic performance, and behavioral problems. poor women display greater rates of smoking, alcohol consumption, and engagement in risky behaviors. such risk factors function as stressors that, in combination with social factors such as crowded and unhygienic living environments, financial difficulties, and unemployment, affect fetus health. ethnicity ethnicity can play an especially large part in determining health outcomes for impoverished minorities. poverty can overpower race, but within poverty, race highly contributes to health outcomes. african americans, even in some of the wealthiest cities in the united states, have lower life expectancy at birth than people in much poorer countries like china or india. in the united states, specifically for african american women, as of 2013 for every 100,000 births 43.5 black women would not survive compared to the 12.7 of white women according to studies, black individuals in south africa have worse morbidity and mortality rates due to the limited access to social resources. poverty is the chief cause of the endemic amounts of disease and hunger and malnutrition among this population. a disproportionate number of cases of the aids epidemic in north america are from american minorities, with 72% of women's aids cases among hispanic or african-american women. among those american minorities, african americans comprise 12% of the american population yet, made up 45% of new hiv diagnoses. blacks in american account for the highest proportion of those living with hiv and aids in america. farmer says the growing mortality differentials between whites and blacks must be attributed to class differentials- which includes recognizing race within impoverished populations. recognition of race as a determining factor for poor health without recognizing poverty has misled individuals to believe race is the only factor. a 2001 study showed that even with health care insurance, many african americans and hispanics lacked a health care provider; the numbers doubled for those without insurance (uninsured: white 12.9%, black 21.0%, hispanics 34.3%). with both race and insurance status as obstacles, their health care access and their health declined. health differentials amongst races can also serve as determining factors for other facets of life, including income and marital status. aids-affected hispanic women hold smaller salaries than average women, are part of poorer families, and are more likely to head households. according to one study, black teenage women living in dysfunctional homes were more likely to have serious health issues for themselves or children. education education plays an especially influential part in the lives of the impoverished. according to mirowsky and ross, education determines other factors of livelihood like occupation and income that determines income, which determines health outcomes. education is a major social determinant of health, with educational attainment related to improved health outcomes, due to its effect on income, employment, and living conditions. social resources, such as education, determine life expectancy and infant mortality, which measures health. education has a lasting, continuous, and increasing effect on health. education is a special determinant of health because it enables people toward self-direction, which leads them to seek goals such as health. education helps the impoverished develop usable skills, abilities, and resources that help individuals reach goals, including bettering health. parent's educational level is also important to health, which influences the health of children and the future population. parent's education level also determines child health, survival, and their educational attainment (caldwell, 1986; cleland & van ginneken, 1988). "children born to more educated mothers are less likely to die in infancy and more likely to have higher birth weights and be immunized. studies in the united states suggest maternal education results in higher parity, greater use of prenatal care, and lower smoking rates, which positively affects child health. an increase in child schooling in taiwan during the educational reform of 1968 reduced the infant morality rate by 11%, saving 1 infant per 1000 births. "fig. 2.1 shows variation between countries in infant mortality from just over 20/1000 live births in colombia to just over 120 in mozambique. it also shows inequities within countries – an infant's chances of survival are closely related to her mother's education. in bolivia, babies born to women with no education have infant mortality greater than 100 per 1000 live births; the infant mortality rate of babies born to mothers with at least secondary education is under 40/1000.all countries included in fig. 2.1 show the survival disadvantage of children born to women with no education." mortality inequalities are produced and reproduced by policies that promotes structural violence for those who are already vulnerable to poverty, while reinforcing the paradigm and the ontological order of power hierarchy. hence, the political engagement of an individual and their communities play an important factor in determining their access to health care. the commission on the social determinants of health discusses that explicit commitment to action through multidisciplinary public policies are required for better access to healthcare. one of the recommended action is to expand knowledge and empower the participation of broad segment of society. a manifestation of such action is the mobilization of the population that has been historically oppressed and to raise question about the systemic issues affecting their life. according to who, civic participation does not just better physical health, but also mental health status, and overall life quality. history exhibits that when the masses become politically aware of the problems around them, they are more empowered to find their own voice and revolt against systemic inequalities to take control of their lives and improve healthcare accessibility and affordability. on the contrary, nations that do not empower its citizens to be politically educated have way worse health outcomes than nations whose citizens are politically engaged. for instance, there has been a surge in mortality differentials and unwavering decline in health benefits coverage, especially among for the population living under poverty line. as stated in global health promotion, over the last 10 years there has been a steady loss of health coverage for 1 million people every year. losing health coverage means that an individual could no longer seek affordable treatment or access healthcare, so their health quality would eventually deteriorate. however, if the citizens were to raise their concerns collective to the government, they would have been able to address this systemic factor and subsequently improve their health outcomes. occupation impoverished workers are more likely to hold part-time jobs, move in and out of work, be migrant workers, or experience stress associated with being unemployed and searching unsuccessfully for unemployment, which all in turn affects health outcomes. according to the world health organization, employment and working conditions greatly affect health equity (kivimaki et al., 2003). this occurs because poor employment conditions exposes individuals to health hazards, which are more likely for low-status jobs. evidence confirms that high job demand, low control, and low rewards for effort in these low status jobs are risk factors for mental and physical health problems, such as a 50% excess risk of heart disease (stansfeld & candy, 2006). the growing power of massive, conglomerate global corporations and institutions to set labor policy and standards agendas has disempowered workers, unions, and the job-seeking by subjecting these individuals to health-damaging working conditions. (emconet, 2007). in high- income countries, there has been a growth in job insecurity and precarious employment arrangements (such as informal work, temporary work, part-time work, and piecework), job losses, and a weakening of regulatory protections. informal work can threaten health through its precarious job instability, lack of regulation to protect working conditions and occupational health and safety. evidence from the who suggests mortality is greater among temporary workers than permanent workers. (kivimaki et al., 2003). since most of the global workforce operates under the informal economy, particularly low- and middle-income countries, impoverished populations are greatly affected by these factors. migration status migrants have a variety of physical and mental health needs, shaped by their background, the host country’s entry and integration policies, and their living and working conditions. refugees and migrants remain among the most vulnerable members of society and may be faced with inadequate or restricted access to health services. xenophobia, discrimination, and working conditions may further affect their mental health disproportionally. comparison of a poor but mainly non-migrant population in rural uganda with disadvantaged migrant population in urban south-africa and urban sweden found lower self-reported frequency of physical activity and lower social support and self-efficacy in the urban migrant samples. socioeconomic and political context nation-state/geographical region which particular nation an impoverished person lives in deeply affects health outcomes. this can be attributed to governmental, environmental, geographical, and cultural factors. using life expectancy as a measure of health indicates a difference between countries in likeliness of living to a certain age. where people are born dramatically impacts their life chances. high-income countries like japan or sweden have a life expectancy of 80 years, brazil-72, india-63. the who cites that for rich countries, only 56 (iceland) to 107 (us) of 1000 adults between 15 and 60 years old will die each year, while western and central african countries have adult mortality rates exceeding 300 and 400 of every 1000. the rates are even higher in african nations in the aids epidemic, such as zimbabwe where 772 of 1000 adults die each year (who 2010). also, the type of health condition varies