The main aim of the research was to map the influence of selected social determinants on health of target immigrant groups. The method was based on the concept of ten social determinants of health as introduced by Wilkinson and Marmot (2003). The quantitative method used were interviews. The survey was carried out in the period from January 2010 to December 2012. Data collection was carried out in two stages. In the first stage, the influence of two social determinants of health (nutrition and addiction) on the respondents' state of health was investigated. The second stage of the survey focused on working conditions and on how respondents can use health care. 246 immigrants were interviewed in the first stage of the survey. They were from the following regions: South Bohemian Region, the capital Prague and Vysočina Region. 236 immigrants from two regions (South Bohemian Region and the capital Prague) were addressed in the second stage of the survey. They were legally settled immigrants in the age group 18 65, of Vietnamese, Mongolian and Ukrainian nationality. The results of the survey clearly show that the target immigrant groups are more exposed to unfavorable working conditions than majority population. Compared to the Czech population the target immigrant groups show statistically significant differences especially in the area of excessive workload and discrimination in the workplace. Increasing incidence of unfavorable working conditions resulted in significant increase in occupational diseases. The factors influencing use of healthcare by immigrants are the type of health insurance, length of residence, sex and knowledge of Czech language. Immigrants who had entered the system of public health insurance used healthcare much more frequently than immigrants with commercial health insurance. Male immigrants smoke and drink alcohol much more heavily than female immigrants. The young generation of immigrants (aged 18 to 29) smoke statistically more significantly than the middle-aged and older generation of immigrants. Middle-aged immigrants (aged 30 to 50) consume more wine and spirits. Their health was perceived subjectively as "worse" by those respondents who at the same time mentioned chronic pain and psychic stress in the workplace. The following measures could lead to elimination of social inequality and to improvement of immigrants' situation in the Czech Republic: equal working conditions for immigrants and Czech employees, improvement of immigrants' knowledge of Czech, shortening of the overall time for obtaining permanent residence, simplification of the terms for gaining citizenship, guarantee of access to public healthcare to all legally settled immigrants.

The aim of this thesis is to argue what it means to embody clinical competence for treating im/migrant patients. Im/migrants are a distinct yet heterogeneous patient population. They come to the U.S. for a variety of reasons, with a great diversity of backgrounds, upbringings, experiences, and ways of life. Considering the structural violence and push and pull factors directly connected to reasons for im/migration and experiences of distress upon settlement in the U.S., the central framework of this thesis is im/migration as a structural determinant of health. The operations of social structures, through policy, law enforcement, and discriminatory belief systems, make im/migrants structurally vulnerable. When healthcare providers treat im/migrant patients from a structurally informed approach to care, the context of these patients’ needs become more apparent and likelihood of positive health outcomes increases. Central to this structural approach, as I explain, is understanding how to best communicate with, gain the trust of, and provide effective social interventions for im/migrant patients relative to the operations of violent social structures. Im/migrant status truly is a determinant of health in its own right, and accordingly, care for im/migrant patients is also a specialized clinical realm with specific skills and competencies. As I argue, healthcare providers can only attain—embody—the competence for treating im/migrants through an awareness of how social structures affect these patients’ lives and modifies the delivery of care.

This Master's thesis called "Labour as a Social Determinant and its Influence on the Health of Medical Staff in Selected Hospitals" is divided into two main sections. The first section summarizes current knowledge from both Czech and world literature from the field of social determinants related to health and labour. The second part of this work deals with the aim of the research, data collection and data processing methods as well as with the very evaluation of the output information and a discussion of the results elicited. The theoretical part is divided into four chapters and consists of basic issues related to the aim of this Master's thesis. The first chapter describes social determinants of health from various points of view. One of the chapter's components is a description of a current conception of these determinants. The second chapter deals with the construct of health, its definition and its conception. Last but not least it treats health as a determiner. The third chapter summarizes a social determinant of labour and labour-related terms. The author is further concerned with the importance of work for humans and with labour safety and hygiene. The fourth and last chapter is dedicated to public health of the Czech republic, its history, the system of health care and further focuses on the structure and services of Ostrov hospital and Sokolov hospital. The aim of this Master's thesis is proposed in the empirical part of this work. The aim was to map the influence of labour as a social determinant of the health of medical staff in selected hospitals. Next, constitutive objectives were established. Their purpose was to map the impact of workplace relationships and their influence on the overall health of medical staff as well as the impact of working environment including salary, working hours, work agenda and workplace security on the overall health of medical staff. The following hypotheses were assessed in connection with the objectives of this work: H1: Workplace relations of medical staff affects their overall health. H2: Salary affects the overall health of medical staff. H3: Working hours affects the overall health of medical staff. H4: Work agenda affects the overall health of medical staff. H5: Workplace safety affects the overall health of medical staff. Based on the statistical testing hypotheses 1, 3 and 4 were confirmed. Hypotheses 2 and 5 were not confirmed. The enquiry within the framework of this Master's thesis was conducted using a quantitative research. The interviewing method and the technique of questionnaire were used for data acquirement. The questionnaire was composed from questions regarding the matter of inquiry, questions evaluating subjective health of the respondents, questions related to the occupation of the people addressed. The round of questions was finally targeted at the issue of respondents' health vs. their work. The questionnaire was anonymous. The research distribution was accomplished via Deputy Minister of health care in both hospitals. The research file was formed by a medical staff who work in Sokolov hospital and Ostrov hospital. The resulting data were entered and processed using SPPS program vision 16.0 and 23.0 (Statistical Package for Social Science). The data were further evaluated and processed via graphs and tables in absolute numbers and percentages. After the evaluation of all questions in the questionnaire I reached a conclusion that labour as a social determinant of health has impact on the health of medical staff. I shall also assume that the majority of respondents were quite positive while rating the overall complacence with their jobs. Their complacence appears despite the mental rather than physical demand which undoubtedly goes with medical careers as well as despite their work conditions and workplace relationship which all impact their overall health.

Introduction : Une faible situation sociale est associée à un risque accru de mortalité et morbidité. Plusieurs facteurs ont été étudiés en lien avec cette association, mais un mécanisme proposé par Tarlov (1996), soit la dissonance entre les attentes et la réalité, n’a pas été investigué. De plus, peu d’études ont examiné en profondeur les facteurs sociaux et psychosociaux influençant la santé avec la participation des personnes vivant la pauvreté et l’exclusion sociale. Objectifs et méthodologie : Cette étude vise à identifier et à décrire les facteurs nuisant à la santé d’adultes ayant un faible revenu, les stratégies et actions de ces personnes en lien avec ces facteurs et les effets de la participation pour ces personnes. Cette étude a utilisé une approche de recherche participative et une méthode de présentation de problèmes selon la pédagogie de Freire. Les participants et participantes étaient huit adultes ayant un faible revenu, fréquentant un organisme communautaire en milieu urbain. Ces personnes ont participé à huit rencontres de groupe, comprenant des activités comme la présentation d’images ou d’histoires représentatives et le jeu de rôle. Ces personnes ont aussi participé à l’analyse thématique des données, incluant cinq rencontres de groupe. Résultats et conclusions : Cette étude identifie un nouveau facteur psychosocial, soit la dissonance entre la situation actuelle perçue et l’idéal de situation conçu tôt dans la vie. Cette dissonance génère un profond mal-être et suit la perte ou la non atteinte de l’idéal de situation. Les autres facteurs identifiés soutiennent ceux d’études précédentes et sont groupés sous les thèmes du manque d’amour et de soutien tôt dans la vie et de la situation actuelle comme prison sociale. Cette étude identifie aussi un effet important de la participation, peu rapporté dans les études participatives, soit les découvertes personnelles ou une meilleure compréhension de soi dans le monde. L’approche de recherche participative combinée à la méthode de présentation de problèmes selon la pédagogie de Freire permet les découvertes personnelles et peut être un moyen d’accompagner les personnes vivant un profond mal-être. Les actions, interventions et politiques devraient permettre aux personnes de réaliser leur idéal de situation et de répondre aux besoins d’amour et de soutien des enfants. / Abstract: Introduction: Poor social circumstances, including low social status, are associated with a higher risk of mortality and morbidity. Many factors have been studied in relation to this association, but a mechanism advanced by Tarlov (1996) concerning dissonance between expectations and reality has not been investigated. Moreover, few studies have examined in depth social and psychosocial factors influencing health, with the participation of people living in poverty and social exclusion. objectives and methodology: This study aims to identify and describe the factors harming the health of low-income adults; the strategies and actions used by low-income adults, which are linked to these factors; and the effects on the participants of participation in the study. This study used a participatory research approach and a problem-posing method based on Freire’s pedagogy. The participants were eight low-income adults using food bank services provided by a community organization in an urban setting. They participated in eight group meetings, which included activities such as presentation of representative stories or images and role-playing. They also participated in the data analysis, during five additional meetings. Results and conclusions: This study identifies a new psychosocial factor, namely, the dissonance between current perceived circumstances and one’s ideal of circumstances conceived early in life. This dissonance generates profound malaise and follows a loss or a failure to achieve the ideal of circumstances. Other factors identified support those from previous studies and are grouped into two themes: lack of love and support from an early age, and current circumstances as a trap. This study also identifies an important and under-reported outcome of participation, which is the experience of personal discoveries or a better understanding of the self in the world. A participatory research approach combined with a problem-posing method based on Freire’s pedagogy enables personal discoveries and might be a means for accompanying people with profound malaise. Actions, interventions, and policies should enable people to achieve their ideal of circumstances and to respond to children’s needs for love and support.