Billy Elliot: Social Determinants Of Health

Question One – Identify and explain each one of the determinants of health (social, biomedical, environmental and socioeconomic) using examples from “Billy Elliot” to support your answer

The movie Billy Elliot provides multiple examples that relate to the four determinants of health – Social, Biomedical, Environmental and Socioeconomic.

Social Determinants –
Social Determinants are the conditions in which people are born, live, grow, work and age. The social determinants are mostly responsible for the health inequalities presented within society – the inequalities between different countries. Some examples of the social determinants are represented with the movie Billy Elliot. Social Determinants include – Social Gradient, Social Exclusion,

Unemployment, Stress, Early Life, Work, Social Support, Addiction, Food and Transport. Some examples of these determinants are:
The social determinant of work/unemployment is signalled as being effected within the movie. Both Billy’s dad and brother were identified as participating in an union strike. They were both on strike along with thousands of other people due to the fact that the government was closing down multiple coal mines; therefore, people were losing their jobs. They were fighting for their rights. Although they were fighting for a good cause it resulted in no/low income for both Jackie and Tony. This then caused a repercussion on the Elliot Family.
Social exclusion describes the social disadvantage, lack of resources, opportunity, participation and skills within society. One may be socially excluded due to ethnicity, colour, race, gender and other factors that stem from discrimination, unemployment and stigmatisation. Billy Elliot is portrayed as being socially excluded from ballet as he is a boy. This is a type of social exclusion due to gender. Within Billy’s town the stereotype of girls doing ballet and boys doing boxing is a strong belief especially from the parents and older generation of the town. This provides evidence as to why Billy’s dad and brother reacted more because they didn’t want to be seen as being related to a boy that did ballet; changing the stereotype.
Billy also is deemed as being under a lot of stress. Billy is only 11 years old and is having to cope with a lot. He attends school which majority of people his age does, but he also has to occasionally look after his nanna who is effected by Alzheimer’s as well as practice his ballet which then further results in further stress as he practices for his big audition. This audition added a mass amount of stress to Billy’s life. This stress was added as his dad sold his late mothers jewellery in order to pay for his audition; his dad also went back to work despite the strike to assist in the financial part of his audition. He doesn’t want to let his dad down seeing as his dad did a lot for him in order for him to get that far. So the stress he placed upon himself to do well in the audition was enormous. One reason was again not to let his dad down but also the fear of his dad getting angry with him if he didn’t do well. His dad is known to be violent when he is angry, although he is slowly getting out of the violent phase there is always the chance that he may be violent again. This enabled Billy to be extra stressed to do well. This amount of stress shouldn’t be placed on a kid as young as Billy; this stress has repercussions of Billy later in life suffering from mass amounts of stress and anxiety.

Biomedical Determinants –
Biomedical Determinants are the influences on health status based on the body. The two main factors that contribute to biomedical determinants are birth weight and body weight. Birth weight representing how your birth weight can present illness’ later in life and body weight representing obesity or malnourishment.
Billy’s birth weight was not expressed within the movie so there is no real connection between the biomedical determinant of health of birth weight and the Billy’s life.
Although, Billy is seen as being a tad on the skinnier side. You can see his body as having little fat; bones are also more visible. The reasoning behind billy being small in weight is that due to lack of income coming into his household Jackie (Billy’s Dad) isn’t able to buy mass amounts of food for the family. He isn’t considered malnourished but does receive close to the average number of nutrients within the amount of food he eats.

Environmental Determinants –
Environmental Determinants is the health of the community affected by the surrounding environment. There are two factors – Natural and Built. Natural Factors are all that occur within the environment that don’t encounter human intervention; some examples may be extreme weather, air quality and vector agents. Built factors are all that have been created or modified by humans i.e. buildings, roads, homes. Billy’s lives in ‘Everington Village’ a coalmining town.
His village being a coalminers town presents the idea of the air quality not being the greatest. This is a built factor as men work on these mines each day. The burning of the coal releases toxic fumes into the atmosphere affecting the air quality.
Another built factor is housing. Billy’s house is a small home that is identical to his neighbours. It is quite compact and small; Billy has to share a room with his older brother Tony. Any natural features such as access to water and vector agents aren’t displayed within the movie as being an issue so what you can gather is that natural factors aren’t a big issue within Billy’s village.

Socio-economic Determinants –
Socio-economic determinants are determinants that effect the wealth and economic status of a human being. Socio-economic determinants include: education, employment, income, family, housing, neighbourhood, access to services, migration and food security.
Billy’s neighbourhood and town don’t seem to have many green spaces such as parks or nature reserves. The setting in each part of the movie is majority concrete and brick. Although when Billy is seen running there is greenery but in the form of a paddock/field, not a man-made green space.
Again, Billy’s housing situation is considered average. His house is small and compact. He shares a bedroom with his brother and within the movie it is seen is bed is two mattresses stacked on one another. The boy’s bedroom also looks packed as there is limited room for their belongings. The other rooms in their house also look compact. It doesn’t help their situation as they also live with nanna so she obviously has her own room which limits the space the rest of the family can occupy.
Billy is provided with what looks like a good education and his access to services is not mentioned. The only access he doesn’t have is the access to a ballet school as it is situated in London but this isn’t a major concern for him or his village. As he does live in a small town the assumption of not having access to every service such as major hospitals and multiple schools but still has a variety of other services they may just not be the best ones.
Finally, the education regarding health was minimal within the movie. Within the movie many people were seen smoking cigarettes and cigars. Both Jackie and Tony smoke which encourages Billy to as well smoke when he is older. They are not educated in the consequences of smoking on their health and impacts it will have on them later on in life.

Question Two – Discuss the impact (possible impact) of the determinants of health on the health of Billy Elliot; and whether these determinants were protective or risk factors on his health

Multiple determinants of health impacted Billy’s life within the movie.

The determinants of Social Exclusion, Social Support and Stress were all impacted within the movie. All posing mostly negative risk factors to his life.
Social exclusion as mentioned prior to this question is a big factor within the movie. Billy is socially excluded from partaking in ballet because he is a boy. This social exclusion is caused by gender ‘rules’. This social exclusion can impact Billy’s life as he may continue to believe that boys can only do what is considered boys stuff and the same with girls, i.e. boxing is for boys and boys only. This social exclusion may also pose a risk factor towards his health as he may feel depressed or sadden due to this. He has the belief that in order to be a man you must do manly things only and may treat people that want to do ‘girl’ things the same way he was treated. Although, this social exclusion is believed to be a risk factor it may also be seen as being protective of his health. The community may have thought that if he did participate in ballet that he is gay. Calling someone gay when they are not affects them mentally and makes them rethink everything they do in order to not be ‘labelled’ that again. So it was protective of Billy mentally/emotionally in that state but also affected him in other

ways.
Billy had an average social support considering his future aspirations within the ballet society. Billy’s dreams of being a ballerina were not supported by his father or brother the two ‘most important people in his life’. This is a risk factor to his health as it poses a greater chance of stress for Billy. If he continues with his ballet, he would be stressed to think what his dad and brother would think about him and if they would support him. Furthermore, he does gain support from his dance teacher, Mrs Wilkinson, and his best friend George. This gives Billy hope and encouragement to continue with his ballet as he sees that some people that are close to him believe in him to aspire and achieve his dreams of becoming a professional.
Billy encountered a rough childhood that no child should go through. His mother died when he was at a young age, resulting in his dad bringing him up as a sole parent. His dad also turns to violence as a repercussion of his anger. He hits and violently attacks his sons when he is angry with them. Billy also now turns to violence when he is angry. Billy results in punching a fellow ballerina at his audition as a source of frustration. He copies his father as he thinks it is ok to hit and punch people as a source of anger or frustration. This is a risk factor for Billy as this violence may continue and spiral into worse things. If he continues this when he is an adult, he could potentially end up in jail.