Determinants of Health
Mr. Anyama Patrick.
Discussion
• Why are some people healthy and some
people are not healthy?
• Whether or not people are healthy depends
on a large number of factors, many of which
are interconnected, and most of which go
considerably beyond acess to health services.
Introduction
• Many factors combine together to affect the
health of individuals and communities.
Whether people are healthy or not, is
determined by their circumstances and
environment.
Introduction
• To a large extent, factors such as where we
live, the state of our environment, genetics,
our income and education level, and our
relationships with friends and family all have
considerable impacts on health,
• whereas the more commonly considered
factors such as access and use of health care
services often have less of an impact.
Introduction
• DETERMINANT
• Any factor that brings about change in a
health condition or other defined
characteristic. Single specified causes. A
determinant makes a difference to a given
outcome.
Determinants of Health
Introduction
“Health is the state of complete physical, mental
, and social well-being and not merely the
absence of disease or infirmity.” (WHO, 1948)
• Health is multidimensional: it is not only
merely the presence or absence of disease,
but also has social, psychological and cultural
determinants and consequences.
Definition
• New definition of health recognizes the inextricable
links between an individual and her/his environment.
It is known as „socio-ecological“ definition.
• Health defined as: „The ability to identify and realize
aspirations, to satisfy needs, and to change or cope
with environment. Health is therefore a resource for
everyday life, not the objective of living. Health is a
positive concept emphasizing social and personal
resources.“
Definition
• Health encompass social and political
concerns and the relationship of individuals to
the environment in which they day live.
• From this perspective, health is not just the
responsibility of the traditional „health“
sector, but all sectors, institutions, and
organizations that may influence the well-
being of individuals and communities.
Disease, Illness, sickness
• Disease - refers to abnormal medically
defined changes in the structure or
functioning of the human body.
• Illness – refers to the individual´s experience
or subjective perception of lack of physical
and/or mental well-being
• Sickness – refers about consequences to
function normally in social roles
Systematic taxonomy of diseases
WHO defines three concepts which refer to distinct
and important dimensions of human experience in
the context of disease:
• Impairment – refers to changes in the individual´s
body (any loss or abnormality of psychological,
physiological or anatomical structure of function)
• Disability – refers about changes in what the
individual can and cannot do
• Handicap - refers about changes in their relationship
with physical and social environment
Definition and Epidemiology
• Practical definitions of health and disease are
needed in epidemiology, which concentrates
on aspects of health that are easily
measurable and amenable to improvement
• Disease present Vs disease absent
• Normality Vs Abnormality
Epidemiological triangle of disease
Epidemiological triangle is based on the theory names
Doctrine of Specific Etiology: the idea that each disease has a
single and specific cause.
The epidemiological triangle portrays the interaction between
agent, host and environment.
Agent – may be chemical (lead…), biological (bacteria…),
physical (violence…)
Host – factors may be genetic or acquired and influence
susceptibility to disease
Environmental factors – may be biologic, social or physical
and affect exposure and susceptibility
EPIDEMIOLOGICAL TRIANGLE OF
DISEASE
• From an epidemiologic point of view, such an agent
as the „necessary but not sufficient“ cause, since
suitable conditions, with respect to the host and the
environment, must be present for disease develop.
• That we must known determinants of health and
disease - determinants are based on the Health Field
Concept (from Marc Lalonde´s documents names A
New Perspective on the Health of Canadians – 1974).
Human Biology (H B)
• Encompasses those aspects of health (both mental
and physical) which are determined by the organic
structure and physiological functioning of the human
body
• The genetic make up of the individual determines
the likelihood of inherited disorders and the
predisposition to later acquired diseases.
• The individual´s constitution is also a determinant of
susceptibility to risk factors arising form certain
lifestyles and environments.
Human Body
• Changes in the human body due to maturation and
aging are also important factors that can interact
with the other three Health Field elements in
determining the individual´s state of health.
• The H B elements has many facets, only a few of
which are adequately understood.
• The medical and allied sciences have made great
progress in understanding the complex process of
the human body and mind, but much remains to be
elucidated.
Environment
Comprises
• Physical environment
• Social environment
The Physical Environment (P E)
Include:
• the quality of air, water and soil;
• the safety of food, drugs, and other products which
human consume or exposed to;
• the physical handling and disposal of waste;
• the control of excessive noise.
Directly affects of P E – by exposure to potentially
hazardous agents (chemicals or radiation)and etc.
Indirectly affects of P E – by global warming, redundant
hunt of animals, etc
Social environment
• Life expectancy – Rural vs Urban, Developed
vs developing UG? Japan?
• Focuses on social determinants of health
• What are the main social determinnats of
health?
Main social determinants of
health
1. Social organization, stress, and health
2. Early life
3. The life course, the social gradient, and health
4. Health and labour market, unemployment, non-
employment, job insecurity
5. Health and psychosocial environment at work
6. Transport and health
7. Social support and social cohesion
8. Food is a political issue
Main social determinants of
health
9. Poverty, social exclusion, and minorities
10. Social patterning of individual health behaviours: the
case of cigarette smoking
11. The social determination of ethnic/racial inequalities in
health
12. The social determinants of health in older age
13. Neighbourhoods, housing, and health
14. Social determinants, sexual behaviour, and sexual health
15. Ourselves and others – for better or worse: social
vulnerability and inequality
Health care system
• In includes medical and dental practice,
nursing, hospitals, specialised facilities,
rehabilitation, drugs, public health services,
and health services provided by allied health
professionals
• Access ??
Lifestyle and behaviours
• Lifestyle consist of aspects of individuals´ behaviour
and surroundings over which they may exercise
control, although recognition of the importance of
the social and physical environmental context in this
concept is increasing.
• Healthy lifestyle comprise patterns of health-related
behaviour, values and attitudes adapted by groups of
individuals in response to their social, cultural and
economic environment.
Determinants of health
Many factors combine together to affect the
health of individuals and communities.
Whether people are healthy or not, is
determined by their circumstances and
environment.
Determinants of health
1. Income and social status - higher income and
social status are linked to better health. The
greater the gap between the richest and
poorest people, the greater the differences in
health.
Determinants of Health
• Education – low education levels are linked with poor
health, more stress and lower self-confidence.
International evidence to show that those
with higher levels of education live longer,
have better health and healthier lifestyles
2. Physical environment – safe water and clean air,
healthy workplaces, safe houses, communities and
roads all contribute to good health. Employment and
working conditions – people in employment are
healthier, particularly those who have more control
over their working conditions
Determinants of Health
4. Social support networks – greater support
from families, friends and communities is
linked to better health. Culture - customs and
traditions, and the beliefs of the family and
community all affect health.
5. Health services - access and use of services
that prevent and treat disease influences
health
Determinants of Health
6. Genetics - inheritance plays a part in
determining lifespan, healthiness and the
likelihood of developing certain illnesses.
Personal behaviour and coping skills –
balanced eating, keeping active, smoking,
drinking, and how we deal with life’s stresses
and challenges all affect health.
Determinants of Health
7. Gender - Men and women suffer from
different types of diseases at different ages.
OTHERS
8. Healthy child development
9. Personal health practices and coping skills
10. Employment
Ten Tips For Better Health
1. Don't smoke. If you can, stop. If you can't,
cut down.
2. Follow a balanced diet with plenty of fruit
and vegetables.
3. Keep physically active.
4. Manage stress by, for example, talking
things through and making time to relax.
5. If you drink alcohol, do so in moderation.
Ten Tips For Better Health
6. Cover up in the sun, and protect children
from sunburn.
7. Practice safer sex.
8. Take up cancer screening opportunities.
9. Be safe on the roads: follow the Highway
Code.
10. Learn the First Aid ABC : airways,
breathing, circulation.
Dr. Liam Donaldson, UK CMO 1999
