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Determinants of
Health

Online Course: Health a…

Introduction

"Health care is an important determinant

of health. Lifestyles are important
determinants of health. But... it is factors
in the social environment that determine
access to health services and influence
lifestyle choices in the first place." WHO
Director-General Dr Margaret Chan[1]

Many factors combine together to affect

the health of individuals and
communities. Whether a person is healthy
or unhealthy is determined by his/her
circumstances and environment. 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.

The context of people’s lives determine

their health, and so blaming individuals
for having poor health or crediting them
for good health is inappropriate.
Individuals are unlikely to be able to
directly control many of the determinants
of health. These determinants, or things
that make people healthy or not, include
the following and many others:

Determinants of Health

The range of personal, social, economic

and environmental factors that influence
health status are known as determinants
of health. These can be classified as:

1. The social and economic

environment
2. The physical environment
3. The person’s individual
characteristics and behaviours

There are many commonly accepted

determinants of health but there is no
single definition. The Office of Disease
Prevention and Health Promotion
(ODPHP
ODPHP) has broadly categorised the
determinants of health[2] and these have
been summarised below:

1. Policy-making

Policies at the local, state and federal level

effect individual and population health.
Increasing taxes on tobacco sales, for
example, can improve population health
by reducing the number of people using
tobacco products. Unfavorable conditions
can result due to substandard policies and
programmes, inadequate governance and
unfair economic arrangements.[3]

2. Social Factors

Social and physical determinants of health

reflect the conditions of the environment
in which people are born, live, learn, play,
work and age. Also known as social
determinants of health, they impact a
wide range of health, functioning and
quality-of-life outcomes. They represent
economic and political systems, physical
and social environments, as well as health
service access. Social determinants of
health (SDOH) have a major impact on
people’s health, well-being, and quality of
life.[4]

Examples include:

Availability of resources to meet daily

needs, such as educational and job
opportunities, living wages or
healthful foods
Social norms and attitudes such as
discrimination
Exposure to crime, violence and social
disorder
Social support and social interactions
Socioeconomic conditions such as
concentrated poverty
Quality schools
Transportation options
Urbanisation and the built
environment such as buildings or
transportation
Worksites, schools and recreational
settings
** Poor health outcomes are associated
with adverse conditions leading to social
risk factors[5]

3. Health Services

Both access to health services and the

quality of health services can impact
health. Barriers to accessing health
services include lack of availability, high
cost, lack of insurance coverage and
limited language access. These barriers to
accessing health services lead to unmet
health needs, delays in receiving
appropriate care, inability to get
preventive services as well as
hospitalisations that could have been
prevented.

4. Individual Behaviour

Individual behaviours such as diet,

physical activity, alcohol, tobacco and
other drug use also play a role in health
outcomes.

5. Biology and Genetics

Some biological and genetic factors affect

specific populations more than others.
Examples of biological and genetic
determinants of health include age, sex,
inherited conditions and genetic make-up.

Global Hands - Social Determinants

Watch on

Healthy People 2020 – Determinant

Watch on

The Social Determinants of NCDs -

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Social Determinants of Health: Clair

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Improving Health
Worldwide

WHO have identified three "common

interventions" for improving health
conditions worldwide:[6]

1. Education

A large number of studies have

demonstrated a strong link between
better education and better health,[7] and
education has been shown to be a reliable
predictor of lower mortality rates.[8][9] The
probability of being in good or very good
health is higher for people with university
or post-secondary education.[10]

2. Social Protection

Countries with some sort of social

protection (i.e. a safety net or social
security system) show improved health
and economic outcomes in circumstances
where people become unable to earn a
living.[11]

3. Urban Development

The physical environment where

communities live has a great impact on
the health of the residents.[12][13] Factors
which have a negative impact on health
include overcrowding, damp living
conditions and crime (in particular fear of
crime). The WHO concludes that health
outcomes "are largely determined by the
accessibility to adequate housing and to
healthy and safe urban environments and
by transport conditions".[6]

Relevance to
Rehabilitation

In our contact time with our patients, we

spend a lot of time understanding their
health and social status. In other words,
we explore the determinants that might be
affecting their health and in particular
ones that we can influence. The model we
use to analyse and understand these
determinants of health is the
biopsychosocial model of health care.

It is essential that healthcare workers

dedicated to improving health increase
their effectiveness by addressing the
“upstream” causes of health in the
community and by engaging in ways to
change the broad policies, systems and
environments that shape the social and
economic conditions that, in turn, so
strongly influence health. Swain et al.[14]
describe opportunities for the health-care
professional to address social
determinants of health. They suggest that
to be most effective at improving the
health of families and communities and to
ensure the greatest impact for the
investment of resources, health
professionals need to expand their
repertoire of skills and activities both with
their individual patients and in the policy
arena.

Resources

Health in the post-2015 development

agenda: need for a social determinants
of health approach: joint statement of
the UN Platform on Social
Determinants of Health.
The Social Determinants of Health: It's
Time to Consider the Causes of the
Causes

Practical
Assessment
and
Treatment
of
Cervicogeni
c
Headaches
An online course by Ari
Kaplan

Learn more on this topic

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expenditure,
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delivery[edit 31 Conclusion | edit source] and next Apply steps their 31
access
engage indicators.[3]
in, and transformative The global change monitoring
at all35 2
Education
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exercise and commitments
physical activity to
report
stages 2017
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million
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as physiotherapists
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interprofessional and
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our each
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patients to their
say health
and how they
next
teamsteps of health Working
providers, with individuals
wellness and fitness and
expenditures.[4]
act; and how this The Global
can be influenced Monitoring by
communities
providers, community commitments health45workers, 3 NHS public
! Report How
gender
organisations
focuses
and
of goodheard
professionals
Physiopedia
on financial
health providers,
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this second
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the local
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reduce their diseaseculture risk andand
health
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and Conclusion
how we act and looks
on the atbasis
how of
" management
improve

poverty
regimes
Working
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their48
many interpretations
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NHS
people globallyWhat
organisations
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payment
are pushed
commitments
and collaborate
and identify
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51 Partnerships
with
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of life
into
and
steps 48
4 power
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in much such
health professionals to help individuals and
a payment takes
organizations; and uphow morethey than 10% or (25%)
influence our
within
populations the health receive sectorappropriate 52 Partnerships health with

# of their
work,
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Commissioning
consumption
Plus
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Rolethe
reality
wellness, fitness,Groups
925 million people
conditions
as health
advocates
expenditures).
and health
health 55
or income

spendimproved
as well
sector for 53
Conclusion
promotion,
(so-called
as
prevention,
Globally, about
Opportunities
more than 10% of
the
Clinical
and and for
social
next inclusion
steps 55 Partnership through commitments 59 |5
management of disease and disability[edit
their household
communication income
and referral on health
pathways care, and
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edit source]as.Support advocates 59 For
scientific, individuals
educational, 60
over
between 200 million spend more than 25%. In
For local hospital
legislative, policyand other
systems
change policy60to For community-
changes that
initiatives to the
recentrehabilitation
based years, out-of-pocket services expenditures
Provisions of
health
promote professional
regular physical workforce activity 60 For andchanges
have
educationfallenand at the $1.90-a-day
training for families and $3.20-a-
to national
exercise policy
to enhance 61 health
Conclusion and prevent andto next
day poverty
increase lines.[4]
the integration Pillars of Universal
and participation
steps 61 Advocacy
Physiopedia
disease .Advocatecommitments for physical education, 65 6 The of
Health
persons Coverage[edit
with disabilities. | editSocial source] Three
health system:
physical conditioning, challenges andand wellness opportunities
pillars are identified
Inclusion[edit | edit as being
source] needed
Social to
inclusion
65 Health inequalities
instruction
About at all levelsduties of education, 67 NHS from
support
aims to keepa UHC strategy, groups
vulnerable and they from are being
Commissioning
preschool through Board higher 67 Outcomes
education
fundamental,
excluded frominterrelated
specific problems
circumstances.
frameworks
.Advocate for68community
News NHS constitution design that 68
restricting
Vulnerable countries
groups includefrom closer
theHealth to
elderly, universal
people
Conclusion
promotes and next
opportunities steps for69 safe physical system
coverage.
with The intersection
disabilities, of these three
commitments
activity and active
Courses 70religious
Conclusion minorities,
forms of transportation and next steps
pillars
women, aims to create an environment in bank
71
forPart Bgirls,
individuals Professions:LGBTQ, Statements etc. [6] The world
and populations offor allaction
ages
which
defines UHC
social is inclusion
a measurable as, “and In every achievable
72
andIntroduction
abilities Advocate
Contribute 73 Allied for healthstrategies that
goal.[6]
country, Raising
some74groups sufficient confront fundsbarriers to ensure that
professionals
reduce inequities Music
and barriers Therapyrelated 76 Dieticians to
the availability
prevent them from of health services that in
fully participating meet
78 Occupational
social
Shop determinants Therapistsof health 80
the majoreconomic,
political, health needs andofsocial the population. These In
Physiotherapists 81 Speech andlife. Language
order
groups tomay do this, it is suggested
be excluded not only that countries
through
Therapists
Contact 83 Paramedics 86 Radiographers
need
legal to: Increase
systems, land, theand efficiency
labour markets, of revenue but
88 Medical students 91 Clinical
collection
also discriminatory Re-prioritise government budgets
or stigmatizing
Commissioning Groups 93 Dentists and oral
to give
attitudes, money beliefs, to health
or perceptions. Explore innovative The 97
health teams 95 General practitioners
financing
disadvantage
Content opportunities
is often based likeon taxessocial on air
Hospital doctors 99 Midwives 101 Nurses 104
tickets,
identity, foreign
which exchange
may be across transactions,
dimensions or of
Obstetricians and gynaecologists 106
tobacco
gender,
Articles Access
age, development
location, occupation, assistance(aid)
race,
Paediatricians 109 Psychiatrists 112 Social
for health
ethnicity, Reducing
religion, reliance
citizenship on out-of-
status,
workers and social care 115 Abbreviations 117
pocket
disability,
Categories paymentssexual (where
orientation people pay
and gender directly
Reference list TABLE OF CONTENTS 56
for health
identity services
(SOGI), they
among other use) as a
factors. way to
This
WORKING FOR HEALTH EQUITY: THE ROLE
finance
kind healthexclusion
of social services. robs Instead of charging
individuals of