ECOLOGICAL & SOCIAL

DETERMINANT
OF HEALTH
Prof.DR.dr.H.J.MUKONO,MS.,MPH
FAKULTAS KESEHATAN MASYARAKAT
UNIVERSITAS AIRLANGGA
SURABAYA
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 1 DEFINITION OF HEALTH

Health is a state of complete physical, mental

and social well-being, and not merely the
absence of disease or infirmity (World Health Organization, 1948).

Health is an individual right and a social justice issue.

It is also a public good.
Governments have a responsibility for the health of their
peoples which can be fulfilled only by the provision of
adequate health and social measures.
 DETERMINANT
OF HEALTH
The determinants of health include:
the social and economic environment, the physical
environment, and. the person's individual characteristics and
behaviours.
The Public Health Agency of Canada has identified 12
determinants of health as follows:
• Income and social status.
• Social support networks.
• Education and literacy.
• Employment/working conditions.
• Social environments.
• Physical environments.
• Personal health practices and coping skills.
• Healthy child development.
 COMMON DETERMINANT
OF HEALTH
→GENETIC FACTOR (BIOLOGICAL)
→ENVIRONMENTAL FACTORS
→LIFE STYLE BEHAVIOR &SOCIO – CULTURAL
→GENDER AND AGE
→SOSIOECONOMIC CONDITION
→OCCUPATION
→INCOME
→HEALTH SERVICE (IMMUNIZATION-NUTRITION FAMILYWELFARE)
1 FACTORS DETERMINING OF HEALTH

Clinical care is less important than many people think

whereas socioeconomic factors and the physical
environment
are quite influential on health and well-being.

Genetic characteristics are also less significant

than many people think.
Whether people are healthy or not, is determined by their
circumstances and environment – the social, economic and
environmental conditions which affect the health of the
population.
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 THE MOST IMPORTANT DETERMINANT
OF HEALTH
“INCOME”
is perhaps the most important social determinant of health.
Level of income shapes overall living conditions,
→affects psychological functioning,
→and influences health
→related behaviours

such as :
quality of diet, extent of physical activity, tobacco use, and excessive alcohol
use.
 WHAT ARE THE SOCIAL DETERMINANTS
1 OF HEALTH?

The social determinants of health are the conditions in which

people are born, grow, live, work and age. These
circumstances are shaped by the distribution of money, power
and resources at global, national and local levels.

The social determinants of health are mostly

responsible for health inequities – the unfair and
avoidable differences in health status seen within and
between countries.

The social determinants of health are multi-layered

and range from societal to individual factors.
 THE SOCIAL DETERMINANTS
1 OF HEALTH

Source: Dahlgren G and Whitehead M (1991)

Policies and strategies to promote social equity
in health. Stockholm, Institute of Future Studies.
 SOCIAL DETERMINANTS OF HEALTH
(SDOH)
DEFINITION
THE CONDITIONS IN THE ENVIRONMENTS WHERE PEOPLE ARE
BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE THAT
AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-
OF-LIFE OUTCOMES AND RISKS.
INCLUDED
1.ECONOMIC STABILITY
IIIII
2.EDUCATION ACCESS AND QUALITY
3.HEALTH CARE ACCSESS AND QUALITY
4.NEIGHBORHOOD AND BUILT ENVIRONMENT
5.SOCIAL AND COMMUNITY CONTEX
 MORE SPECIFIC SOCIAL DETERMINANTS
OF HEALTH
(SDOH)
IIIII

INCLUDED
1.RASIAL AND ETHNIC BIAS
2.CULTURAL DTFFERENCES
3.MEDIA INFLUENCES
4.POLITIC
5.LIVING CONDITION
6.GEOGRAPHY
 Law As a Social Determinant of Health

Public Health Legal

Law Practice Epidemiology

Legal epidemiology is the study of law as a factor in the cause,

distribution, and prevention of disease and injury in a population

Burris S, Ashe M, Levin D, et al. Annu Rev Public Health. 2016;37:135-48.

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 ECOLOGICAL DETERMINANT
OF HEALTH
The Ecological Determinant of Health are
“ The Ecosystem – based ‘goods and services’
that we get from nature.
 THE MOST IMPORTAN OF
ECOLOGICAL DETERMINANT
OF HEALTH
1.OXYGEN
2.WATER
3.THE OZON LAYER
4.VARIOUS NATURAL RESOURCES
5.DETOXIFYING PROCESSES
6.REASONABLY STABLE
7.HABITABLE CLIMATE
8.FOOD
9.FUEL
 AN ENVIRONMENTAL DETERMINANT OF
HEALTH IS, IN GENERAL,
Any external agent (biological, chemical, physical,
social, or cultural) that can be causally linked to a
change in health status.
EXAMPLES OF PHYSICAL DETERMINANTS INCLUDE:
Natural environment, such as:
Plants, weather, or climate change. Built environment,
such as buildings or transportation. Worksites,
schools, and recreational settings. Housing, homes,
and neighborhoods.