Aust

inol.
:

det
ermi
nant
sofheal
thi
ncl
udes:

I
ncomeandsoci
alst
atus

Soci
alsuppor
tnet
wor
ks

Educat
ionandl
it
eracy

Empl
oyment
/wor
kingcondi
ti
ons

Soci
alenvi
ronment
s

Physi
calenvi
ronment
s

Per
sonalheal
thpr
act
icesandcopi
ngski
ll
s

Heal
thychi
lddevel
opment

Bi
ologyandgenet
icendowment

Heal
thser
vices

Gender
Cul
tur
e

*
HEALTHDETERMI
NANTCONTEXTS*

Thecontextofpeople’
sli
vesdeterminethei
rhealth,
andsoblami ngindivi
dualsforhavingpoor
heal
thorcrediti
ngthem f
orgoodheal t
hisinappropri
ate.I
ndi
vidual
sar eunli
kelytobeableto
di
rect
lycontrolmanyofthedeterminantsofhealt
h.Thesedeterminants—orthingsthatmake
peopl
ehealthyornot—incl
udetheabovef actor
s,andmanyot hers:

I
ncomeandsoci
alst
atus-hi
gherincomeandsoci
alst
atusar
elinkedtobett
erhealt
h.The
gr
eat
ert
hegapbetweentheri
chestandpoor
estpeopl
e,t
hegreatert
hedif
ferencesi
nhealt
h.

Educati
on–loweducat
ionl
evel
sar
eli
nkedwi
thpoorheal
th,
mor
est
ressandl
owersel
f-
confi
dence.

Physi
calenvi
ronment–saf
ewaterandcl
eanai
r,heal
thywor
kpl
aces,
saf
ehouses,
communiti
esandroadsal
lcont
ri
butet
ogoodhealt
h..

Employmentandworki
ngcondi
ti
ons–peoplei
nemploymentar
eheal
thi
er,
par
ti
cul
arl
ythose
whohavemorecont
rolovert
hei
rworki
ngcondi
ti
ons

Soci
alsupportnet
wor
ks–gr
eat
ersuppor
tfr
om f
ami
li
es,
fri
endsandcommuni
ti
esi
sli
nkedt
o
bet
terheal
th.

Cul
tur
e-cust
omsandt
radi
ti
ons,
andt
hebel
ief
soft
hef
ami
lyandcommuni
tyal
laf
fectheal
th.

Geneti
cs-inherit
anceplaysaparti
ndeter
mini
nglif
espan,heal
thi
nessandt hel
ikeli
hoodof
devel
opingcertai
nill
nesses.Per
sonal
behavi
ourandcopingskil
ls–balancedeating,keepi
ng
acti
ve,smoking,dri
nki
ng,andhowwedeal wit
hli
fe’
sstressesandchal
lengesal
laf f
ecthealt
h.
Heal
thser
vices-accessanduseofser
vicest
hatpr
eventandt
reatdi
seasei
nfl
uencesheal
th

Gender-Menandwomensuf
ferf
rom di
ff
erentt
ypesofdi
seasesatdi
ff
erentages.

*
EVI
DENCEBASEOFHEALTHDETERMI
NANTS!
*

Anevi dencebaseaboutt heimpactt hatprojects,

pr ogr ammesandpol i
cieshavehadonheal th
i
sr equiredt ocar r
youtHI A.Thebestavai lableevidencei susedwithintheappr aisalstageof
HIAt odet erminewhati mpact smayoccur( bothposi tiveandnegat ive),t
hesi zeoft hei mpact
(i
fpossi ble)andt hedistributionoft hatimpacti ndiffer entpopulat
iongr oups.I ti
sgener all
y
assumedt hattheevidencef orheal thimpact sexists, andt hatsearchingandcol lati
ngwi l
l
providet henecessar yevi dence.Unf ortunatelythi
si snotof t
enthecase, andt heevi denceof
healthimpact sisoftennotavai lable.Thisi sbecauseoft helongcausalpat hwaybet weenthe
i
mpl ement ati
onofapr oject/progr amme/ policyandanypot enti
ali
mpactonpopul ationhealt
h,
andt hemanyconf oundingf act orst hatmaket hedet ermi nati
onofal inkdiff
icul t
.Wi thi
nthe
HIAitisi mpor tantthereforetobeexpl ici
taboutsour cesofevi denceandt oident if
ymi ssi
ngor
i
ncompl eteinformat i
on.

Provi
dingacompr ehensi
ver evi
ewoft heevi
dencebasei snotsimple.Itneedstodrawont he
bestavai
lableevidence–t hatfrom r
eviewsandr esearchpapers,andi ncl
udingquali
tat
iveand
quanti
tat
iveevidence.Thisinformati
onmustbesuppl ementedwi t
hl ocalandexpert
knowledge,pol
icyinformation,andproposalspecif
icinformati
on.

However
,ther
ear
eexampleswherethebestavai
lableevi
dencehasbeendocument
ed,
andi
n
somecasessummar
ised.Thesear
epresentedbelow:

Tr
anspor
t

FoodandAgr
icul
tur
e

Housi
ng

Wast
e
Ener
gy

I
ndust
ry

Ur
bani
zat
ion

Wat
er

Radi
ati
on

Nut
ri
ti
onandheal
th

Tr
anspor
t

Evi
denceofheal
thi
mpactf
ocuson:

Accident
sbet
weenmot
orvehi
cles,
bicycl
esandpedest
ri
ans(
par
ti
cul
arl
ychi
ldr
enandyoung
people)
.

Pol
lut
ionf
rom bur
ningf
ossi
lfuel
ssuchaspar
ti
cul
atesandozone.

Noi
sef
rom t
ranspor
tat
ion.

Psychosoci
alef
fect
ssuchassever
anceofcommuni
ti
esbyl
arger
oadsandt
her
est
ri
cti
onof
chi
ldren’
smovement.

Cl
i
mat
echangeduet
oCO2emi
ssi
on

Lossofl
and

I
mpr
ovedphysi
calact
ivi
tyf
rom cycl
ingorwal
king
I
ncr
easedaccesst
oempl
oyment
,shopsandsuppor
tser
vices

Recr
eat
ionalusesofr
oadspaces

Cont
ri
but
est
oeconomi
cdevel
opment

Vect
orbor
nedi
seases

*
FoodandAgr
icul
tur
e*

Tobaccof ar
mingandi t
simpactonheartdi
sease,st
roke,
cert
aincancersandchr
oni
c
respi
rator
ydisease.I
ncludi
ngpassi
vesmokingandi mpactoffoet
aldevel
opment
.Pest
ici
de
poli
ciesontobaccocropsrequi
reconsi
derat
ion.

Changesi
nlanduse,
soi
lqual
it
y,choi
ceofcr
op,
useofagr
icul
tur
all
abourandoccupat
ional
heal
th.

Mechani
sat
ionofwor
kpr
evi
ousl
ydonebyhand,
andpl
ant
ati
onagr
icul
tur
e.

Fi
sher
ies–bi
otoxi
ns,
pol
lut
ion,
chemi
caluse,
wast
ewat
er,
processi
ng,
andoccupat
ionalheal
th

For
est
ry–vect
orbor
nedi
seases,
occupat
ional
heal
th,
andf
oodsecur
it
y.

Li
vest
ockuse–vect
orbor
nedi
seases,
drugr
esi
dues,
ani
malf
eed,
wast
e,andf
oodsecur
it
y.

Sustai
nablef
armi
ngincl
udingchemicalandener
gyuse,
biodi
ver
sit
y,or
gani
cpr
oduct
ion
methods,anddi
ver
sit
yoffoodsproduced.

Fer
ti
li
seruse–ni
tr
atel
evel
sinf
ood,
pol
lut
ionofwat
erways,
re-
useofagr
icul
tur
alwast
e.

Wat
er–i
rr
igat
ionuseandi
tsi
mpactonr
iver
/wat
er-
tabl
elevel
sandpr
oduct
ionout
put
s.

Pest
ici
deusageandvet
eri
nar
ydr
ugs–l
egal
requi
rement
s,bestpr
act
ice,
consumeri
ssues.

Foodpackagi
ng,
preser
vat
ionandsaf
ety
,andavoi
danceofl
ongst
orageandt
ravel
.

Accesst
o,anddi
str
ibut
ionoff
ood
Householdf
oodsecur
it
y–appropr
iat
efoodbei
ngav
ail
able,
withadequateaccessandbei
ng
aff
ordabl
e(l
ocat
ionofmar
ket
s,super
market
sandcl
osureofsmallsuppl
ier
screati
ngfood
desert
sinci
ti
es)
.

Foodsuppl
ies,
incl
udi
ngnat
ional
andr
egi
onal
foodsecur
it
y,andr
egi
onalpr
oduct
ion.

Nati
onalf
oodsecuri
ty–abletopr
ovi
deadequat
enut
ri
ti
onwi
thi
nacount
rywi
thoutr
elyi
ng
heavi
lyonimpor
tedproduct
s

Col
d-chai
nrel
iabi
li
ty–t
hesaf
etyoft
ranspor
ti
ngpr
oduct
sthatdet
eri
orat
emi
crobi
ologi
cal
lyi
n
t
heheat.

Di
etar
ypat
ter
ns,
diver
sit
yoff
oodavai
labl
eandhomepr
oduct
ion,
par
ti
cul
arl
y:

Fr
uitandv
eget
abl
econsumpt
iononr
educedst
roke,
hear
tdi
seaseandr
iskofcer
tai
ncancer
s,

Total,
saturatedandpolyunsat
uratedf
at,carbohydr
atesandsugar
sconsumpt
iononobesi
ty,
heartdisease,st
rokeandothervascul
ardiseases.

Alcoholconsumpt i
onandi mpactonsoci al
effectsrel
atedt obehaviour(t
raf
fi
caccidents,
wor k/homeacci dents,
violence,socialr
elat
ions,unwantedpr egnancyandSTDs) ,andtoxi
c
effects(all
-causemor t
ali
ty,alcoholi
sm,certai
ncancer s,l
iverci
rrhosis,
psychosi
s,poisoni
ng,
gast r
it
is,st
r oke,
foet
alalcohol syndromeandot hers).

Micr
onut
ri
entssuchasi
ron,
vit
ami
nA,
zincandi
odi
neandt
hei
rimpactondef
ici
ency
sy
ndromes.

Foodsaf
etyandf
oodbor
nei
ll
nesshazzar
ds

Foodandwaterar
ethemajorsour
cesofexposur
etobot
hchemicalandbiol
ogi
calhazzards.
Theyi
mposeasubstanti
alheal
thr
iskt
oconsumersandeconomi
cbur densoni
ndivi
duals,
communit
iesandnat
ions.

Mi
croor
gani
smssuchassal
monel
la,
campyl
obact
er,
E.col
iO157,
li
ster
ia,
chol
era.

Vi
rusessuchashepat
it
isA,
andpar
asi
tessuchast
ri
chomonosi
sinpi
gsandcat
tl
e.

Nat
ural
lyoccur
ingt
oxi
nssuchasmycot
oxi
ns,
mar
inebi
otoxi
nsandgl
ycosi
des.

Unconvent
ionalagentssuchast
heagentcausi
ngbovi
nespongi
for
m encephal
opat
hy(
BSE,
or
"
madcowdi sease"
),

Per
sist
antor
gani
cpol
lut
ant
ssuchasdi
oxi
nsandPCBs.Met
alssuchasl
eadandmer
cur
y.

Newfoodsdevel
opedfrom bi
otechnol
ogysuchascropsmodi
fi
edt
oresi
stpest
s,changesi
n
ani
malhusbandr
y,ant
ibiot
icuseandnewf oodaddi
ti
ves
Housi
ng

Evi
denceofheal
thi
mpact
sfocuson:

I
mpr
ovement
sinhousi
ngandi
mpr
ovedment
alheal
thandgener
alheal
th

Thepossi
bil
it
yofi
mpr
ovedhousi
ngl
eadi
ngt
orentr
ises,
impact
ingnegat
ivel
yonheal
th.

Movementofori
ginalt
enant
saf
terhousi
ngi
mpr
ovementandt
her
efor
enotbenef
it
ingf
rom t
he
i
mprovements.

Housi
ngt enure,out
doortemper
atur
e,i
ndoorai
rqual
i
ty,
dampness,housingdesi
gn,r
ent
subsi
dies,r
elocati
on,al
ler
gensanddustmit
es,
homeaccidentpr
event
ion,andfi
repr
event
ion.

Homel
essness.

Wast
e

Evi
denceofheal
thi
mpact
sfocusesonenvi
ronment
alandsoci
aldet
ermi
nant
srel
atedt
o:

thet
ransmi
ssi
onofagentsofi
nfect
iousdi
seasef
rom humanandani
malexcr
eta(
sani
tat
ion,
hygi
eneandwater
-r
elat
ed);

exposur
etotoxi
cchemi
cal
sinhumanandani
malexcr
eta;andi
nindust
ri
alwast
esdi
schar
ged
i
ntotheenvi
ronment
;
envi
ronment
aldegr
adat
ion,
dir
ectandi
ndi
recti
mpact
sonheal
th;

exposur
etor
adi
oact
ivewast
es;

exposur
etoheal
th-
car
ewast
es;

exposur
etosol
idwast
esandi
nvol
vementi
ninf
ormalwast
erecycl
ing;and

br
eedi
ngofdi
seasevect
ors.

Ener
gy

Evi
denceofheal
thi
mpact
sfocusonheal
thhazzar
dssuchas:

Fossi
lfuel
s

Bi
omassf
uel
s

Hy
dropowerandt
hei
rimpactonvect
orbor
nedi
seases,
andpol
lut
ion

El
ect
ri
cit
ygener
ati
onandt
ransmi
ssi
on

Nucl
earpower

Ot
herener
gysour
ces
Occupat
ionalheal
thef
fect
sofener
gywor
ker
s

I
mpact
sonecosyst
ems,
agr
icul
tur
e,f
orest
s,f
isher
iesandbui
ldi
ngmat
eri
als

Noi
se

Vi
suali
mpact

Gl
obalwar
ming

I
ndust
ry

Evi
denceofheal
thi
mpact
sfocusoni
ndust
ri
alsect
orssuchas:

Asbest
osandmanmadef
ibr
es

Basi
cchemi
cal
s

Cement
,gl
assandcer
ami
cs

El
ect
roni
cds

I
ronandst
eel
Manuf
act
ureofr
ubberandpl
ast
icpr
oduct
s

Met
alpr
oduct
s

Mi
ning

Pest
ici
des,
pai
ntsandphar
maceut
ical
s

Pet
rol
eum pr
oduct
s

Pul
pandpaer

Ser
vicei
ndust
ri
es

Text
il
esandl
eat
her

Woodandf
urni
tur
e

*
Indust
ry*

Evi
denceofheal
thi
mpact
sfocusoni
ndust
ri
alsect
orssuchas:

Asbest
osandmanmadef
ibr
es

Basi
cchemi
cal
s

Cement
,gl
assandcer
ami
cs

El
ect
roni
cds
I
ronandst
eel

Manuf
act
ureofr
ubberandpl
ast
icpr
oduct
s

Met
alpr
oduct
s

Mi
ning

Pest
ici
des,
pai
ntsandphar
maceut
ical
s

Pet
rol
eum pr
oduct
s

Pul
pandpaer

Ser
vicei
ndust
ri
es

Text
il
esandl
eat
her

Woodandf
urni
tur
e

*
SUMMARY!
!!
!*

*
PUBLI
CHEALTHPHARMACYCOMPETENCE*

*
Concept&Det
ermi
nant
sofheal
th:
*

-
takenot
eoft
het
ypesofconceptandt
hei
rrel
ati
vei
mpl
icat
ionst
oheal
thcar
e.

*
Thedet
ermi
nant
sofheal
th:
*

*
Int
roduct
ion*

Manyfact
orscombinetogethert
oaff
ectt
hehealt
hofindivi
dual
sandcommuni t
ies.Whet
her
peopl
eareheal
thyornot,i
sdetermi
nedbythei
rci
rcumstancesandenvi
ronment.Toalar
ge
ext
ent,f
actorssuchaswherewel i
ve,t
hest at
eofourenvironment,
geneti
cs,ouri
ncomeand
educati
onlevel
,andourrel
ati
onshi
pswi t
hf ri
endsandfamilyal
lhaveconsider
abl
eimpactson
healt
h,whereasthemorecommonl yconsideredfact
orssuchasaccessanduseofhealt
hcare
servi
cesoft
enhavelessofanimpact.

*
Thedet
ermi
nant
sofheal
thi
ncl
ude:
*

t
hesoci
alandeconomi
cenvi
ronment
,

t
hephysi
calenvi
ronment
,and

t
heper
son’
sindi
vidualchar
act
eri
sti
csandbehavi
our
s.

Thecontextofpeople’
sli
vesdeterminethei
rhealth,
andsoblami ngindivi
dualsforhavingpoor
heal
thorcrediti
ngthem f
orgoodheal t
hisinappropri
ate.I
ndi
vidual
sar eunli
kelytobeableto
di
rect
lycontrolmanyofthedeterminantsofhealt
h.Thesedeterminants—orthingsthatmake
peopl
ehealthyornot—incl
udetheabovef actor
s,andmanyot hers:

I
ncomeandsoci
alst
atus-hi
gherincomeandsoci
alst
atusar
elinkedtobett
erhealt
h.The
gr
eat
ert
hegapbetweentheri
chestandpoor
estpeopl
e,t
hegreatert
hedif
ferencesi
nhealt
h.

Educati
on–loweducat
ionl
evel
sar
eli
nkedwi
thpoorheal
th,
mor
est
ressandl
owersel
f-
confi
dence.

Physi
calenvi
ronment–safewaterandcleanair
,healthyworkpl
aces,saf
ehouses,
communiti
esandr oadsal
lcont
ri
butetogoodhealth.Employmentandwor kingcondit
ions–
peopl
einempl oymentar
ehealt
hier
,par
ti
cular
lythosewhohavemor econtrolovert
heir
worki
ngconditions

Socialsupportnetwor
ks–gr eat
ersupportf
rom famil
ies,
friendsandcommuni
ti
esisl
inkedto
bett
erhealth.Cult
ure-cust
omsandt radi
ti
ons,andthebeliefsofthef
amil
yandcommunityal
l
aff
ecthealth.

Geneti
cs-inherit
anceplaysaparti
ndeter
mini
nglif
espan,heal
thi
nessandt hel
ikeli
hoodof
devel
opingcertai
nill
nesses.Per
sonal
behavi
ourandcopingskil
ls–balancedeating,keepi
ng
acti
ve,smoking,dri
nki
ng,andhowwedeal wit
hli
fe’
sstressesandchal
lengesal
laf f
ecthealt
h.

Heal
thser
vices-accessanduseofser
vicest
hatpr
eventandt
reatdi
seasei
nfl
uencesheal
th

Gender-Menandwomensuf
ferf
rom di
ff
erentt
ypesofdi
seasesatdi
ff
erentages.
SUMMARY

HEALTHPROMOTI
ON

-t
akenot
eoft
he3Model
sofheal
thPr
omot
ions.

*
Whati
sheal
thpr
omot
ion?
*

Healthpromoti
onenablespeopl
etoincreasecont
rolovert
hei
rownhealth.I
tcoversawide
rangeofsoci
alandenvironment
ali
nter
ventionst
hataredesi
gnedtobenefi
tandprotect
i
ndivi
dualpeopl
e’shealt
handquali
tyofli
febyaddressi
ngandprevent
ingtherootcausesofi
ll
healt
h,notj
ustfocusi
ngont r
eat
mentandcur e.

*
Ther
ear
e3keyel
ement
sofheal
thpr
omot
ion:
*

*
1.Goodgover
nancef
orheal
th*

Healt
hpr omoti
onr equi
respol
icymakersacrossallgovernmentdepartmentst
omakeheal t
ha
centr
alli
neofgover nmentpol
icy.Thi
smeanst heymustf act
orhealt
himplicat
ionsi
ntoal
lthe
deci
sionstheytake,andpri
ori
tizepol
ici
est
hatpr eventpeopl
efrom becomingil
landprot
ect
them f
rom inj
uri
es.

Thesepol i
ciesmustbesuppor tedbyr egulati
onsthatmatchprivat
esectorincent i
veswith
publi
cheal t
hgoals.Forexampl e,byaligni
ngt axpol
ici
esonunheal t
hyorhar mfulpr oduct
s
suchasal cohol
,tobacco,andfoodpr oduct swhicharehi
ghi nsalt
,sugarsandf atwi t
h
measur estoboosttradei
not herareas.Andt hroughlegi
slat
ionthatsupport
sheal thy
urbanizat
ionbycreatingwalkablecit
ies,reducingai
randwat erpoll
uti
on,enforcingthe
wearingofseatbeltsandhelmet s.
*
2.Heal
thl
it
eracy*

Peopl
eneedt oacquiretheknowledge,ski
ll
sandinformati
ont omakeheal t
hychoi
ces,f
or
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