Ageing, Determinants of Health, and
Evidence-Based Medicine
HCMP
2
Giovanni Fattore
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Learning objectives of Class II
• Beyond health expectancy: years in good health and
ageing
• Let you be familiar with the main determinants of health
• Let you be aware of the distinctions between health
care policy and health policy
• Discuss the obesity epidemics and possible policy to
address
• Let you get a first idea of what Evidence-Based
Medicine is
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The evolution of multiple-chronic conditions related to age and the socio-
economic factors in Scotland
+20%
10%
Source: Barnett et al, 2012 4
The (EU) healthcare demand and the burden of
chronic conditions
✓ Europe has the highest burden of chronic
diseases that account for 86% of all
deaths
✓ 2 out of 3 people aged +65 have at least
two chronic conditions
✓ 70% to 80% of healthcare costs are
spent on chronic diseases (€700
billion in the EU 25), out of which 97%
are presently spent on treatment while
only 3% on prevention
✓ Poor reliability of data to understand the
real costs of chronic conditions
Source: Health Policy Forum: Answer to DG Sanco consultation on chronic diseases (2012)
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Health Determinants
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One Health or Planetary Health (Stefano Recchia, 2021)
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Source: https://www.farodiroma.it/one-health-una-strategia-per-la-salute-globale-di-stefano-recchia/
Difference in Life Expectancy between the least and the
most educated quintiles
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Silano, Agostoni and Fattore 2019
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The correlation of social spending and mortality rates in 18
European Countries:
(source: Stuckler et al, 2010)
Social Determinants
•Education – higher levels of education often lead to better health due to
increased knowledge and resources.
•Employment and Working Conditions - Job security, work safety, and
stress levels can significantly influence health.
•Social Support Networks - Strong family and community support can
improve health outcomes through emotional support and practical
assistance.
•Culture - Cultural norms and values can affect health behaviors and access
to health services.
•Gender - Health risks and outcomes can vary significantly between genders
due to biological differences, social roles, and unequal power dynamics.
•Peace there about 20 active wars in the world (about 150-200,000 death in
the Russian-Ukrain war)
Giovanni Fattore MIHMEP HCSP 12
Session 2
Economic Determinants
Income and Social Protection - Higher income levels generally provide
better access to healthcare, nutritious food, and healthier living
conditions.
Food Security - Availability, accessibility, and affordability of nutritious
, food directly impact health status.
Housing and Basic Amenities - Quality, safety, and stability of housing
along with access to basic services like clean water and sanitation are
crucial for good health.
Giovanni Fattore MIHMEP HCSP 13
Session 2
Enviromental Determinants
Physical Environment - This includes pollution levels, presence of
hazardous substances, and climatic conditions that can affect
health.
Built Environment - Urban design, infrastructure, and public
spaces can influence physical activity levels and risks of accidents.
,
Access to Healthcare Services - Availability of and access to
quality healthcare services can greatly influence health outcomes.
Climate Change - Changes in climate can affect health through
heatwaves, cold snaps, increased pollution, and altered patterns of
disease
Giovanni Fattore MIHMEP HCSP 14
Session 2
Lifestyles, Education and Health expenditure are the main
contributing factors of the gain in life expectancy
Contributions to life expectancy gains at birth between 1990 and 2013
Source: OECD Data and Estimates, James et al (2016) (OECD Health working paper)
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Obesity in adults from 1975 to 2016
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Itlay: Obesity among children and adolescents
from 1975 to 2016
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Class discussion about obesity and the policies
to contrast it
1. Which are the long trend factors determining obesity?
2. List the possible determinants of obesity!
3. Present possible policy options to address obesity
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Health care policies (policies targeted to provide
services) and health policies (wider range of
interventions aimed at improving people health)
Health Policies Health care policies
Education Hospital care
Environmental protection Primary care
Transport safety Outpatient specialist care
Sport and recreation Intermediate care
Work and living environments Mental Health
Food and nutrition Pharmaceutical care
Public Health Interventions
Rehabilition
Health education
……….
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What is Evidence-Based Medicine
Listen to the video and search the meaning of the terms that are
unknown to you. Be prepared to simply present this terms in class (you
can use Chat-GPT or other generative AI programs)
• https://www.youtube.com/watch?v=P-G2veeYC1Q
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