Determinants of Health

What is
health?
 “Health is a state of complete physical,
mental and social well-being and not merely
the absence of disease or infirmity" (WHO,
Multiple 1994)

definitions “Health is a state of well-being and the

capability to function in the face of changing
circumstances” (WHO 1986)
of health Health is, therefore, a positive concept
exist emphasizing social and personal resources as
well as physical capabilities.
Improving health is a shared responsibility of
health care providers, public health officials,
and a variety of other actors in the
community
Health
• Health is not simply about behaviour or exposure to risk, but how
social and economic structures shape the health of populations.
• The origins of good health are multiple and cross-sectorial
• A focus on the origins of health:
- Emphasizes the need for cross-sectorial assumptions of
responsibilities
- Creates multiple options for intervention
 • Health starts in our homes, schools, workplaces,
neighbourhoods, and communities.
• We know that taking care of ourselves by eating well and
staying active, not smoking, getting the recommended
immunizations and screening tests, and seeing a doctor
when we are sick all influence our health.
• Our health is also determined by

Introduction -Access to social and economic opportunities;

- The resources and supports available in our homes,
-Neighbourhoods, and communities;
-The quality of our schooling;
-Safety;
-Cleanliness of our water, food, and air;
-Nature of our social interactions and relationships.
 • In recent decades, “social determinants of
health” has received considerable attention as a
foundational concept in the field of population
and public health

Evidence • Given that social determinants of health are vital

for overall public health achievement, a clear

d based
understanding of the concept is crucial.

• The list of social determinants of health has

implications on clinical practice and policy making
(Islam, 2019.
Frontiers in public health ).
 • Despite remarkable technological and biological
advances in health care, far less progress has
been made in addressing social determinants of
health.
• Nursing, with its holistic model of health care, is

Evidence positioned to be a leader in improving health by

linking SDH to outcomes through analysis and
action.

d Based • Nursing has always had a strong focus on SDH.

Florence Nightingale emphasized the importance
of hygiene, nutrition, social network, and social
class

(Olshansky, 2017, American Journal of Nursing)

Five key areas of determinants include
 • What makes some people healthy and
others unhealthy?

Determinants • How can we create a society in which

of Health- everyone has a chance to live long healthy
lives?
referred to as
'the causes of • The range of personal, social, economic,
and environmental factors that influence
the causes', health status are known as determinants
of health.
 • are myriad but they are often categorised as 'upstream',
'midstream' and 'downstream' determinants.
• Upstream factors are those under national control and
include social, physical, economic and environmental

The factors such as education, employment, income and

housing.

determinants • Midstream factors are intermediate level factors which

affect defined populations such as local communities,
schools or universities and include local availability of

of health are: healthy choices such as diet, facilities for exercise and
safe neighbourhoods.
• Downstream factors include individual lifestyle factors
(such as smoking, alcohol intake and diet) and
demographic and hereditary factors that an individual
has no influence over.
 Developing objectives that address
Healthy the relationship between health status
and biology, individual behavior,
People 2020 health services, social factors, and
policies.
is exploring
these Emphasizing an ecological approach to
disease prevention and health
questions by: promotion.

• - An ecological approach focuses on both

individual-level and population-level
determinants of health and intervention
 Policies at the local, regional, and
international level affect individual and
population health.

Eg. Increasing taxes on tobacco sales, can

Policymakin improve population health by reducing the
number of people using tobacco products
g • Some policies affect entire populations over
extended periods of time while simultaneously
helping to change individual behavior.

eg- safety standards for cars, including

seat belts, DUI, etc
 Reflect the social factors and physical
conditions of the environment in
which people are born, live, learn,
play, work, and age.

Social AKA as social and physical

determinants of health,

Factors - they impact a wide range of health,

functioning, and quality-of-life
outcomes.
Social determinants

Exposure to crime,
lack of/unstable Social norms and
Availability of resources violence, and social
housing, food insecurity, attitudes, such as
to meet daily needs disorder, such as the
lack of transportation) discrimination
presence of trash

Exposure to mass media

and emerging Socioeconomic
Social support and social
technologies, such as conditions, such as Quality schools
interactions
the internet or cell concentrated poverty
phones

Transportation options Public safety Residential segregation

Physical determinants
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

Exposure to toxic substances and other physical hazards

Physical barriers, especially for people with disabilities

Aesthetic elements, such as good lighting, trees, or benches

What good does it do to treat people's illnesses ...
….then send them back to the conditions that made them sick?
 Barriers to • Barriers to accessing health
services include:
• These barriers to accessing
health services lead to:
accessing
health services • Lack of availability • Unmet health needs
include: • High cost • Delays in receiving
• Lack of insurance coverage appropriate care

• Limited language access • Inability to get preventive

services
• Hospitalizations that could
have been prevented
Individual Behavior

Many public health and health care interventions focus on changing

individual behaviors

- eg. substance abuse, diet, and physical activity.

• Positive changes in individual behavior can reduce the rates of chronic disease.
• Diet
• Physical activity
• Alcohol, cigarette, and other drug use
• Hand washing
Biology and Genetics Factors
• Affect specific populations more than others.
- eg. older adults are biologically prone to being in poorer health than adolescents
due to the physical and cognitive effects of aging.
• Sickle cell disease is a common example of a Genetic determinant of health
• Eg. Age
Sex
HIV status
Inherited conditions - sickle-cell anemia, hemophilia, and cystic fibrosis
Carrying the BRCA1 or BRCA2 gene- increases risk for breast and ovarian cancer
Family history of heart disease , Chronic diseases
The Impact of Social Determinants of Health

According to CDC, it has been well-established that poverty

inhibits access to healthy foods and safe neighbourhoods,
and that higher levels of education influence better health

When such resources are lacking, social determinants can

create undesirable circumstances, such as disparities and
discrimination may impact multiple generations
HP and DOH
• The social determinants of health are fundamental to HP.

• HP strategies need to address social factors, as many differences in health are socially
created.
• Negative social determinants of health can impact both an individual’s knowledge about
healthcare and resources, and limit access to them

• As health promotion professionals, we have the opportunity, and obligation to apply the
same best practices we routinely apply to other initiatives to our efforts to address social
risk factors and unmet social needs.
 • Involving the population as a whole in the context of
The Ottawa their everyday life, rather than focusing on people at
risk for specific disease.
Charter • Directed towards the action on the determinants or
(1986) causes of health; requiring co-operation between
sectors and government responsibility
define the • Combining diverse, but complementary, methods or
approaches; including individual communication and
principles of education as well as legislation and fiscal measures,
health organisational and community development
• Effective and concrete community participation
promotion • Involvement of health professionals, particularly in
primary health care