Determinants of Health

Question 1

Define health determinants

Answer 1

= Health determinants are factors that affect human health. It can be Biological, Behavioural, Social, and Structural.

Question 2

Biological determinants of health include:

Answer 2

• Age: old and young are at greater risk of becoming ill.
• Sex: Biological characteristics which include anatomy and Physiology. Male and females may be at higher risk for different diseases or be directly affected. e.g Prostate cancer and Breast cancer.
• Immune status: certain diseases affect the body’s natural defense systems, increasing the risk of HIV, TB, Diabetes, and Cancer [these sicknesses make the immune system weak]
• Genetics:

Question 3

Behavioral determinants of health include:

Answer 3

• Diet: insufficient food results in inadequate diet intake and child malnutrition, death, and disability. Excess food intake –>lack of exercise and then obesity.
• Physical activity: lack thereof leads to obesity
• Substance use: Alcohol and cigarettes
• Hand washing
• Mask wearing
• Physical distancing

Question 4

Social determinants of health include:

Answer 4

These situations are dependant on the individual in his or her community:

• Household economics
• Single-parent households: most households run by single moms. food, vaccination, stimulation, is the child getting all these?
• Communities in areas with a high prevalence of violence: the link between health and social circumstances.

Question 5

Structural determinants of health include:

Answer 5

• Social, economic, and political mechanisms generate social class inequalities in society.
• Macro-level
• Degree that government subsidizes health care or education.
• Policies about pollution, management of toxic waste. Policies about the built environment.
• Housing.

Question 6

Why should we know the determinants of health?

Answer 6

The way we define the causes of human ills often determines the solutions we seek.

Question 7

The graph that depicts the social model of health.

Answer 7

• In the centre, in red, are the biological determinants which are things that a person cannot exactly change.
• In the orange are the factors considered modifiable , but also largely influenced by social and community factors
• The green shows the living and working conditions which are also very much influenced by the blue which are the structural determinants.

Question 8

How then does the WHO define the social determinants of Health?

Answer 8

The World Health Organisation defines the social determinants of health as“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”.

Question 9

Proximal, Distal, and intermediate determinants, what do we mean by these?

Answer 9

Proximal Determinants? = Act on both micro and macro levels. Also referred to as downstream or directly affecting health.

Intermediate Determinants? = Origin of some proximal determinants. Broader social system and community structures. [focuses on the yellow?]

Distal determinants? = national, institutional, political, legal, and cultural factors, they indirectly influence health. These are called Upstream.

Question 10

Sources of a persons social situation

Answer 10

• i) Education
• ii) Work opportunities
• iii) Access to basic needs
• iv) Access to care [health and welfare]
• v) Low levels of social capital or community infrastructural support.

Question 11

Addressing the determinants of Health: what is required

Answer 11

• Cannot be achieved by the health sector alone
• Requires multiple stakeholders, community engagement and participation and a multi-sectoral approach – refer to my lecture on the elements and principles of PHC

Question 12

Case study - go through

Answer 12

• Thembi, is 14 months old and lives with her grandmother in a homestead in the Mount Frere district. Her grandmother receives a pension of R1800 per month, but this supports two other grandchildren and herself. She keeps chickens but cannot grow a vegetable garden because rain has been erratic and the homestead has no running water. Thembi was breastfed for one week. Thembi’s grandmother has been feeding the little girl a thin porridge, but in the last two weeks she has not been eating well. Thembi’s stomach was distended; she gave the baby an enema. She was diagnosed with marasmic-kwashiokor (severe wasting and oedema), and dehydration.