Lecture 12Framing the Determinants of Population Health: the Dahlgren & Whitehead Model Flashcards
Causes of causes
For individuals: “any event, characteristic or other definable entity, that brings about a change for better or worse in health”
Income
Employment
Education
Housing and neighbourhoods
Societal characteristics e.g. racism, attitudes to alcohol or violence, value on children
Autonomy and empowerment – social cohesion
These determinants may vary at different life-stages
(IEEHSA)
Determinants of health for populations
(AKA Causes of the Causes for populations)
Concepts are similar as for individuals, but nature of determinants is often different
– Not just application of the individual perspective to whole population, but includes characteristics of the population itself.
Determinants of health in populations are also related to the context in which the population exists
Systolic BP in middle-aged males
Approaches to reducing high BP in the population
Often, determinants and actions/interventions designed to improve population health are discussed using the analogy of a river:
Downstream interventions operate at the micro (proximal) level, including treatment systems and disease management.
Upstream interventions operate at the macro (distal) level, such as government policies and international trade agreements.
Proximal and Distal determinants (causes of causes)
Distal Determinants:
A determinant of health that is either distant in time and/or place from the change in health status.
Distal determinants of health are also referred to as ‘upstream factors’. E.g. national, political, legal and cultural factors that indirectly influence health by acting on the proximal factors.
Proximal Determinants:
A determinant of health that is proximate or near to the change in health status;
‘Near’ generally refers to any determinant that is readily and directly associated with the change in health status. E.g. lifestyles and behavioural factors related to nutrition or smoking or other exposures.
Using the Dahlgren and Whitehead Model
Level 1 – the individual
Age, sex, constitutional factors & individual lifestyle factors
At the core of the Dahlgren & Whitehead model are factors that are sometimes referred to as ‘non-modifiable’ determinants: genes and biology
There are important distinctions between the impact on individuals and populations
– Single gene disorders = rare among the population
– Polygenic inheritance = influences likelihood of offspring developing a disease
Genes are important, but so too is the influence of the environment
Level 1 – the individual
There is a wealth of evidence demonstrating the importance of food, exercise, and risky behaviours in relation to health outcomes.
– Remember the social gradient
The choices you make as an individual impact on the likelihood that you will have good (or bad) health
Habitus: lifestyle, values, dispositions and expectation of particular social groups ‘learned’ through everyday activities
– Ability to change behaviour(s) may vary by social group
Level 2 – the community
Social and community networks & Living and working conditions
Families and friends play a significant role in developing ‘normative’ behaviours
Attitudes and behaviours of people living and working in the local community influence the sense of what is normal and acceptable
Social capital – the value of social networks that facilitates bonds between similar groups of people
– Provides an inclusive environment for people from diverse backgrounds
– Civic participation, volunteerism, supportive communities
– “It’s not what you know, but who you know”!
Level 3 – the environment
General socioeconomic, cultural and environmental conditions
Physical environments
– Water quality, clean air, all living things
Built environments
– Design of communities: buildings, roads, light rail
Cultural environments
– Knowledge, beliefs, and values that are accepted by a group of people
Biological environments
– Emerging or re-emerging toxins affecting populations
The ecosystem
– Biodiversity, climate change, the ecological footprint
Political environments
– Approaches to improving population health
The Current Living Standards Framework
The Wealth of Aotearoa: The Four Capitals
Structure
social and physical environmental conditions/patterns
(social determinants) that influence choices and opportunities
available
Agency
the capacity of an individual to act independently and make
free choices
