Lecture 13: 'causes of the causes' the dahlgren and whitehead model Flashcards
What are the causes of the causes (for individuals)
Any event, characteristic or other definable entity, that brings about a change for better or worse in health
What are the possible events for the causes of the causes for individuals
- income
- employment
- education
- housing and neighbourhoods
- societal characteristics e.g racism
- autonomy and empowerement - social cohesion
may vary at different life-stages
How it differs (and similars) to individuals causes of the causes
What are the causes of the causes (for populations)
Concepts are similar 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
* also related to the context of the population
What are downstream 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 an immediate cause of disease
What are downstream determinants often referred to (and provide examples)
Proximal causes e.g lifestyle and behavioural factors related to nutritiion, like smoking
What are upstream determinants
- a determinant of health that is either distant in time and/or place from the change in health status
What are upstream determinants often referred to as (and prove an example)
Distal causes e.g national, political, legal and cultural factors that indirectly infleunce health by acting on downstream determinants
Would upstream or downstream determinants be something that you can change today
Downstream
How do downstream interventions operate
Operate at the micro (proximal) level, including treatment systems, and disease management (address downstream determinants)
How do upstream interventions operate
At macro (distal) level, such as government policies and international trade agreements (address upstream determinants)
How do upstream interventions impact our lives
They are things we cant change overnight, but impact our behaviours e.g government policies
Describe level 1 of the D&W model - the individual
- Age, sex, constitutional factors and individual lifestyle factors
- sometimes referred to as non-modifiable determinants (gene 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
What is habitus in level 1 of the D&W model
Lifestyle, values, dispositions and expectation of particular social groups ‘learned’ through everyday activities
* Abillity to change behaviours cary by social group
What is level 2 of the D&W model
Social and community networks and living and working conditions
How do family and friens affect our behaviours
- in developing ‘normative’ behaviours
- attitudes and behaviours of people in working community influences sense of what is normal and acceptable
What is social capital
The value of social networks that facilitates bonds between similar groups of people.
What does social capital provide
Inclusive environment for people from diverse backgrounds
What is Level 3 of the D&W model
Physical, built, cultural, biological, political environment and the ecosystem.
What is natural capital
Refers to all aspects of the natural environment needed to support life and human activity.
Refers to land, soil, water, plants and animals, as well as minerals and energy resources
What is social capital
The norms and values that underpin society.
Includes things like trust, the rule of law, the Crown-Māori relationship, cultural identity and the connections between the people and communities.
What is human capital
People’s skills, knowledge and physical and mental health.
Things that enable people to participate fully in work, study, recreation and in society more broadly.
What is financial capital
Includes things like houses, roads, buildings, hospitals, factories, equipment, and vehicles.
Make up the countries physical and financial assets which have a direct role in supporting incomes and material living conditions.
What is ‘structure’ in population and health
- Social and physical environment conditions/patterns (i.e social determinants) that influence choices and opportunities available
What is ‘agency’ in population health
The capacity of an individual/community to act independently and make free choices.
What is structure and agency needed for
Distinguish between different determinants in framework. For D&W model, structure is upstream and agency is choices.
What is the D&W framework used for
Help idenitify determinants of health (risk of protective factors of disease) and consider levels of intervention.
What does the D&W model recognise
Determinants operate at different scales
* Upstream (distal) or downstream (proximal)
* Micro (individual), meso (family, living, work), macro (national/global)
