Lecture 13: 'causes of the causes' the dahlgren and whitehead model

Question 1

What are the causes of the causes (for individuals)

Answer 1

Any event, characteristic or other definable entity, that brings about a change for better or worse in health

Question 2

What are the possible events for the causes of the causes for individuals

Answer 2

• income
• employment
• education
• housing and neighbourhoods
• societal characteristics e.g racism
• autonomy and empowerement - social cohesion

may vary at different life-stages

Question 3

How it differs (and similars) to individuals causes of the causes

What are the causes of the causes (for populations)

Answer 3

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

Question 4

What are downstream determinants

Answer 4

• 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

Question 5

What are downstream determinants often referred to (and provide examples)

Answer 5

Proximal causes e.g lifestyle and behavioural factors related to nutritiion, like smoking

Question 6

What are upstream determinants

Answer 6

• a determinant of health that is either distant in time and/or place from the change in health status

Question 7

What are upstream determinants often referred to as (and prove an example)

Answer 7

Distal causes e.g national, political, legal and cultural factors that indirectly infleunce health by acting on downstream determinants

Question 8

Would upstream or downstream determinants be something that you can change today

Answer 8

Downstream

Question 9

How do downstream interventions operate

Answer 9

Operate at the micro (proximal) level, including treatment systems, and disease management (address downstream determinants)

Question 10

How do upstream interventions operate

Answer 10

At macro (distal) level, such as government policies and international trade agreements (address upstream determinants)

Question 11

How do upstream interventions impact our lives

Answer 11

They are things we cant change overnight, but impact our behaviours e.g government policies

Question 12

Describe level 1 of the D&W model - the individual

Answer 12

• Age, sex, constitutional factors and individual lifestyle factors
• sometimes referred to as non-modifiable determinants (gene and biology)

Question 13

There are important distinctions between the impact on individuals and populations

Answer 13

• single gene disorders = rare among the population
• polygenic inheritance = influences likelihood of offspring developing a disease

Question 14

What is habitus in level 1 of the D&W model

Answer 14

Lifestyle, values, dispositions and expectation of particular social groups ‘learned’ through everyday activities
* Abillity to change behaviours cary by social group

Question 15

What is level 2 of the D&W model

Answer 15

Social and community networks and living and working conditions

Question 16

How do family and friens affect our behaviours

Answer 16

• in developing ‘normative’ behaviours
• attitudes and behaviours of people in working community influences sense of what is normal and acceptable

Question 17

What is social capital

Answer 17

The value of social networks that facilitates bonds between similar groups of people.

Question 18

What does social capital provide

Answer 18

Inclusive environment for people from diverse backgrounds

Question 19

What is Level 3 of the D&W model

Answer 19

Physical, built, cultural, biological, political environment and the ecosystem.

Question 20

What is natural capital

Answer 20

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

Question 21

What is social capital

Answer 21

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.

Question 22

What is human capital

Answer 22

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.

Question 23

What is financial capital

Answer 23

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.

Question 24

What is ‘structure’ in population and health

Answer 24

• Social and physical environment conditions/patterns (i.e social determinants) that influence choices and opportunities available

Question 25

What is ‘agency’ in population health

Answer 25

The capacity of an individual/community to act independently and make free choices.

Question 26

What is structure and agency needed for

Answer 26

Distinguish between different determinants in framework. For D&W model, structure is upstream and agency is choices.

Question 27

What is the D&W framework used for

Answer 27

Help idenitify determinants of health (risk of protective factors of disease) and consider levels of intervention.

Question 28

What does the D&W model recognise

Answer 28

Determinants operate at different scales
* Upstream (distal) or downstream (proximal)
* Micro (individual), meso (family, living, work), macro (national/global)