Lecture 13. Framing the determinants of population health:The Dahlgren & Whitehead model Flashcards
What are causes of causes or ‘ determinants of determinants’?
eg smoking is a cause for lung cancer
cause of cause would be “what caused smoking”- peer pressure, environment/ work
what caused the risk factor in the first place?
downstream vs upstream interventions
–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
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 behavioral factors related to nutrition or smoking or other exposures.
Distal Determinants:
A determinant of health that is either distant in time and/or places 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.
Social gradient
as we go from least to most deprived populations the rate of disease increases
LVL1 - the individual factors
‘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 the likelihood of offspring
developing a disease
LVL -the individual lifestyle factors
Non-modifiable factors (age, sex, genetics)
Modifiable: lifestyle( diet, exercise), values, dispositions and
the expectation of particular social groups ‘learned’
through everyday activities
LVL 2- The community
•Social and community networks & Living and
working conditions
•Families and friends play a significant role in developing
‘normative’ behaviors.
The working environment influences the sense of what is normal and acceptable
-social capital- the value of social networks facilitates bonds between similar groups of people
LVL 3- the environment
•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
Structure
- social and physical environmental
conditions/patterns (social determinants) that
influence choices and opportunities available
(social and community networks and upstream factors )
Agency
– the capacity of an individual to act
independently and make free choices
(individual lifestyle factors+ social and community networks)
What is the K shape economy?
specifically in relation to post covid economic responses. that have benefited some people, while making it harder for others.
Eg. Houseowners will have more wealth, while tenants have to pay higher rent, without a significant wage increase. This gap is widening.
The four capitals
