Lecture 13: The health system as a determinant of health

Question 1

What are the three parts

Answer 1

1. Health as a determinant
2. Current health challenges
3. Health targets

Question 2

Determinants of health

Answer 2

How important is health care/the health
system?

• Working out the relative importance involves a large element of judgement. (Exact numbers aren’t possible or that credible.

Question 3

Determinants of health (II)

Answer 3

Across estimates, medical care is thought to
only explain maybe 10-20% of variation.

• So much of what’s important are the overlaps between these categories.

Question 4

Ethnicity impacts on

Answer 4

How you are treated by the health system,

• Your genetics and biology,
• The environments you are likely to have grown up in, and
• Your social circumstances, including likely access to education

Question 5

Ethnicity (II)

Answer 5

This is before anything relating these items to your own individual behaviour.

• Disentangling anything in this space is tough and fraught … as always, the population health framing is that inequities result from structural issues first and foremost

Question 6

Causes vs. spending

Answer 6

Despite the lower importance
of health care on outcomes,
most money is
spent here.

• US: on these figures, medical
  care accounts for 11% of
  variation but 60% of resource.
• Sense of being able to do
  something quickly/
  in short term?
• An unwillingness to act in
  other areas?
• An inability to meaningfully
  affect other areas?
• Issues with the US
  healthcare system?

Question 7

Who defines the health system as

Answer 7

“All activities whose primary purpose is to
promote, restore or maintain health”

Question 8

Lots of important determinants of health fall
outside this:

Answer 8

Housing, nutrition, education etc.

• What if we contain ourselves to just looking at health
  though?

Question 9

2. Current health
   challenges - OECD

Answer 9

OECD reports every two years (next
due November 2025) in “Health at a
Glance”.
* Financial pressures/affordability
* Ongoing recovery from COVID-19
* Unhealthy lifestyles
* Barriers to access (esp. in primary
care)
* Quality of care, including patient-
centred care
* Digital health has potential to
transform, but many countries ill-
prepared