Lecture 15: Framing Determinants On The Dahlgren And Whitehead Model Flashcards
What are determinants of health for the individual?
“Any event, characteristic or other definable entity that brings about a change for better or worse in health”
Examples of individual determinants?
Income, employment, education, housing, neighbourhoods, societal characteristics (eg racism), autonomy and empowerment (social cohesion)
What are different categories for life stage determinants?
Pre-birth Childhood Adolescence Adulthood Older-age
What are three ways life course events can interact to influence long term health and wellbeing?
- Cumulative eg poverty trap
- Multiplicative eg CDV risk factor
- Programming eg foetal stimulus/disruption affecting later life
Are the concepts between population and individual determinants similar but the nature different?
Yes, population determinants to health relate to geography ie related to context in which the population exists
Two approaches to reduce health risk in a population?
Downstream
Upstream
What is a “downstream” approach
Interventions that operate at a proximal level (micro)
Includes treatment systems and disease management ie seeing a doctor
What is an upstream approach?
Interventions that operate at a distal level (macro)
Eg government policies, international trade agreements ie sugar tax
(Is not victim blaming)
What are the three Dahlgren and Whitehead Model levels?
- Individual lifestyle factors
- Social and community networks (+ working and living conditions)
- General socioeconomic, cultural and environmental conditions
What are examples of living and working conditions?
Ag/food production Education Work environment Unemployment Water and sanitation Health care services Housing
What are examples of individual level determinants?
Mother’s nutrition (pre birth)
Parenting, security, learning
Decision-making, nutrition, sleep, exercise
Work/life balance, relationships
Age/sex/behavioural risk factors + lifestyle
What are examples of level 2 community determinants?
Neighbours, sports facilities, organisations (eg church), education, health and social services, local influence (eg workplace, home), social capital
What are environmental level determinants?
Global ecosystem
Cultural (what people believe) social, political, physical (water, air), built (eg roads, homes, parks) environments.
What determinants of the Dahlgren and Whitehead model are non-modifiable?
Genes and biology (although genes are not just responsible, often environment plays a role)
Are the impact of individual determinants different regarding individuals and populations?
Yes, single gene disorder = rare in a population
Polygenic inheritance = influences likelihood of offspring developing a disease
What affect individual levels?
Lifestyles, values learned through every day activity. Ability to change behaviour varies from different social groups
Individual choice
What affects community level determinants?
Family and friends
Attitudes/behaviour of community
Social capital
What is social capital?
The value of social networks that facilitates bonds between similar groups of people
- provides an inclusive environment for people from diverse backgrounds
What is structure?
Social and physical environment conditions/patterns (social determinants) that influence choices and opportunities available (level 2 and 3)
What is agency?
The capacity of the individual to act independently and make free choices
Purpose of Dahlgren and whitehead model?
To help identify risk or protective factors and consider levels of intervention
There is permeability between levels (all affect the others)
What are the different scales determinate a operate at?
Micro= individual Meso = social/family/living/work Macro= global/national
