Lecture 15: Framing Determinants On The Dahlgren And Whitehead Model

Question 1

What are determinants of health for the individual?

Answer 1

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

Question 2

Examples of individual determinants?

Answer 2

Income, employment, education, housing, neighbourhoods, societal characteristics (eg racism), autonomy and empowerment (social cohesion)

Question 3

What are different categories for life stage determinants?

Answer 3

Pre-birth
Childhood
Adolescence
Adulthood
Older-age

Question 4

What are three ways life course events can interact to influence long term health and wellbeing?

Answer 4

1. Cumulative eg poverty trap
2. Multiplicative eg CDV risk factor
3. Programming eg foetal stimulus/disruption affecting later life

Question 5

Are the concepts between population and individual determinants similar but the nature different?

Answer 5

Yes, population determinants to health relate to geography ie related to context in which the population exists

Question 6

Two approaches to reduce health risk in a population?

Answer 6

Downstream

Upstream

Question 7

What is a “downstream” approach

Answer 7

Interventions that operate at a proximal level (micro)

Includes treatment systems and disease management ie seeing a doctor

Question 8

What is an upstream approach?

Answer 8

Interventions that operate at a distal level (macro)
Eg government policies, international trade agreements ie sugar tax

(Is not victim blaming)

Question 9

What are the three Dahlgren and Whitehead Model levels?

Answer 9

1. Individual lifestyle factors
2. Social and community networks (+ working and living conditions)
3. General socioeconomic, cultural and environmental conditions

Question 10

What are examples of living and working conditions?

Answer 10

Ag/food production
Education
Work environment 
Unemployment 
Water and sanitation 
Health care services 
Housing

Question 11

What are examples of individual level determinants?

Answer 11

Mother’s nutrition (pre birth)
Parenting, security, learning
Decision-making, nutrition, sleep, exercise
Work/life balance, relationships
Age/sex/behavioural risk factors + lifestyle

Question 12

What are examples of level 2 community determinants?

Answer 12

Neighbours, sports facilities, organisations (eg church), education, health and social services, local influence (eg workplace, home), social capital

Question 13

What are environmental level determinants?

Answer 13

Global ecosystem

Cultural (what people believe) social, political, physical (water, air), built (eg roads, homes, parks) environments.

Question 14

What determinants of the Dahlgren and Whitehead model are non-modifiable?

Answer 14

Genes and biology (although genes are not just responsible, often environment plays a role)

Question 15

Are the impact of individual determinants different regarding individuals and populations?

Answer 15

Yes, single gene disorder = rare in a population

Polygenic inheritance = influences likelihood of offspring developing a disease

Question 16

What affect individual levels?

Answer 16

Lifestyles, values learned through every day activity. Ability to change behaviour varies from different social groups
Individual choice

Question 17

What affects community level determinants?

Answer 17

Family and friends
Attitudes/behaviour of community
Social capital

Question 18

What is social capital?

Answer 18

The value of social networks that facilitates bonds between similar groups of people
- provides an inclusive environment for people from diverse backgrounds

Question 19

What is structure?

Answer 19

Social and physical environment conditions/patterns (social determinants) that influence choices and opportunities available (level 2 and 3)

Question 20

What is agency?

Answer 20

The capacity of the individual to act independently and make free choices

Question 21

Purpose of Dahlgren and whitehead model?

Answer 21

To help identify risk or protective factors and consider levels of intervention
There is permeability between levels (all affect the others)

Question 22

What are the different scales determinate a operate at?

Answer 22

Micro= individual
Meso = social/family/living/work
Macro= global/national