M1s2 Introduction To Determinants Of Health Flashcards
Population
-groups of individuals with a shared characteristic
-health can be understood at this level
-can be geographically or politically defined but don’t need to be
Examples of population:
-recreational skiers in North America
-Indigenous women
-Children living with disabilities enrolled in a particular school system
Population health
-health outcomes of a group of individuals, including the distribution of such outcomes within the group
-field of population health includes: health outcomes, patterns of health determinants, policies and interventions that link those 2
- Canadian’s public health agency definition “population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups” “the population health approach recognizes that health is a capacity or resource rather than a state… being able to purse one’s goals, to acquire skills, and education, and to grow”
Epidemiology
-fundamental discipline of population and public health
-study of the distribution and determinants of disease in populations
-provides important information to develop, implement, and evaluate approaches to prevent disease and improve quality of life in populations
Distribution:
-focus of descriptive epidemiology
-how specific health outcomes are dispersed or patterned across a population
-this is essential for developing hypotheses about the etiology (origins) of disease or other health problems and for planning health services
Determinants:
-focus of analytical epidemiology
-anything that influences the state of health in an individual and/or distribution of health states in a population
What are the fundamental assumptions to note when understanding influences on health and disease
-diseases do not distribute randomly in population but rather in relation to factors that determine health for the individuals in that population
-factors that determine health status can be identified by studying distributions of health outcomes in populations
Determinate of health definition
-broad yet interconnected factors that determine an individuals health status
-WHO’s definition “range of personal, social, economic, and environmental factors which determine the health status of individuals or populations”
-important to understand these concepts to explain health from a broader lens and to identify what can be done to address different health conditions in different settings
Note: with various public health implications, many organizations are interested in determinants of health, which means they can describe differently depending on source or organization
List some key determinants of health
-income and social status
-employment and working conditions
-education and literacy
-childhood experiences
-physical environments
-social supports and coping skills
-healthy behaviours
-access to health services
-biology and genetic endowment
-gender
-culture
-race/racism
Numerous key determinants of health interrelate to one another and people have so many factors
The Dahlgren and Whitehead model
-shows main determinants groups these factors reveal overarching layers of influences on health that are woven together
5 parts of model starting from middle:
Age, Sex, and Constitutional Factors
-these factors closest or most proximal to personal and biological features of individuals
Include:
Sex
Age
Genetic makeup
Our sex and genes can contribute directly to our susceptibility to specific diseases for example
Individual lifestyle factors
-factors associated with an individual’s health practices and behaviours
Ex. Eating, movement practices
-important factors but remember not always associated with individuals freedom to choose, can be influenced by larger factors at family, community, or even broader levels
Social and Community Networks
-extends to which people receive social support from peers, family members or other people in their communities
-stronger levels of support and stronger social networks are associated with better health outcomes
-culture and being able to express one’s culture extremely important for individual health
Living and working conditions
-include: aspects of education system, work environments, housing and health care services as well as access to things like water and sanitation services or food production
General Sociology-Economic, cultural and environmental conditions
-outermost ring
-called distal factors as broader factors
-impacts of climate change for example considered here, general level of poverty or affluence in a country and how that supports its larger social and government system
Social determinants of health
-refers to specific group of social and economic factors within the broader determinants of health, that influence health outcomes
-conditions which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life
-refers to specific features of and pathways by which social and societal conditions affect health and how these can be altered by informed action
-circumstances shaped by distribution of money, power, and resources at global, national and local levels which are themselves influenced by policy choices
Physical determinants of health
-factors in physical environment which affect health risk and health outcomes
Include:
-air quality and air pollution
-water quality and safety
-soil contamination
-occupational hazards and risks
-motor vehicle usage and safety
-our housing
These factors may be affected by elements of the social and policy environments
Social and Physical Determinants of Health examples
Physiological factors:
-knowledge
-attitude
-beliefs
-ideas about health and illness
Biological factors:
-Sickle Cell Anemia which is an inherited disorder caused by changes in the gene for hemoglobin. Person with this often require health care support and treatment for painful episodes and other complications
Environmental factors:
-Chernobyl. The breakdown of this nuclear facility in the USSR in 1986 led to serious health consequences for countless persons living in and around the facility
-violence and genocide
Health Policy Effects:
-access to healthcare. For example Canadian health act ensures all Canadians have access to timely and appropriate medical care. Is an Example of policy which affected health outcomes at individual level
Individual Behaviours:
-smoking. Genesis of a smoking addition is indicated by making decision to smoke and the subsequent addiction leaves many people depended to on the harmful habit
Health inequities
-the unfair and unavoidable differences in health status seen within or between countries
Health hazards can come from things like poverty, poor housing, unemployment, lack of education etc
Three actions we see in public health
- Individuals themselves
Ex. Make stronger to push up hill - Reduce health hazards
Ex. Bolder climbing smaller - Work towards poverty reduction campaigns or provision of affordable housing in communities
-reduce slope and make easier for everyone to be healthy regardless of health hazards or individual characteristics faced with
Root, Underlying and Proximal Determinants of health
-help us assess why various health conditions exist and provide insight on how to address as considering at different levels of affect
Root causes:
-broader factors in natural environment (like agricultural practices in a country), macro-environment (like countries type of government) and population level inequalities (such as differences in employment opportunities or political influence by an ethical group) underpin a whole number of health outcomes at population level
-many determinants that influence and exacerbate the Experince of health hazard
-could be distant (or distal) to individual
Examples include
-Natural environment: climate, water and food supply
-Macro issues: historical conditions, demography, governance, economic and political policies, conflicts/war
-Inequalities: distribution of wealth, distribution of employment and education opportunities, distribution of political influences
Underlying causes:
-between two extremes of root causes and proximal causes
-aspects of our built environment and social context that might influence our health as a medium range, underlying causes
-essential to see the distal (upstream), underlying (midstream), and proximal (downstream) factors that often simultaneously influence health of individuals
Exs
-Built environment: land use and city planning, transportation services, services and facilities (like shops, parks, libraries)
-social context: community policies and investments, enforcement of ordinances, civic participation, quality of education
Proximal causes:
-closer to individual like personal health behaviours including smoking status or physical activity level or wether person exposed to toxic chemicals in job for example are more “downstream” factors
Exs
Material Circumstances: income, living and working conditions, food availability, environmental toxins
Behavioural Factors: physical activity, smoking, alcohol use, dietary practices, sexual behaviour, use of health care
Psychosocial factors: education level, social participation and integration (or exclusion), social support, resources, available in social networks
