Determinants of health
School of Public Health
SPHMMC
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WHO definition of health?
Why it was defined as such?
Application of the definition??
How to achieve health at individual or population level?
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Session objective
At the end of this lecture, students are expected to know:
• Definition/ description of determinants
• Relate PH problems with factors in concern
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Definitions
• Health problem – is a condition of humans that can be
represented in terms of measurable health status or
quality of life indicators
• Health problem is measured in terms of outcomes???
• Risk factors – the factors linked with specific health
problems are generally termed risk factors
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Definitions cont…
• Risk factors can exist at one of three levels:
– those risk factors most closely associated with the
health outcome in question are often termed
determinants
– risk factors that play a role further back in the chain
of causation are called direct and indirect contributing
factors
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Definitions cont…
• Risk factors can be described at:
– individual or
– population level
• E.g tobacco use for an individual increases the chance
of developing heart disease or lung cancer, and
• The increased prevalence of tobacco use in a
population increases that population’s incidence of (and
mortality rates from) these conditions
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Definitions cont…
• Determinants are scientifically established factors that
relate directly to the level of a health problem
• As the level of the determinant changes, the level of the
health outcome changes
• Determinants are the most proximal risk factors
through which other levels of risk factors act.
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Definitions cont…
• Direct contributing factors are factors that directly
affect the level of determinant
• Eg. Low birth weight rate is a determinant for neonatal
mortality rate
• The prevalence of tobacco use (direct contributing
factor) among pregnant women is associated with the
risk of low birth weight
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Definitions cont…
• A determinant can have many direct contributing
factors
• E.g for birth weight, other direct contributing factors
include low maternal weight gain and inadequate
prenatal care
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Definitions cont…
• Indirect contributing factors affect the level of the
direct contributing factors, which in turn, affects the
level of the determinant
• Many indirect contributing factors can exist for each
direct contributing factors
• Eg. For prevalence of tobacco use among pregnant
women, indirect contributing factors might include:
– Easy access to tobacco for young women
– Lack of health education
– Lack of smoking cessation programs
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Definitions cont…
• The health problem analysis frame work begins with
the identification of a health problem and
• Proceeds to establish one or more determinants
• For each determinant, one or more direct contributing
factors, and
• For each direct contributing factor, one or more
indirect contributing factors
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Health problem analysis worksheet
Indirect Contributing Factors
Direct Contributing Factor
Determinant
Direct Contributing Factor
Direct Contributing Factor
Indirect Contributing Factors
Indirect Contributing Factors
Health Problem
Direct Contributing Factor
Determinant
Indirect Contributing Factors
Indirect Contributing Factors
Direct Contributing Factor
Direct Contributing Factor
Indirect Contributing Factors
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Definitions cont…
• Intervention strategies at the community level generally
involve addressing the indirect contributing factors
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Determinants of health
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Personal and inborn features of individuals
Social and cultural issues
Economic determinants
Political determinants
The environment
Education
People’s own health practices and behavior
Access to appropriate health care services
Policies and programs
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Personal and inborn features of individuals
• Include genetic makeup, sex and age
• One can inherit a genetic marker for a particular disease
• Men & women are physically different
• Women face risk of childbearing, cervical & uterine
cancers
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Personal and inborn features of individuals cont..
• Women also have higher rates of certain health
conditions, such as thyroid and breast cancer
• Old people are much more likely to die of heart disease
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Social and cultural issues
• Social status is an important health determinant
• People of higher social status have more control over
their lives than people of lower status
• People of higher social status tend to have higher
income & education,
• both (higher income & education) are strongly
correlated with better health
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Social and cultural issues cont…
• Gender roles that are ascribed to women in many
societies have important impact on health
• ….women have less income, less education, and fewer
opportunities to engage in safe employment
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Social and cultural issues cont…
• The extent to which people get social support from
families, friends, and community have link to health
• The stronger the support that people get from those
networks, the healthier people will be
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Social and cultural issues cont…
• Culture is also important determinant of health
• Culture helps to determine:
– how one feels about health and illness,
– how one uses health services, and
– the health practices in which one engages
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The environment
• The environment, both indoor and outdoor, is
powerful determinant of health
• Safety of the environment in which people work is
important for health
• Indoor air pollution → respiratory illness & asthma
• Lack of safe drinking water & sanitation →major
contributor of ill health in poor countries
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The environment cont…
• Many people in poor counties work in environments
that are very unhealthy
• These people lack skills, social status, and opportunities
• As a result, they may work:
– without sufficient protection with hazardous
chemicals,
– in polluted air, or
– in circumstances that expose them to occupational
accidents
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Education
• Is powerful determinant of health
• Education brings with it knowledge of good health
practices
• It provides opportunities for:
– gaining skills,
– getting better employment,
– raising one’s income, and
– enhancing one’s social status
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Education cont…
• There is extremely strong and positive correlation
between the level of education & all key health
indicators
• People who are better educated:
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Do not smoke / smoke less
are less obese
have fewer children, and
take better care of their children’s health than do people with
less education
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People’s own health practices and
behavior
• Being able to identify when you or a family member is
ill and needs health care can be critical to good health
• One’s health also depends on how one eats, or if one
smokes, drinks too much alcohol, or drives safely
• Being active physically and getting exercise regularly is
better for one’s health than is being sedentary
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Access to appropriate health care
services
• The more likely you are to access services of
appropriate quality, the more likely you are to stay
healthy
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Policies and programs
• Policies and programs in the health sector and other
sectors have impact on health
• A country that has universal health insurance is likely to
have healthier people than a country that does not
insure all of its people
• The uninsured may lack needed health services
• Countries that promoted safe water supply for all of its
people have healthier people
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Political determinants of health
• Social and political upheavals such as war, conflict, and
civil unrest have negative impacts on health
• Strong political will is critical in setting national priorities
on health, in order to:
– ensure access to health care, and
– to achieve an equitable health system
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Political determinants of health cont…
• Corruption of all types:
– damages the economy,
– discourages foreign assistance, and
– erodes the expectation and behavior of citizens.
• corruption undermine efforts to improve health
outcomes.
• According to the corruption perception index,
– 10 of the 34 most corrupt countries are in Africa
– 7 are in Asia, and
• all are nations with a heavy burden of disease.
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Economic determinants of health
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Income is a strong predictor of health status.
As income decreases, rates of poor health increase
The relationship between income and health exists
for all the usual measures of health outcomes
including morbidity, perceived health status and
mortality
Children from poor families have higher rates of
illness, injury and death than other children.
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Group work
• Identify determinants, direct contributing factors,
and indirect contributing factors for cervical cancer,
hypertension and tuberculosis.
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Thank You!!!
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