Social determinants of health and life
style
Miloslav Klugar, Ph.D., PhDr.
Social Medicine and Medical Ethics
Department of Social Medicine and Health Care Policy
Office number: 5.087
Office hours: Friday 9:00 – 11: 00
Faculty of Medicine and Dentistry
Palacky University in Olomouc
Social risks of contemporary society
Economical
Different standards of living and poverty
Discrimination and social exclusion
Unemployment and the nature of work
Environmental
 Environmental threats
Globalization
Genetic experiments
Social stress
 Traffic issues
Social risks of contemporary society
 Demographical
 Population ageing
 Life protection
 Political
 Institution malfunctioning
 Hidden threats
 Terrorism
 Transnational capitalism
 The Values
 Inheritance of cultural and social capital
 Social inequality
 Excessive consumption
 Extinction of emotions
 Relativity of values
Social Determinants, Social Medicine
Social risks of contemporary societies determine
the health risks as well (differences in health
status of the population)
“Social Medicine” particularly engaged with social
prevention in the biomedical field
…also deals with health care system, social
epidemiology and social gerontology or social
pediatrics, social psychiatry
Lalonde’s Health Field Concept
Marc Lalonde
Health minister in Canada in the 70s
Concept of YPLL (years of potential life lost)
 YPLL
Measure of relative impact of several diseases and
health problems in a society
Illustrates the losses suffered as a consequence of the
death
Premature death
Occurs before a given predetermined age (life
expectancy at birth)
Years potential life lost
calculation of YPLL for a defined cause
adding all the deaths for that cause in each age group
multiplying that sum by the years between the median of the age
chosen age limit, as in the following formula
l - the lower age limit established
L - the upper age limit established
i - the age at death
di - the number of deaths at age i
Lalonde’s analysis 1981
 Car accident
 IHD
 Other accidents
 Respirational d. + lung c.
 Suicide
213 000
193 000
179 000
140 000
69 000
He proved in the five most significant causes of death the
main influence of environmental factors and consequences
of personal choices.
Not only influence of health care organizations.
Horizontal concept of Determinants of
Health by Lalonde and WHO
Human
Biology
The
Environment
Health care
Organization
10 – 15%
20 – 25%
10 – 15%
Health Status
Lifestyles,
behaviours and
Risk Factors
50 – 60 %
Vertical concept of Determinants of
Health
LS
Environment
Socioeconomic
system
Value system
Cultural and Political tradition
Genome
Horizontal concept of Determinants of
Health
LIFESTYLE AND BEHAVIORAL RISK F.
 Substance abuse
 Tobacco, Alcohol, Drugs
http://gamapserver.who.int/gho/interactive_charts/tobacco/policies/atl
as.html?filter=filter4,South-East%20Asia
 European Football Championship (EURO 2012) was totally tobacco
free.
 Tobacco use contributes to the deaths of some 650 000 European Union
(EU) citizens a year, including thousands who never smoked but had to
breathe the smoke from others.
 Alcohol consumption –interactive chart
http://gamapserver.who.int/gho/interactive_charts/gisah/consumption_
2005/atlas.html
LIFESTYLE AND BEHAVIOURAL R. F.
 Use of protective devices
Seat belts
Bicycle helmets
Skiing and Snowboarding helmets
 Sexual practices
LIFE STYLE
 A healthy lifestyle
 WHO recommendations eating lots of fruits and vegetables, reducing fat,
sugar and salt intake and exercising.
 12 steps to healthy eating according to WHO
1)
2)
3)
4)
5)
“Eat a nutritious diet based on a variety of foods originating mainly from
plants, rather than animals.
Eat bread, grains, pasta, rice or potatoes several times per day.
Eat a variety of vegetables and fruits, preferably fresh and local, several
times per day (at least 400 g per day).
Maintain body weight between the recommended limits (a BMI of 18.5–25)
by taking moderate levels of physical activity, preferably daily.
Control fat intake (not more than 30% of daily energy) and replace most
saturated fats with unsaturated vegetable oils or soft margarines.
Replace fatty meat and meat products with beans, legumes, lentils,
fish, poultry or lean meat.
7) Use milk and dairy products (kefir, sour milk, yoghurt and cheese)
that are low in both fat and salt.
8) Select foods that are low in sugar, and eat refined sugar sparingly,
limiting the frequency of sugary drinks and sweets.
9) Choose a low-salt diet. Total salt intake should not be more than one
teaspoon (6 g) per day, including the salt in bread and processed,
cured and preserved foods. (Salt iodization should be universal where
iodine deficiency is endemic.)
10) If alcohol is consumed, limit intake to no more than 2 drinks (each
containing 10 g of alcohol) per day.
11) Prepare food in a safe and hygienic way. Steam, bake, boil or
microwave to help reduce the amount of added fat.
12) Promote exclusive breastfeeding up to 6 months, and the
introduction of safe and adequate complementary foods from the age
of about 6 months. Promote the continuation of breastfeeding during
the first years of life.”
6)
LIFE STYLE
 According to WHO 2011
Obesity is one of the greatest public health challenges of the
21st century.
Prevalence tripled in industrials countries from 1980s
Alarming is child obesity > rice at an alarming rate
Obesity > NCD
Obesity is directly responsible for 2-8% of health costs and
10-13% of deaths