Determinants of Health

Health

Determinants of HealthMohamed M. B. Alnoor

MAN 215ContentDefinition of HealthConcepts of HealthDimensions of HealthConcept of Well-beingDeterminants of HealthInequity in HealthUsually subjugated to other desireswealthpowerprestigeknowledgeH E A L T H ?H E A L T H ?Health was forgotten - League of Nations WW I - United Nations WW II Introduced at a conference in 1945During the last few decades there is reawakening: that it is a fundamental human right . Absence of disease

The condition of being sound in body, mind or spirit, especially freedom from physical disease or pain Webster English Dictionary

Definition of HealthSoundness of body or mind, that condition in which its functions are duly and efficiently discharged Oxford English DictionaryDefinition of HealthChina and Greece : view health not only as the absence of negative states but also the presence of positive ones.

Chinas notion of health is based on Ying & Yang. (positive and negative energies); balance is health.

Definition of HealthMetaphors for the Body:

Popular Metaphor: The body is comprised of four humors: blood phlegm yellow bile black bileimbalance diseaseDefinition of Health WHO Definition : Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity 1948

stretched in 1979 to include : the ability to lead a socially and economically productive lifeDefinition of HealthThe WHO definition is not without criticism- It is too broad- Health is not a state -process of continuous adjustment - to demands of living - meanings we give to life - dynamic conceptDefinition of Health-idealistic goal not -realistic idea.-Using the WHO definition, 70-95% of people are classified as unhealthy.The WHO definition is not without criticismDefinition of HealthIn spite of these limitations, the WHO definition is:Broad and positive.It sets out a high standard for positive health.It represents the overall goal that nations should strive to reach.

BUT!The WHO definition is not without criticismDefinition of HealthCONCEPTS OF DISEASESussers TerminologySickness: a state of social dysfunction.Illness:a subjective state of feeling unwell.Disease:a physiological/psychological dysfunction Health-sickness spectrumHealth is a relative, not an absolute concept -always involves many degrees.Illness also involves many degrees. positive health better healthfreedom from sicknessunrecognized sickness mild sicknesssevere sicknessdeath

Handicap and DisabilityAccident of a soldierDiseaseAmputation of footImpairmentInability to walk Unemployment Handicap

Disability Dont let your disability handicap you !

Changing Concepts of Health 1- Biomedical : health is the absence of disease - Germ theory of disease.-Minimizes the role of : Environmental, Social, Psychological, Economic, Cultural and other determinants.Changing Concepts of Health 1- Biomedical :

-Germ theory could not solve or explain : Nutritional problems, Chronic diseases, Accidents, Substance abuse, Psychological diseases, Pollution, Population explosion and other Non communicable health problems.Changing Concepts of Health2- Ecological Concept: Health is a Dynamic Equilibrium between Man and his Environment. Imbalance results in Disease.

Imperfect manImperfect Environment2- Ecological Concept:

** Adaptation of Man to his Environment leads to better health and longer life expectancy even in the absence of modern health services.Changing Concepts of HealthChanging Concepts of Health3-Psychosocial concept:Cultural , Economic and Political factors in addition to the Biomedical concept.Changing Concepts of Health4-Holistic concept: Includes all the factors of the other concepts in addition to all human activities such as : education, communication, agriculture, industry, housing , recreation etcEmphasis is on Promotion & Protection of Health

Dimensions of healthPhysicalMentalSociala multi-dimensional process Physical Dimension of Health-Implies perfect functioning of organs, at optimum capacity , and in harmony.-Involves the ability to carry out daily tasks, and achieve fitness . -A normal person: -no evident disease, -growth is comparable peers .

Dimensions of healthNot merely the absence of mental illness but the ability to respond to the various experiences of life with flexibility and a sense of purpose.

Mental Dimension of HealthDimensions of healthMental health is a state of balance or harmony between the individual and others as well as between the individual and the environmentMental Dimension of HealthDimensions of healthThe following characteristics are attributes of a mentally healthy person: a) he is free from internal conflicts, b) he accepts criticism, c) he searches for identity, d) he has a strong sense of self-esteem, e) he knows himself, f) he has a good self-control, g) he faces problems and tries to solve them.

Mental Dimension of HealthDimensions of healthImplies harmony and integration of the individual with the world he lives in.

It covers interpersonal ties and extent of involvement with society.

Dimensions of health Social Dimension of HealthAbility to interact successfully with people within the environment, maintaining intimacy with others, showing respect and tolerance for those with different opinions and beliefs.Dimensions of health Social Dimension of HealthHealth practices and beliefs are strongly influenced by the persons : economic level life stylefamily culture

Dimensions of health Social Dimension of Health Low-income groups are less likely to seek health care to prevent or treat illness;

High-income groups are more prone to stress-related habits and illness

Dimensions of health Social Dimension of HealthFor every 10% increase in the number of the unemployedThere is an increase of : 1.2% in total mortality

1.7% increase in cardiovascular disease, 1.3% more cirrhosis cases, 1.7% more suicidesDimensions of health Social Dimension of HealthOther Dimensions Spiritual dimension It includes: -principles and ethics -the purpose in life -religious beliefs and values

all are important components of the way the person behaves in health and illness.

Dimensions of healthVocational dimension When work is fully adapted to human goals, work often plays a role in promoting both physical and mental health. The importance of this dimension is clear when individuals suddenly lose their jobs or retire.

Other DimensionsDimensions of health

Concept of WELL-BEING

WHO definition introduces the concept of Well-being.

Objective components: -Standard of living -Level of living

Subjective component: -Quality of life Standard of living (Proposed by WHO to mean): -income and occupation -standards of - housing - sanitation - nutrition -level of provision of services - health - education - recreation

Concept of WELL-BEING

Level of living:Used in the UN. Consists of 9 components: -Health -Food consumption -Education -Occupation & working conditions -Housing -Social security -Clothing -Recreation & leisure -Human rights Health is the most important

Concept of WELL-BEING

Quality of life:Perception of individual or group of feeling of: Happiness, satisfaction & gratification as experienced in such life concerns as: -Health -Marriage & family -Work & financial situation -Educational opportunities -Self-esteem -Belongingness -Trust in others

Concept of WELL-BEING

Physical Quality of Life Index (PQLI) It consolidates three Indicators : -Infant mortality -Life expectancy at age one -literacy

Concept of WELL-BEING

Human Development Index : (HDI):Composite index involving three areas -Longevity (life expectancy at birth) -Knowledge (adult literacy rate and mean years of schooling -Income(GDP per capita US$ )

Concept of WELL-BEING

New ConceptsGender- Related Development Index(GDI)Gender Empowerment Measure(GEM) They reflect gender inequalities : human development or economic and political opportunities.

Concept of WELL-BEING

Human Poverty Index(HPI)

HPI measures DEPRIVATION in those dimensions

HDI measures average ACHIEVEMENTS in basic dimensions of human development.

New Concepts

Concept of WELL-BEING

Determinants of Health

Determinants of Health

- Behavioral- Environmental- Health services- Gender- Other factors Determinants of Health

1- Behavioral:

Determinants of Health

-Nutrition/ food-Personal hygiene-Habits & customs-Smoking ( passive smoking )-Alcohol & substance abuse

Habits are routines of behavior that are repeated regularly and tend to occur subconsciously. Custom: the long-established traditions of a society collectively. Behaviors within a society or group.

46 -Exercise -Sleep -Violence/ abuse -Recreation -Compliance to treatment -Reaction to stressComprehensive listDeterminants of Health1- Behavioral:

2- Environmental: A- Physical environment: -Air - Water (quantity and quality) - Waste disposal -Housing -Climate -temp. -humidity and rainfall Determinants of Health

Determinants of Health 2- Environmental: A- Physical environment:

-Geography -Heat -Light -Noise -Vibration -RadiationB- Biological environment: -Man(age, sex, genetic)-Microbes -Insects-Rodents-Animals-Plants

Determinants of Health 2- Environmental:

Age : age at exposure determines outcome : Early exposure polio or hepatitis leads mild infection. Exposure to radiation at puberty is associated with the HIGHEST risk of breast cancer .Sex : men and women have different health problems. Genetic: Determining : lifespan, healthiness and the likelihood of developing certain illnesses. e.g Genetic Diseases, Disease Resistance and Disease Susceptibility

50C- Psychosocial environment:-Habits-Customs-Ethnicity-Cultural values

Determinants of Health 2- Environmental:

Ethnicitylanguageculture religion common origin (ancestry) shared history

Identification with a social group on grounds of :Determinants of Health2- Environmental: C- Psychosocial environment:

CultureKnowledge,Beliefs,Goals, Values, Attitudes andPractices

Complex social phenomenon of shared :Determinants of Health2- Environmental: C- Psychosocial environment:

-Religion/Morals -Education/health awareness -Employment -Community life -Housing

Determinants of Health2- Environmental: C- Psychosocial environment:

-Political organization : -% GNP on health -Resource allocation -Services: -Availability -Accessibility -Commitment to development ( social NOT economic )

for allpeopleDeterminants of Health2- Environmental: C- Psychosocial environment:

GNP (Gross National Product): is the market value of all products and services produced in one year by labor and property supplied by the residents of a country. 55Psychosocial Determinants of Health and Disease-Unemployment and mortality-Goal frustration and negative life events and gastrointestinal disorders -Stress and the cold, ..etc.

PSYCHOSOCIALFACTORSHEALTH/DISEASEDeterminants of Health2- Environmental: C- Psychosocial environment:

Psychosocial Determinants of Health and Disease-SES is associated with health outcomes: Mortality Morbidity Disability Well-beingpeople of higher SES have better health than people of lower SES:

Determinants of Health2- Environmental: C- Psychosocial environment:

Determinants of Health2- Environmental: C- Psychosocial environment:

Infant mortality, 1982

Determinants of Health2- Environmental: C- Psychosocial environment:

59How EDUCATION influences healthHigh level of education can lead to:Employment: secure well paid health benefitsGood health: by developing favorable knowledge attitudes behaviorsDeterminants of Health2- Environmental: C- Psychosocial environment:

PERSONAL

SOCIAL

ECONOMIC gender/ethnicity/age health behavior knowledge & skills engagement & participation networks cultural norms parental socioeconomic status employment incomeDeterminants of Health2- Environmental: C- Psychosocial environment:

Smoking is more common among less educated men in India

Determinants of Health2- Environmental: C- Psychosocial environment:

Determinants of Health- Behavioral- Environmental- Health services- Gender- Other factors3- Health Services: -H. E. -MCH -Control of communicable disease -Control of non-communicable disease Determinants of Health

4- Gender:1993 Global Commission on Womens Health -Reproductive health -Nutrition -Employment/occupation -Domestic violence

Determinants of Health

5- Other Factors:.Transition: Industrial age information age

Information & Communication Revolutioneasy access to health information medical professionals and the public

Determinants of Health

Intersectoral contributions : Food & agriculture Education Industry Social welfareDeterminants of Health5- Other Factors:

Rural development Raising standard of living Employment opportunities Increased wages

Determinants of Health5- Other Factors:

INEQUALITYINEQUITY

Health Inequities existBETWEEN COUNTRIES andWITHIN COUNTRIESLife Expectancy :

Children have dramatically different life expectancies depending on where they were born: Japan or Sweden: > 80 years; Brazil: . . . . . . . . . .. . . .72 years; India: . . . . . . . . . . . . . . . 63 years; African countries: < 50 years.

Health inequities between countriesHealth inequities between countriesA child born in a developing country: (Africa, Asia, or Latin America) is roughly 10 times more likely to die before reaching age five than a child born in Europe or North Americathe infant mortality rate (the risk of a baby dying between birth and one year of age) is: 2 per 1000 live births in Iceland. >120 per 1000 live births in Mozambique;

Risk of maternal death during or shortly after pregnancy is only 1 in 17 400 in Sweden but it is 1 in 8 in Afghanistan. Health inequities between countriesInfant mortality in selected Latin American countries, 1960-90

Health inequities between countries

Maternal MortalityNorway and GuineaJapan andSierra LeoneLife ExpectancyHealth inequities between countriesHealth inequities within countriesWorldwide between: rich and poor, men and women, dominant and marginalized ethnic groups

all lead to differences in health and longevity.: by genderIndia Subcontinent(UN 1987-9): girls:

death rate nearly twice as boys: due to family behavior .

1/6 death: neglect and discrimination .

< boys: immunization and nutritional status.

Health inequities within countriespoor municipalities rich municipalitiespoorest 20% only12% ofpublic spending for health care.Venezuela (1994): Indonesia (1990): by SES:3 times IMR

Health inequities within countriesIMR: infant mortality rate

79by race/ethnicityKenya: likelihood of a child dying before age 2 varied by ethnicity (7.4% vs 19.7%) USA: African-American infant mortality is twice that for European-Americans

Guatemala: malnutrition 40% higher among indigenous children

Health inequities within countriesThe poorest of the poor have higher levels of illness and premature mortality.

In countries at all levels of income, health and illness follow a social gradient:Health inequities within countriesSocial Gradient The poorest of the poor, around the world, have the worst health. Within countries, the lower an individuals socioeconomic position the worse would be his health. This is a global phenomenon, seen in low, middle and high income countries.Runs from top to bottom of the socioeconomic spectrumHealth inequities within countries Widening economic inequalities everywhere

Strong evidence that health and wealth are connected

Yet no routine monitoring of how widening gaps in wealth may impact health

Health inequities within countries

Reasons of Health inequities Inequalities in health status is not a natural phenomenon but is the result of the social conditions in which people :are bornliveworkage

Importance of monitoring inequities in health 1. ill-health poverty

2. Human rights 3. In most societies, less tolerance for disparities in health than in wealth 4. Could increase pressure (open the door) to address social and economic inequities

Solutions ????Assessing and measuring the relation between health inequity and the social determinants of health is crucial for finding solutions to close the gap in health inequity.

Equity in health needs to be higher on the agendas of governments ,national & international organizations

Capability for ongoing monitoring of equity in health must be developed everywhere

Solutions ????New philosophy of Health*Fundamental right*Intersectoral*Integral part of Development*Central to Quality of Life*Involves Individuals, Families, Communities Local, National and International responsibilities *Social Investment*World wide Social Goal Health Education Agriculture Labor Treasury Housing

HEALTH