Health DeterminantsCarlos Amade, MD

Human

Beings

Biological

Physical Social

Environments of human beings

Address the relationship between health status and biology, individual behavior, health services, social factors, and policies.

Emphasizing an ecological approach to disease prevention and health promotion (Individual and population-level determinants determinants of health and interventions).

How can we create a society in which everyone has a chance to live long healthy lives?

Definition:

The range of personal, social, economic, and environmental factors that influence health status

Determinants of health

Policymaking Social determinants Health services Behavior Biology and genetics

Determinants of health include

Framework For Thinking About The Determinants Of Population Health

(from „The future of the Public‘s Health“, IOM 2003)

Policies at the local and State level affect individual and population health.

Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior.

For example to set and regulate standards for motor vehicles and highways.

Policymaking

Disease is caused by either pathology or politics

There is strong evidence indicating that factors outside the health care system significantly affect health. These “determinants of health” include income and social status, social support networks, education, employment and working conditions, physical environments, social environments, personal health practices and coping skills, healthy child development, health services, gender and culture.

Taking Action on Population Health: A Position Paper for Health Promotion and Programs Branch Staff. Ottawa: Health Canada, 1998

Canadian Government Statements on Social Determinants of Health

Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age.

They impact a wide range of health, functioning and quality of life outcomes.

Social determinants

Social determinants of health have a direct impact on health

Social determinants predict the greatest proportion of health status variance

Social determinants of health structure health behaviours

Social determinants of health interact with each other to produce health

Why Emphasize Social Determinants?

Social Health

Determinants

Societal Resources

Equity and Social Justice

The Physical Environment

Upstream Approaches –Social Cohesion, Social Equity,Social Capital

Downstream Approaches –Provision of Clinical Services

Adapted from Milstein B, Homer J. The dynamics of upstream and downstream: why is it so hard for the health system to work upstream, and what can be done about it? CDC Health Systems Workgroup; Atlanta, 2003.

A Safe, Healthy Population

Adverse SocialConditions

Vulnerable Population

CreatesVulnerability

Targeted Protection

Reduces Vulnerability

Diagnosed, but with no complications

Primary Prevention

Clinical complications requiring treatment

Secondary Prevention

Tertiary Prevention

Disabilityand Death

Opportunities for Public Health Interventions

A Social Determinants Framework

Both access to health services and the quality of health services can impact health.

Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.

Lack of access, or limited access, to health services greatly impacts an individual’s health status.

Health Services

Lack of availability High cost Language …..

Barriers to access health services

Individual behavior also plays a role in health outcomes.

Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity.

Positive changes in individual behavior can reduce the rates of chronic disease in this country.

Individual Behavior

Diet Physical activities Hand washing Drug use …..

Individual behavior includes

Some biological and genetic factors affect specific populations more than others.

Sickle cell disease is a common example of a genetic determinant of health. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia

Biology and Genetics

Think: Age Sex HIV status …

Biology and genetics

B E I N G S

Recall categories of preventable causes of disease

Thank you