The determinants of health
February 20, 2011 - 0:0
In discussing the determinants of health it is useful to distinguish between the health of individuals and populations. The determinants of health for any individual relate highly to the unique characteristics of that individual.
In the first instance, these characteristics are highly determined by biology, the gender, age, and genetic background of the individual. These characteristics play a primary determining role and are usually not modifiable.For example, it is obvious that a man cannot die from ovarian cancer, or a woman from testicular cancer. Generally, only an older person will suffer from Alzheimer's disease; only a person with a genetic deficit will suffer from Down syndrome.
Medical science and public health can do little to change these powerful determinants of health in the individual.
However, it is also anticipated that most individuals born in the Western world of the twenty-first century are biologically equipped to have a life expectancy of some seventy to eighty years.
The health of populations is a different concept from that of the health of individuals, and the determinants of the health of populations may be conceptualized very broadly.
The following is just a short list of some of the hypothesized determinants of population health:
Health care services, sewers and drains, potable water, sanitation, adequate nutrition, shelter, transportation networks, supportive social environments, healthful public policy, stable child-rearing environments, healthful work environments, and peace and tranquility.
What is apparent in such a broad list is that most of the hypothesized determinants are outside of the traditional medical care sector of clinics and hospitals.
Many determinants of population health are determined by human conditions at the broadest level of political interaction, such as the protection from the ravages of poverty, war, and refugee status.
Most important, the individual has relatively little direct control over these determinants.
Even in those arenas where the individual believes he or she has control, such as in pursuit of education, occupation, and income through the life span, the reality remains that access to education, occupation, and income is socially determined.
People suffer disease and illness due to social processes that are only remotely related to personal health care.
As public health moves away from personal health care as the major determinant of public health to a position where it is merely one of many determinants of public health, the role of the social and behavioral sciences becomes more important in understanding population health.
The World Health Organization European Office lists ten social determinants of health that are supported by strong research evidence:
(1) The social gradient (people's relative social and economic status and circumstances strongly affect their health throughout life); (2) stress (stress harms health); (3) early life (the effects of early development last a lifetime); (4) social exclusion (social exclusion creates misery and costs lives);
(5) Work (stress in the workplace increases the risk of disease); (6) unemployment (job security increases health, well-being, and job satisfaction);
(7) social support (friendship, good social relations, and strong supportive networks improve health at home, at work, and in the community);
(8) Addiction (individuals turn to alcohol, drugs, and tobacco and suffer from their use, but use is influenced by the wider social setting); (9) food (healthful food is a political issue); and (10) transport (healthful transport means reducing driving and encouraging more walking and cycling, backed up by better public transport).
(Source: Health.yahoo.net)