Determinants of Health

Original Editor - Rachael Lowe

Top Contributors - Rachael Lowe, Wendy Walker, Naomi O'Reilly, Laura Ritchie, Kim Jackson, Jess Bell, Robin Tacchetti, Rucha Gadgil, Tarina van der Stockt, Vidya Acharya, Shaimaa Eldib and Carin Hunter  

Introduction

"Health care is an important determinant of health. Lifestyles are important determinants of health. But... it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place." WHO Director-General Dr Margaret Chan

Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.

Determinants of health

The determinants of health include:

1. the social and economic environment,
2. the physical environment, and
3. the person’s individual characteristics and behaviours.

The WHO suggests that individuals are unlikely to be able to directly control many of the determinants of health:

• Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
• Education – low education levels are linked with poor health, more stress and lower self-confidence.
• Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
• Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.
• Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
• Health services - access and use of services that prevent and treat disease influences health
• Gender - Men and women suffer from different types of diseases at different ages.

Social and economic environment determinants of health

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. Health inequities are unjust and avoidable. In order to reduce health inequities, there is a need to address the wider socioeconomic and structural factors that influence how people become sick, what risk factors they are exposed to, how they access services, and how they use those services.

Based on social and environmental conditions in which people live. According the to World Health Organisation the 9 social determinants of health are:

1. Stress
2. Early life
3. Social exclusion
4. Work
5. Employment
6. Social support
7. Addiction
8. Food
9. Transport

Relevance to Physiotherapy

In our contact time with our patients we spend a lot of time understanding thier health and social status, in other words we explore and determinants that might be affecting their health, and in particular ones that we can influence.  The model we use to analyse and understand these determinants of health is the biopsychosocial model of health care.