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What are the Determinants of Health?

Executive Summary

Many factors contribute to the health of individuals and the communities in which they reside, some of which are modifiable to promote increased health and wellness. These determining factors are influenced by a combination of influences such as genetics, circumstances, and environment. Most characteristics of a society and its infrastructure can, in turn, affect the corresponding health of its citizens. This article discusses these determinants of health in detail and offers additional links to more in-depth resources including case studies, tools, and articles.

  • Background
  • Income & Social Status
  • Social Support Network
  • Education & Literacy
  • Employment & Working Conditions
  • Social Environment
  • Physical Environment
  • Personal Health Practices & Coping Skills
  • Healthy Child Development
  • Biology & Genetic Endowment
  • Health Services
  • Gender 
  • Culture

 

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Background

There are many factors that affect the health of individuals and the communities in which they live. The health of people is determined by numerous interrelated factors including lifestyle, circumstances and environment. Some determinants can be influenced, while others are more difficult to control. Some scholars categorize determinants of health into social versus other factors. For a detailed account of social determinants of health from a Canadian perspective, the following book is valuable. Evidence suggests that the healthcare sector can achieve better health outcomes for less money by spending more of its dollars on public health and primary care work that builds healthier communities, social supports, and environments which are often referred to as upstream and equity work.


The Determinants of Health Include: 

Income and Social Status

Higher income and social status are linked to improved health status. These two factors may be the most important determinants of health. The greater the gap between the richest and the poorest people in an area, the greater the disparities in their health. More on a successful initiative to improve health disparity among underserved populations in New York is available in a related case study. The diagram below (using data from Lynch, Kaplan, et al., 1998)6 highlights the relationship between income and mortality and is consistent across the world whereby those with higher incomes tend to live longer than their poorer counterparts. 


Social Support Network

Greater support from families, friends, and communities is linked to better health for individuals. Social support is a source of emotional reassurance and provides a safe place for a person to discuss their problems, which can help them to cope with adversity. Social networks provide information and practical support, such as knowing someone who can assist in a time of need. It can also support people in making healthier behaviour choices.


Education and Literacy

Health status improves with a person’s level of education. Education both contributes to and is a result of social position. Education influences social position in various ways; each of the factors indirectly influences a person’s health. Education contributes to health and prosperity by equipping people with knowledge and skills for problem-solving, and helps provide a sense of control and mastery over life circumstances. It increases opportunities for job and income security, and job satisfaction. It also improves people's ability to access and understand information to help keep them healthy. Health literacy is a related concept and is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." More than 60% of Canadians are considered to have low levels of health literacy, which poses a significant challenge for both population and public health initiatives. A health literate health care organization supports patient-provider communication to improve health care quality, reduce medical errors, facilitate shared decision-making, and improve health outcomes.


Employment/Working Conditions

Unemployment, underemployment, stressful or unsafe work is associated with poorer health. People who have more control over their work circumstances and fewer stress-related demands on the job are healthier and often live longer than those engaged in more stressful or riskier work and activities.


Social Environment

The importance of social support also extends to the broader community. Social or community responses can add resources to an individuals’ repertoire of strategies to cope with changes and foster good health. The array of values and norms of a society influence in varying ways the health and well-being of both individuals and populations.


Physical Environment

Factors related to housing, air quality, water quality, safe houses, and transportation systems all contribute to health. Environmental influences on health can be positive or negative, and range from global, to national and/or regional issues, to the local built environment, to the social environment. 


Personal Health Practices and Coping Skills

Individuals can prevent diseases, promote self-care and make choices that enhance health. Lifestyle includes not only individual choices, but also the influence of social, economic, and environmental factors on the decisions people make about their health. Personal life “choices” are influenced by the socioeconomic environments in which people live, learn, work and play. Further reading is available on changing patient behaviour. The Life Expectancy Calculator may be a useful tool for clinicians in helping patients understand some of the factors within their control to improve health status (e.g. smoking, alcohol consumption, physical activity, etc).


Healthy Child Development

Early childhood development is a determinant of health later in life. Other determinants of health in turn also affect the development of children. Determining the inclusion or exclusion, content, and frequency of a wide variety of preventive health interventions that is particularly useful during childhood (but covers the entire lifespan) is made useful via the Canadian Guide to Clinical Preventive Health Care.


Biology and Genetic Endowment

The basic biology and organic makeup of the human body is a fundamental determinant of health. Genetic inheritance provides pre-disposition to a wide range of individual responses that can affect health status throughout the lifespan. 


Health Services

Access and use of services that promote health and prevent disease influence health. Simple measures, such as protecting water supplies, often have the greatest impact on overall health. Examining high-use populations in terms of health care utilization can be an effective way to target interventions tailored to specific groups such as those with multiple co-morbidities.


Gender

Gender refers to the societal characteristics that society ascribes to the two sexes. Gendered norms influence the health system's practices and priorities. Gender inequities do not only result from income disparities; gender is also linked to differential access to health services, to unequal obligations to provide unpaid family care duties, and to disparities in nutrition. More on the extent to which gender influences health outcomes, morbidity and utilization patterns can be found in a presentation entitled Sex, Gender, and Health.


Culture

The customs, traditions, and the beliefs of the family and community all affect health. A person’s cultural background has an influence on their beliefs, behaviours, perceptions, emotions, language, diet, body image, and attitudes to illness, pain, and misfortune. All of these factors can influence health and the use of healthcare services. 

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