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Health determinants

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"what are the determinats of health differences. it includes issues related to health services inequity".

"what are the determinats of health differences. it includes issues related to health services inequity".


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  • 1. Carlos Amade, MD
  • 2. Human Beings Biological Physical Social
  • 3.  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).
  • 4.  Definition:  The range of personal, social, economic, and environmental factors that influence health status
  • 5.  Policymaking  Social determinants  Health services  Behavior  Biology and genetics
  • 6. (from „The future of the Public‘s Health“, IOM 2003)
  • 7.  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.
  • 8. Disease is caused by either pathology or politics
  • 9. 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
  • 10.  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.
  • 11.  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
  • 12. 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 Social Conditions Vulnerable Population Creates Vulnerability Targeted Protection Reduces Vulnerability Diagnosed, but with no complications Primary Prevention Clinical complication s requiring treatment Secondary Prevention Tertiary Prevention Disability and Death Opportunities for Public Health Interventions A Social Determinants Framework
  • 13.  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.
  • 14.  Lack of availability  High cost  Language  …..
  • 15.  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.
  • 16.  Diet  Physical activities  Hand washing  Drug use  …..
  • 17.  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
  • 18.  Think:  Age  Sex  HIV status  …
  • 19.  B  E  I  N  G  S