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Determinants of Health
Objectives are 
• Student should know-- 
• Health is multidimensional. 
• Should able to tell-determinants of health. 
• Health is affected- Genetic / Biological factors 
Environmental factors. 
Socioeconomic factors , 
Life style.
Determinants of Health 
• Health is multi factorial. 
• Some are inside the body-genetic/intrinsic 
• Some are - External factors /environmental 
• Interaction of them may be--- 
--health promoting 
--deleterious.
Common Determinants of Health 
• Genetic factors (biological) 
• Environmental factors 
• Life style 
Behavioral & socio-cultural 
• Gender & Age 
• Socioeconomic conditions 
Education, Occupation, Income 
• Health services –utilization 
Immunization, Family welfare ,nutritional…
Other determinants of health - 
• Food & agriculture 
• Education. 
• Science & technology. 
• Standard of living. 
• Social justice, equity, human rights. 
• Govt Polices to raise stand of living 
• Inter sectoral contributions 
• Dissemination of information (IEC)
Biological determinants 
• Genetic make-up (Heredity) 
• It is permanent & can not be altered. 
• Transmitted by hereditarily. 
• No treatment. 
• Many be Prevented to some extent.
Environmental factors- 
• Internal environment/Micro 
• External environment/Macro 
Physical-air, water, soil 
Biological-plants,animals,microbes 
Social-culture,belifes,traditions- 
Dynamic equilibrium is Health
Behavioral & socio-cultural 
(Life style) 
• Depends on economic status 
(rich & poor) 
• Cultural values 
vegetarianism-Non-vegetarianism 
• Social values 
Status of women 
• Personal habits 
Smoking….. 
• Behavioral pattern 
High risk behavior
Life style 
• Learnt by observations by –parents, teachers, peer 
groups, mass media….. 
Includes cultural pattern, social value & behavior… 
• The way people thinks & live 
- developed through process of socialization& 
social interaction. (traditional lifestyles) 
• So cultivate healthy lifestyles 
like proper nutrition & sleep, exercise, avoid 
drug abuse,
Life-style makes the difference 
• Malnutrition. 
• Population explosion. 
• Mental health problems. 
• RCH 
• Cancer. 
• Diabetes mellitus 
• Cardiovascular diseases 
• AIDS & STDs. 
• Environmental pollution.
Socioeconomic conditions 
• Determined by-Income (per capita) 
Literacy 
Occupation 
Purchasing capacity 
• Indirectly by-religion & caste 
- Housing 
- Political support
Economy & literacy 
• Determines quality of life (PQLI) by 
-Employment ,housing, nutrition. 
- Productive work promotes health 
-Finally determine health status 
-
Socioeconomic conditions--- 
• Per capita GNP 
• GNP directed to wards health care 
• Political commitment 
• Efficient leadership
Health services 
• Availability & utilization of health services 
• Should include comprehensive services 
• Need based essential 
• Must reach to social periphery 
• Equitably distributed 
• Accessible at affordable cost 
• Socially acceptable
Health services 
• Should promote health & prevent illnesses. 
Eg:- Immunization of children— 
Provision of safe drinking water— 
ANC-will reduce MMR & IMR. 
• Services must reach to all sections.
Family welfare services 
• Covers spectrum of personal & community 
services for treatment ,prevention & 
promotion of health 
Like--- immunization, family planning, 
MCH,ICDS, Nutritional….
Gender & Age 
• Women’s affected by gender difference 
• Nutrition & development 
• Violence 
• Social status 
• Economic independence 
• During reproductive age 
• Aging –leads Geriatrics problem
Other factors 
• Better IEC system 
• Rural development 
• Employment opportunities 
• Increased wages 
• Family support systems 
• Inter-sectoral coordination between— 
Depts. of education , agriculture, civil, 
labor, environment, social welfare….
Indicators of health 
• To measure health status. 
• To compare 
• To assess the health needs 
• To plan & implement---- 
• To evaluate health care
Health is measured multi-dimensionally & 
indirectly 
Health Indicators classified as…. 
• Mortality indicator 
• Morbidity indicators 
• Disability indicators 
• Nutritional status indicators 
• Health care delivery indicators 
• Utilization rates
Health Indicators also classified as…. 
• Indicators of social & mental health. 
• Socio-economic indicators. 
• Health policy indicators. 
• Environmental indicators. 
• Indicators of quality of health.
Mortality Indicators 
• Crude death rates 
• Infant mortality rates 
• Maternal mortality rates 
• Child mortality rates. 
• Proportional mortality rates.
Morbidity indicators 
• Incidence rate 
• Prevalence rate. 
• Notification rate. 
• Out patients attendance rate. 
• Hospital admission rate 
• Duration of stay in the hospital.
Disability rates 
• Event type 
No of days of restricted activity. 
Bed disability days. 
Sickness absenteeism. 
• Person type 
Limitation of mobility. 
Limitation of daily activity.
Nutritional status indicators 
• Incidence of LBW 
• Incidence of LBW 
• Anthropometric measurements of < 5 
mid arm circumference 
height & weight with age
Health care delivery indicators 
• Doctor : Population. 1:2500 
• Nurse: Population 1:5000 
• Health worker: Population 1:3000 
• Sub centers: Population 1:3000 
• P H C : Population 1:30000
Indicators of social & mental health 
• Rates of crimes--- murder, theft, suicides, 
Prostitution, gambling, drug abuse…. 
• Rates of accidents. 
• Rate of divorces, family violence
Socioeconomic indicators 
• Growth rate of population. 
• Per capita income / GNP. 
• Percentage of people below poverty line. 
• Level of unemployment. 
• Dependency ratio. 
• Literacy rate. 
• Family size.
Health policy indicators 
• Proportion of the budget (NGP) spent on… 
Health services— 
RCH, RNTCP, ICDS, Pulse polio 
Health related services— 
Water supply 
Sanitation. 
Nutrition 
Housing. 
Community development.
Environmental indicators 
• Indicators relating pollution of air, water, 
noise, soil, radiation solid waste… 
• Percentage of houses having .. 
safe water supply. 
adequate sanitary facilities.
• Thus there is no single comprehensive 
indicator to assess or to measure the health 
status of country. 
• Each indicator reflects one aspect of health. 
• Ideal indicator is yet to be developed.
Thus there is no single comprehensive 
indicator to assess or to measure the 
health status of country.
Utilization rates 
• Proportion of infants “fully immunized” 
• Proportion of mothers with adequate ANC. 
• Proportion of Deliveries conducted by TBA. 
• “Bed occupancy” rate in the hospital. 
• Coverage with insecticidal spraying.

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Determinants of health

  • 2. Objectives are • Student should know-- • Health is multidimensional. • Should able to tell-determinants of health. • Health is affected- Genetic / Biological factors Environmental factors. Socioeconomic factors , Life style.
  • 3. Determinants of Health • Health is multi factorial. • Some are inside the body-genetic/intrinsic • Some are - External factors /environmental • Interaction of them may be--- --health promoting --deleterious.
  • 4. Common Determinants of Health • Genetic factors (biological) • Environmental factors • Life style Behavioral & socio-cultural • Gender & Age • Socioeconomic conditions Education, Occupation, Income • Health services –utilization Immunization, Family welfare ,nutritional…
  • 5. Other determinants of health - • Food & agriculture • Education. • Science & technology. • Standard of living. • Social justice, equity, human rights. • Govt Polices to raise stand of living • Inter sectoral contributions • Dissemination of information (IEC)
  • 6. Biological determinants • Genetic make-up (Heredity) • It is permanent & can not be altered. • Transmitted by hereditarily. • No treatment. • Many be Prevented to some extent.
  • 7. Environmental factors- • Internal environment/Micro • External environment/Macro Physical-air, water, soil Biological-plants,animals,microbes Social-culture,belifes,traditions- Dynamic equilibrium is Health
  • 8. Behavioral & socio-cultural (Life style) • Depends on economic status (rich & poor) • Cultural values vegetarianism-Non-vegetarianism • Social values Status of women • Personal habits Smoking….. • Behavioral pattern High risk behavior
  • 9. Life style • Learnt by observations by –parents, teachers, peer groups, mass media….. Includes cultural pattern, social value & behavior… • The way people thinks & live - developed through process of socialization& social interaction. (traditional lifestyles) • So cultivate healthy lifestyles like proper nutrition & sleep, exercise, avoid drug abuse,
  • 10. Life-style makes the difference • Malnutrition. • Population explosion. • Mental health problems. • RCH • Cancer. • Diabetes mellitus • Cardiovascular diseases • AIDS & STDs. • Environmental pollution.
  • 11. Socioeconomic conditions • Determined by-Income (per capita) Literacy Occupation Purchasing capacity • Indirectly by-religion & caste - Housing - Political support
  • 12. Economy & literacy • Determines quality of life (PQLI) by -Employment ,housing, nutrition. - Productive work promotes health -Finally determine health status -
  • 13. Socioeconomic conditions--- • Per capita GNP • GNP directed to wards health care • Political commitment • Efficient leadership
  • 14. Health services • Availability & utilization of health services • Should include comprehensive services • Need based essential • Must reach to social periphery • Equitably distributed • Accessible at affordable cost • Socially acceptable
  • 15. Health services • Should promote health & prevent illnesses. Eg:- Immunization of children— Provision of safe drinking water— ANC-will reduce MMR & IMR. • Services must reach to all sections.
  • 16. Family welfare services • Covers spectrum of personal & community services for treatment ,prevention & promotion of health Like--- immunization, family planning, MCH,ICDS, Nutritional….
  • 17. Gender & Age • Women’s affected by gender difference • Nutrition & development • Violence • Social status • Economic independence • During reproductive age • Aging –leads Geriatrics problem
  • 18. Other factors • Better IEC system • Rural development • Employment opportunities • Increased wages • Family support systems • Inter-sectoral coordination between— Depts. of education , agriculture, civil, labor, environment, social welfare….
  • 19.
  • 20.
  • 21. Indicators of health • To measure health status. • To compare • To assess the health needs • To plan & implement---- • To evaluate health care
  • 22. Health is measured multi-dimensionally & indirectly Health Indicators classified as…. • Mortality indicator • Morbidity indicators • Disability indicators • Nutritional status indicators • Health care delivery indicators • Utilization rates
  • 23. Health Indicators also classified as…. • Indicators of social & mental health. • Socio-economic indicators. • Health policy indicators. • Environmental indicators. • Indicators of quality of health.
  • 24. Mortality Indicators • Crude death rates • Infant mortality rates • Maternal mortality rates • Child mortality rates. • Proportional mortality rates.
  • 25. Morbidity indicators • Incidence rate • Prevalence rate. • Notification rate. • Out patients attendance rate. • Hospital admission rate • Duration of stay in the hospital.
  • 26. Disability rates • Event type No of days of restricted activity. Bed disability days. Sickness absenteeism. • Person type Limitation of mobility. Limitation of daily activity.
  • 27. Nutritional status indicators • Incidence of LBW • Incidence of LBW • Anthropometric measurements of < 5 mid arm circumference height & weight with age
  • 28. Health care delivery indicators • Doctor : Population. 1:2500 • Nurse: Population 1:5000 • Health worker: Population 1:3000 • Sub centers: Population 1:3000 • P H C : Population 1:30000
  • 29. Indicators of social & mental health • Rates of crimes--- murder, theft, suicides, Prostitution, gambling, drug abuse…. • Rates of accidents. • Rate of divorces, family violence
  • 30. Socioeconomic indicators • Growth rate of population. • Per capita income / GNP. • Percentage of people below poverty line. • Level of unemployment. • Dependency ratio. • Literacy rate. • Family size.
  • 31. Health policy indicators • Proportion of the budget (NGP) spent on… Health services— RCH, RNTCP, ICDS, Pulse polio Health related services— Water supply Sanitation. Nutrition Housing. Community development.
  • 32. Environmental indicators • Indicators relating pollution of air, water, noise, soil, radiation solid waste… • Percentage of houses having .. safe water supply. adequate sanitary facilities.
  • 33. • Thus there is no single comprehensive indicator to assess or to measure the health status of country. • Each indicator reflects one aspect of health. • Ideal indicator is yet to be developed.
  • 34. Thus there is no single comprehensive indicator to assess or to measure the health status of country.
  • 35. Utilization rates • Proportion of infants “fully immunized” • Proportion of mothers with adequate ANC. • Proportion of Deliveries conducted by TBA. • “Bed occupancy” rate in the hospital. • Coverage with insecticidal spraying.