Determinants of Health – A practical approach!
By Dr Ranil Appuhamy
Compiled by Gabriel-Wealth Olatuja.
Health is the state of complete physical, mental and social well-being, not just the absence of disease or infirmity. Good health is something we strive to achieve, not just individually but also as a community.
If we look around us, our family friends and others, we know that health is very variable. For example, in 2016 the life expectancy of a child born in Nigeria was 50years, while in Australia it was 83 years.
But even within Australia, the life expectancy of indigenous people is about 10 years lower than that of non-indigenous people and even within a specific group of people, health can change based on a person’s income level of education or occupation.
Why is Health Variable?
To answer that question, we must understand the factors that influence health. The factors that influence a person’s health are called determinants of health.
These include who they are, such as age, sex and genetic makeup and what they do as in health behaviors such as smoking, physical activity, alcohol use and diet.
Health is also largely influenced by the conditions in which people are born, grow, live, work and age, collectively called the social determinants of health. The social determinants of health are shaped by the distribution of money, power and resources at an international, national and local level.
These can lead to health inequities which are the difference in health between different groups of people that is unfair and avoidable.
Let’s take a look at the social determinants of health using a framework developed by the World Health Organization, according to this framework, there are two broad groups of health determinants:
- Structural health determinants and
- Intermediary health determinants.
Structural determinants are the socio-economic and political context that people live in. It includes governance, economic, social and public policies.
Also, the social and cultural values placed on health issues can lead to the unequal distribution of material and monetary resources which can shape a person’s socioeconomic position.
Socioeconomic position is characterized by education, occupation, income, gender, race or ethnicity and social class.
The structural determinants .of health operate through a set of intermediary determinants that impact a person’s exposure vulnerability and outcomes to factors affecting their health.
These include material circumstances such as the quality of housing, the financial means to buy healthy food, clothing or other requirements for healthy living and work environment.
Psychosocial factors like stressful living circumstances, relationships and social support, behavioral and biological factors, in addition to these health systems determine the type of healthcare, the quality of it and how easily accessible it is.
Bridging the structural and intermediary determinants are social cohesion and social capital. The links between all these determinants are not always linear but can be complex interdependent and interact in many different ways to influence health.
For example income can limit opportunities for achieving good health and conversely, poor health can limit opportunities for people to participate in the workforce.
Remember these determinants can act across the course of a person’s life. So, the next time you think about a health issue, consider not only who they are and what they do but also the conditions in which they are born, grow, live, work and age. If we understand and act on them, we can build a healthier world for everyone.
References/Further reading:
1. WHO Social Determinants of Health: https://www.who.int/teams/social-determinants-of-health
2. Australia’s Health: https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/table-of-contents
3. WHO: Country Statistics: https://www.who.int/countries/sle/