2 the Determinants of Health

7/28/2019 2 the Determinants of Health

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The Determinantsof Health


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The Determinantsof HealthHealth has been defined by

the World Health Organization

(WHO), as the state of mental,

physical, and social well being

and does not merely connote the

absence of illness.


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Health is a multi-factorialphenomenon The absence of symptoms does not

connote healthfulness

The presence of symptoms does notnecessarily connote illness.

There are varying degrees or states of

health


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The state of being healthy or unhealthy

can be expressed in many ways or thereare many factors to consider to determine

the condition of health of an individual.

Health Economics deals with themanipulation of these factors that will give

people better health. This poses a

problem for health planners since health isdifficult to both qualify and quantify.


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How do we manipulate health? What determineshealth?Underlying Socio-economic,

demographic and cultural

factors

______________________Individual

Age, Sex

Education

Occupation

Attitudes

Health Benefit

Household

Income/Wealth

Age-sex composition

Social network

Community

Ecological climate

Market and prices

Transportation size and

structure

Social structure and

Proximate

Factors

___________

Health Care

Service

Utilization

EnvironmentalContamination

Nutrient

Dietary Intake

Fertility

Injury

Health

Outcomes

__________

Mortality

Morbidity

Nutritional

Status

Disability


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Health Outcomes are objective measures

of health. They are the parameters used to

measure the health condition ofindividuals, communities or countries.

Proximate determinants are factors that

have a direct influence on health

outcomes. Proximate means attached,

near or direct


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Health Outcomes Economics seeks to maximize the output

of any given input. It means that moregoods should be produced and distributed

for a minimum amount of resources used.

Given this objective, the health plannersare able to measure improvements in

health.


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For planning purposes, the state of

health of individual, a community or

country is showcased by health

outcomes/parameters/indicators. Health

outcomes are objective measurements of

health and disease. They can be:Distinct figures examples are life

expectancy, nutritional status( height or

weight for age)Ratios - examples are mortality ,

morbidity rate, incidence or prevalence.


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Health OutcomeMeasurements Fertility Rate measures the reproductive capacity

of groups

Crude Birthrate (CBR)=

Mortality rate measures risk of dying with a specific

group or dying from a cause

Crude Death Rate(CDR) = ,

X 1000


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Health OutcomeMeasurements Cause Specific Death Rate (CSDR)

=

x F

Infant Mortality Rate (IFR) =


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Health OutcomeMeasurementsMorbidity Rate measures the frequency of illnesses with specific

population

Prevalence Rate (PR) =

X 1000

Incidence Rate =

x F


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The preceding examples show that health can

be and should be objectively measured. They

also show how health is being objectivelymeasured.

These measurements are important because;

1. They give planners an objective idea of thehealth status of communities, regions or

entire countries.

2. It can be used for monitoring and measuringthe effectiveness of health activities and

programs to improve health. This can be

done before and after a program has been

implemented.


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Proximate FactorsProximate factors are factors that directly affect

the health status or outcomes of individuals orgroups.

These factors may be innate to a person, e.g. ,

nutrient intake and fertility. These arephysiological factors which directly affect the

health status of individuals.

These are maybe external factors, e.g.,environmental contamination, injuries, and

health care service utilization which also

directly affect the health status of people or

communities


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Proximate Factors and health programs developedProximate Factors Health Program s Developed

Health Care Service Utilization OPLAN Bakuna Jollibee, OPLAN AlisDisease

Environmental Contamination Anti-pollution campaign, Worker Health

and Safety Programs

Nutrient Dietary Intake Barangay Day Care Centers,

Vitamin A campaign

Fertility Responsible Parenthood InformationDrive

Injury Dont Drink and Drive Campaign


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Underlying Socio-Economic,Demographic and Cultural Factors These are factors that do not directly affect

health outcomes, but have an influence on

the proximate factors which ultimately affect

the health status.

These factors will ultimately influence the

activities, exposures and attitudes of

individuals, households and communities

towards health.


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These underlying factors affect the proximate factors which

then affect health outcomes.

A. Individual Level

Occupation as a Coal Miner

(Occupation as an

underlying determinant)

Exposure to mining

contaminant

(Environmental

contamination as

proximate determinant)

Increased Incidence of

workers lung disease

(Health Status/Outcome)

B. Household Level

Low household income

(Income/wealth as underlying

determinant)

Poor nutritional intake

Nutritional Intake as

proximate determinant)

Poor nutritional status( low

weight for height)

Health Status/Outcome

C. Community Level

Poor

Transportation/Transportation

network

(Transportation structure as

underlying determinant)

Poor Health care service

utilization

Health care service as a

proximate factor)

Deaths in the area

(Health ststus/outcome)


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Each of the proximate determinants and the

underlying causes affect the outcomes in

some way or another. It is important toremember that these may all be intervention

points which can help improve health status

or outcomes. However, it is also important tonote that not all factors are within the control

of health practitioners and public health

officials. Thus the theoretical holistic

approach to the treatment of illnesses will

require the cooperation of a lot of sectors

which may be easier said than done.


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Relationship of Health and Economics There is a theoretical relationship between health

and economics which operates like a cycle.

It goes like this: Better economy allows countries to

allocate more financial, technological, and manpower

resources for health-producing activities and

programs. More resources allocated and used

health lead to improvements in health status . The

improvement in health status then lead to betterproductivity, more specifically among workers. This

then contribute to a better economy.

2 the Determinants of Health

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