Determinants of Health

1. Determinants of Health PATH216 Mohamed M. B. Alnoor

2. Content • Definition of Health • Dimensions of Health • Determinants of Health • Inequity in Health

3. H E A L T H ? • Valued less than other desires wealth power prestige knowledge

4. H E A L T H ? • Health was forgotten - League of Nations WW I - United Nations WW II Introduced at a conference in 1945 • During the last few decades there is reawakening: that it is a fundamental human right .

5. Definition of Health “Absence of disease” “The condition of being sound in body, mind or spirit, especially freedom from physical disease or pain” Webster English Dictionary

6. Definition of Health “Soundness of body or mind, that condition in which its functions are duly and efficiently discharged” Oxford English Dictionary

7. Definition of Health WHO Definition : “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ”1948

8. Physical Mental Social Dimensions of health a multi-dimensional process

9. Dimensions of health Physical Dimension of Health -Implies perfect functioning of organs, at optimumcapacity , andin harmony. -Involves the ability to carry out daily tasks, and achieve fitness . -Anormal person: -no evident disease, -growthis comparable peers .

10. Dimensions of health Mental Dimension of Health Not merely the absence of mental illness, but also the ability to respond to the various experiences of life with flexibility and a sense of purpose.

11. Dimensions of health Mental Dimension of Health Mental health is a state of balance or harmony between the individual and others as well as between the individual and the environment

12. Dimensions of health Mental Dimension of Health The following characteristics are attributes of a mentally healthy person: a) he is free from internal conflicts, b) he accepts criticism, c) he searches for identity, d) he has a strong sense of self-esteem, e) he knowshimself, f) he has a good self-control, g) he faces problems and tries to solve them.

13. Dimensions of health Social Dimension of Health Ability to interact successfully with people within the environment, maintainingintimacy with others, showing respect and tolerance for those with different opinions and beliefs.

14. Dimensions of health Social Dimension of Health Health practices and beliefs are strongly influenced by the person’s : • economic level • life style • family • culture

15. Dimensions of health Social Dimension of Health Low-incomegroups are less likely to seek health care to prevent or treat illness; High-income groups are more prone to stress-related habits and illness

16. Dimensions of health Other Dimensions Spiritual dimension It includes: -principles and ethics -the purpose in life -religious beliefs and values all are important components of the way the person behavesin health and illness.

17. Dimensions of health Other Dimensions Vocational dimension When work is fully adapted to human goals, work often plays a role in promoting both physical and mental health. The importance of this dimension is clear when individuals suddenly lose their jobs or retire.

18. Determinants of Health

19. Determinants of Health

20. Determinants of Health - Behavioral - Environmental - Health services - Gender - Other factors • Physical environment • Biological environment • Psychosocial environment

21. Determinants of Health 1- Behavioral: -Nutrition/ food -Personal hygiene & customs -Habits -Smoking ( passive smoking ) -Alcohol & substance abuse

22. Determinants of Health 1- Behavioral: -Exercise -Sleep -Violence/ abuse -Recreation -Compliance to treatment -Reaction to stress

23. Determinants of Health 2- Environmental: A- Physical environment: -Air - Water (quantity and quality) - Waste disposal -Housing -Climate -temp. -humidity and rainfall

24. Determinants of Health 2- Environmental: A- Physical environment: -Geography -Heat -Light -Noise -Vibration -Radiation

25. Determinants of Health 2- Environmental: B- Biological environment: -Man(age, sex, genetic) -Microbes -Insects -Rodents -Animals -Plants

26. Determinants of Health 2- Environmental: • C- Psychosocial environment: • -Habits • -Customs • -Ethnicity • -Cultural values

27. Determinants of Health2- Environmental: C- Psychosocial environment: Ethnicity language culture religion common origin (ancestry) shared history Identification with a social group on grounds of :

28. Determinants of Health2- Environmental: C- Psychosocial environment: Culture Knowledge, Beliefs, Goals, Values, Attitudes and Practices Complex social phenomenon of shared :

29. Determinants of Health2- Environmental: C- Psychosocial environment: • -Religion/Morals • -Education/health awareness • -Employment • -Community life • -Housing

30. Determinants of Health2- Environmental: C- Psychosocial environment: How EDUCATIONinfluences health High level of education can lead to: • Employment: secure well paid health benefits • Good health: by developing favorable knowledge attitudes behaviors

31. Determinants of Health2- Environmental: C- Psychosocial environment: • -Political organization : • -% GNP on health • -Resource allocation • -Services: • -Availability • -Accessibility • -Commitment to development ( social NOT economic ) for all people

32. Determinants of Health2- Environmental: C- Psychosocial environment: -SES is associated with health outcomes: Mortality Morbidity Disability Well-being people of higher SES have better health than people of lower SES:

33. SES: Socio-economic status • Education • Occupation • Income • Housing

34. SES: Socio-economic status • Education SCORE • Illiterate • Elementary • Intermediate • Secondary • University • Postgraduate • 1 • 3 • 4 • 5 • 7 • 8

35. SES: Socio-economic status • Occupation SCORE • Unemployed • Laborer • ------------- • ------------- • ------------- • Professional • 1 • 3 • 4 • 5 • 6 • 8

36. SES: Socio-economic status • Income (per month) SCORE • < 1000 • 1 000- 4 000 • 5 000-14 000 • ------------- • ------------- • > 50 000 • 1 • 2 • 3 • 4 • 5 • 6

37. SES: Socio-economic status • Housing SCORE Type • Shack • Traditional house • Apartment • Villa • 1 • 3 • 6 • 8

38. SES: Socio-economic status • Housing SCORE Neighborhood • 1 • ----------- • ----------- • ----------- • ----------- • ----------- • 2 • 3 • 4 • 5

39. SES: Socio-economic status • Housing SCORE Ownership • Rented • Mortgaged • Owned • 1 • 5 • 8

40. SES: Socio-economic status Housing Education Type Income Occupation Ownership T o t a l Neighborhood Average 1 1 1 1 1 1 1 4 Minimum Score 7 8 8 6 8 5 8 29 Maximum

41. SES: Socio-economic status • Lower Class • Middle Class • Upper Class RANGE 4 - 29 4 - 10 < 11 11 - 22 11 - 22 23 - 29 >23

42. Determinants of Health2- Environmental: C- Psychosocial environment: -SES is associated with health outcomes: Mortality Morbidity Disability Well-being people of higher SES have better health than people of lower SES:

43. Determinants of Health 3- Health Services related determinants : -H. E. -MCH -Control of communicable disease -Control of non-communicable disease

44. Determinants of Health 4-Gender related determinants: 1993 Global Commission on Women’s Health -Reproductive health -Nutrition -Employment/occupation -Domestic violence

45. Determinants of Health 5- Other Factors: • .Transition related determinants: Industrial age information age Information & Communication Revolution easy access to health information medical professionals and the public

46. Determinants of Health 5- Other Factors: • Intersectoral related determinants : Food & agriculture Education Industry Social welfare

47. Determinants of Health 5- Other Factors: • Rural development • Raising standard of living • Employment opportunities • Increased wages

48. INEQUALITY INEQUITY عدم المساواة الظلم

49. Health Inequities exist BETWEEN COUNTRIES and WITHINCOUNTRIES

50. Health inequities between countries Life Expectancy : Children have dramatically different lifeexpectancies depending on where they were born: Japan or Sweden: > 80 years; Brazil: . . . . . . . . . .. . . .72 years; India: . . . . . . . . . . . . . . . 63 years; African countries: < 50 years.