Determinants of Health

1. B B P S Determinants of Health Biological Behavioral Physical Environment 4. Social

2. Over Time: • Overall health status of Australians has improved significantly • Mortality Rates have decreased • Life Expectancy has increased by nearly 30 years • Unfortunately not all groups within Australians share the same level of good health as the rest of the population • The factors that lead to differences in health status are collectively known as the Determinants of Health

3. What are the Determinants of Health? • Health of an individual is based on • Uncontrollable Factors (genetics, gender, predisposition to a disease) • Controllable Factors (diet, smoking status, exercise levels) • All these factors (that determine health status)are known as determinants of health and can be classified into 4 categories

4. Determinants of Health • Definition from Study Design (copy down) • Factors that raise or lower a level of health in a population or individual. Determinants of health help to explain or predict trends in health and why some groups have better or worse health than others. They can be classified in many ways – biological, behavioural and social.

5. What are the Determinants of Health?

6. Differences between dimensions and determinants of health • Dimensions of health • what health is • P.M.S. • Determinants of health • how health status is determined • B.B.P.S.

7. Determinants of health All Determinants Biological Determinants Behavioural Determinants Social Determinants Physical Environment Factors relating to the body that impact on health, such as: Genetics, hormones, body weight, blood pressure, cholesterol, birth weight The physical surroundings in which we live, work and play. It includes water, air, housing, roads Actions or patterns of living of an individual or group that impact on health, such as: Smoking, sexual activity, eating practices Aspects of society and the social environment that impact on health, such as: Poverty, early life experiences, social networks

8. Biological Determinants Factors relating to the body that impact on health

9. Biological Determinants

10. Behavioural DeterminantsActions or patterns of living of an individual or group that impact on health

11. Behavioural Determinants

12. Physical environment determinants Factors relating to the physical environment

13. Physical environment

14. Social Determinants Aspects of society and the social environment that impact on health Socio Economic Status Access to Health Care Work Social Determinants Early Life Experiences Social Exclusion Transport Housing Stress Food Security

15. Social Determinants

16. Activity • Write down a list of things that influence your health

17. ACTIVITY • Categorise that list into the following 3 subtitles • BIOLOGICAL • BEHAVIOURAL • SOCIAL SOCIAL - - - - - BIOLOGICAL - - - - - BEHAVIOURAL - - - - -

18. ACTIVITY • Would your list be similar to that of someone living in Africa? Explain your answer

19. What are the Determinants of Health? • The determinants of health can sometimes be referred to as RISK FACTORS or PROTECTIVE FACTORS • Risk Factor – determinants which are detrimental to health (smoking) • Protective Factors – Promote or enhance health (exercising)

20. Write • Select 1 example (of any determinant of health) from each category and explain how each influences health and health status. It can have a positive or negative influence Behavioural – Exposure to the sun  Affect on health Increase chance of  developing skin cancer Affect on Health Status Decrease life expectancy Increase Mortality & Morbidity

21. Determinants of Health Can the determinants interrelate with one another?

22. RISK factors – those factors that are detrimental to health Many determinants interrelate Behavioural – excessive drinking Biological - overweight Social – lack of social connections

23. ACTIVITY - Risk Factors • In groups of 2-3 think of a risk factor of a determinant of health that impacts on the other determinants of health, then write it down!

24. PROTECTIVE factors – those factors that promote or enhance health Many determinants interrelate Behavioural – regular physical activity Biological- healthy body weight Social – belonging to a team

25. Protective Factors • In groups of 2-3 think of a protective factor of a determinant of health that impacts on the other determinants of health.

26. BIOLOGICAL DETERMINANTS OF HEALTH

27. Biological Determinant Body Weight The effect of Body Weight on the health status of Australians Healthy weight range Over weight Obese Under weight • Maintaining a “healthy” body weight is beneficial for health • Genetics plays a role in body weight as does food intake • Young people who are overweight or obese obese adults

28. Biological Determinant Body Weight The effect of Body Weight on the health status of Australians Under weight Healthy weight range Over weight Obese AFFECTS ON HEALTH • Effect on Physical Health • high blood pressure • high blood cholesterol • impaired glucose regulation • CVD • respiratory conditions • Arthritis • Effect on Social Health • social marginalisation (being separated from the rest of society) • Effect on Mental Health • low self esteem

29. Activity • In groups come up with as many factors (that affect health status) that can be associated with: • Being Overweight or Obese • Being Underweight BIOLOGICAL BEHAVIOURAL SOCIAL

30. Biological Determinant Body Weight • There has been a significant rise in prevalence overweight and obesity in Australia over the past 20–30 years. • Excess body fat increases the risk of developing a range of health problems, including Type 2 diabetes, cardiovascular disease, high blood pressure, certain cancers, sleep apnoea, osteoarthritis, psychological disorders and social problems (WHO 2000). • Underweight is associated with malnutrition and poor health. Disordered eating— anorexia and bulimia, among people in the developed world also results in poor health. • High body weight—also referred to as high body mass—was estimated to be responsible for 7.6% of the total burden of disease in Australia in 2003, placing it a close third behind tobacco smoking and high blood pressure

31. BMI • Body weight assessments are made using the body mass index (BMI) • BMI = weight (kg) • height (m) 2 • BMI • Under 18 very under weight • 19-20 under weight • 20 – 25 health weight range • 26-30 overweight • Over 30 obese

32. Biological Determinant Body Weight • There is likely to be strong growth in the level of diabetes over the next 20 years, mostly as a direct result of increasing levels of obesity. • About half of Australian adults are overweight or obese according to the 2004–05 (National Health Survey) • The prevalence of overweight and obesity has increased across all age groups from 1995 to 2004–05. The most marked increases were among those aged 25–44 years and 75 years and over,

33. What does my waist measurement mean? The waist measurements below3 (no matter what your height is) suggest you have an increased risk of developing a chronic disease:Increased risk- Men: more than 94 centimetres- Women: more than 80 centimetresGreatly increased risk - Men: more than 102 centimetres- Women: more than 88 centimetres NOTE: These are World Health Organisation and National Health & Medical Research Council figures.

34. Measure up campaign http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/home http://www.youtube.com/watch?v=UWTlHqca5AM http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/How%20do%20I%20measure%20myself-lp/$File/POPUL0137_Women_A4_HR.pdf http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/How%20do%20I%20measure%20myself-lp/$File/POPUL0137_Men_A4_HR.pdf

35. Blood pressure Pressure of the beating heart on the arterial walls Contracting heart – systolic Relaxing heart - diastolic Normal BP – 120/80 measured in mm of mercury or mmHg Hypertension is the condition of high blood pressure 140/90 – 180/110 There is an increase in pressure on the arterial walls and heart

36. Risk factors • Risk factors • Stress, smoking, excess alcohol, genetics, diet • Links to • CV disease, heart attack, stroke

37. Cholesterol • Fat required by the body • Produced in the liver • Found in animal and plant products • 2 types of cholesterol • LDL low density lipoprotein - bad cholesterol • HDL high density lipoprotein – good cholesterol • High cholesterol leads to narrowing of the arteries atherosclerosis • Measured by a blood test • Under 5.5 mmol/L is good • Risk – excess alcohol, smoking, diet high in fat, lack of exercise, genetics.

38. READING And Note taking • Read pages 45 - 48 • Make dot points on how body weight, blood pressure and blood cholesterol can impact on health status

39. QUESTIONS TO ANSWER • Test your knowledge p.48 • Questions - 3, 4, 5, 6, 7, 9 • Apply your knowledge p.48 • Questions – 11, 12, 13

40. Impaired glucose regulation • Glucose is the preferred fuel for the cells • When glucose is eaten it is absorbed into the bloodstream • When blood glucose levels rise, insulin is released from the pancreas to allow the glucose to travel into the cells • If blood glucose levels are constantly high then insulin levels are also high. • If this occurs over a long period of time, the cells can become resistant to the insulin, preventing the glucose from being absorbed. • This is known as insulin resistance

42. Glucose intolerance or insulin resistance • Can occur as a result of: • Genetic predisposition • Stress • Pregnancy • Lack of exercise • Smoking • Being overweight • A diet high in fat • High BP 1. What are the implications for health and health status? 2. What treatment is there?

43. Birth Weight • 1. What weight is classified as low birth weight? • 2. what are the implications for health and health status. • 3. what are the causes of low birth weight?

44. Answers • 1. anything under 2500g • 2. underdeveloped immune system, susceptible to infections, more likely to suffer form premature death, disabilities such as speech and learning, as adults high BP, type 2 diabetes, CV disease. • 3. premature birth, age of the mother ( under 15 or over 45), mother nutrition, smoking, alcohol or drugs during pregnancy, illness during pregnancy.

45. Biological Determinant Genetics • Predisposition to disease • “A person's may be at increased risk of inheriting a disease or condition if they have a biological parent who has had the disease.” • Genetics can influence how likely a person may develop a certain condition or disease person is at an increased risk • Sometimes the interaction of genes combined with other determinants (biological, behavioural and social) results in an individual being more susceptible to a disease or condition. • Examples of diseases – genetic predisposition • Alzheimer's disease ■Schizophrenia • Migraine headaches ■Type 1 & 2 diabetes • CVD - High blood pressure, hypertension • Spina bifida • Certain cancers – (including breast and prostate) • Depression

46. Biological Determinant Genetics • Predisposition to skin cancer Individual Exposure to UV radiation Sunburn particularly childhood ◘ Genetics ◘ Fair skin (skin type is genetic) ◘ Parents – skin cancer ◘ Moles on body Behavioural Biological ? Social Outside Job

47. Apple Vs. PearThe tendency to deposit fat around the middle of the body is influenced by a person’s genes. Which body shape is at higher risk of CVD, diabetes, hypertension and high cholesterol and why?

48. Biological Determinant Genetics – Body Type • Body fat distribution and health risk • A person’s waist circumference is a health risk • Fat around the abdomen “pot belly” – more likely to develop obesity-related health conditions • diabetes ■ high cholesterol • hypertension ■ CVD • Fat around the hips and buttocks – not the same risk • Body type – affect self esteem and self concept

49. READING And Note taking • Write the Heading: • Biological Determinant: Genetics, Hormones • Read pages 52- 55 • Make dot points on how genetics and hormones can impact on health status

50. QUESTIONS TO ANSWER • Read the Case Study p.54 Ch 2.4 • Fat? Blame your granny – Australian scientists discover amazing diet secret • Complete Questions • TYK 1,3,5, 6 • AYK 9, 10