Health determinants in Epidemiology

What is Health?

The World Health Organization (WHO) has defined health as a state of physical, mental & social well-being of a person in which diseases and infirmities are absent.

It is a state of complete physical mental and social well-being and not just the absence of disease or infirmity. Good health is something we always strive to achieve, not just individually but also as a community.

If we look around us, we would come to know that health status of a person doesn’t exactly match with others. This varies with each individual in our family, friends, and others.

Even life expectancy of children born in different conditions and locations doesn’t match. The life expectancy of a new born child may vary within countries. The changes can be observed across the communities, races, ages, genders etc. within the same country. Even, within the specific communities, health can change based on person’s income, education, occupation, and another societal determinant.

What are the determinants of health?

So, why health is so variable? To answer this question, we must understand the factors that influence health of a person.

These factors which impact a person’s health are called determinants of health. Such health determinants may include various factors such as age, sex, genetic makeup, other social and environmental factors.

Health of a person may also get affected by their health-related behavior such as smoking, physical activities, alcohol use, diet etc.

In general, health is largely impacted by the conditions in which people grow and the government policies in a specific region. The social conditions like socioeconomic status, education levels, neighborhood and physical environment, employment status, social support networks, and access to health care are considered as the social determinant. Similarly, government policies are another important part of the health determination. Here, in brief, we will discuss these main two types of health determinants.

The structural determinants of health

Structural determinants are considered the ‘root causes’ of health variability in health status of people. These determinants include the economic and social policies of the governing bodies in any specific community. These policies ultimately affect education, incomes, working environment, access to house and medical care of people living there.

The structural determinants of health deals with the levels of equality or inequality of resources distribution among the people in a specific location. Structural determinants explore the way of resource distribution within a country to understand impact of biasness in access to resources within a country or community.

The resource distribution can possibly bias on the basis of races, gender, social classes, geographies, or other specific social group of people. Ultimately, the structural determinants of health shape the overall quality of the social health determinants experienced by people in their communities and neighborhoods.

Structural determinants are the socioeconomic and political context that people live in. These determinants not only include government’s economic social and public policies but also the social and cultural values placed on health issue. Therefore, these factors can lead to the unequal distribution of mental and monetary resources.

The structural determinants of health operate through a set of intermediary determinants. Which impacts a person’s exposure, vulnerability, and outcomes to the factors affecting their health.

The Social Determinants of Health

Social Health determinants include the circumstances of people such as where they born, live, grow, study, and work. The social determinants of health for a person are shaped by a set of the forces beyond the control of that person. Such determinants include resources, material conditions, psycho-social and behavioral aspects of an individual.

These are associated with the living and working conditions of a person. It majorly includes his income, access to housing, and medical care services.

Psychological factors like stressful living, circumstances relationship, social support behavior also impacts health of a person.

Furthermore, biological factors like genetic makeup also plays a major role as a health determinant. Health care systems also plays a major role in terms of availability of type of healthcare services, it’s quality and accessibility. This ultimately depends upon the social cohesion and social capital of a community or country.

Main Factors affecting health status

In general, following types of factors can influence health of a person:

Personal health related behaviors

Biological factors

Societal factors

Environmental factors

Any of the above factors can influence health status of an individual or a community. In any epidemiological study, all these factors are considered as the health care determinants. 

Furthermore, there is a possibility where health status of a person can be influenced by more than one determinant.

The links between all these determinants are not always linear. They can be complex, interdependent and can interact in many different ways to influence health. For example, our income can limit opportunity for achieving good health. Conversely, poor health can limit a percentage for people to participate in workforce.

We need to understand that determinants can act across the course of a person’s life. So, at the time we think to analyze about health issues of a person, we need to consider all the possible determinants. To study pattern of a disease and its associated determinants and distributions, we must not know only who they are, and what they do, but also the condition in which they born, grow, live, work, etc.

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