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'''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]]
'''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]]  


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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
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== Introduction  ==
== Introduction  ==


"Health care is an important determinant of health. Lifestyles are important determinants of health. But... it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place." Director-General Dr Margaret Chan  
''"Health care is an important determinant of health. Lifestyles are important determinants of health. But... it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place."''  WHO Director-General Dr Margaret Chan<ref>Dr Margaret Chan. [http://www.who.int/dg/speeches/2008/20080828/en/ Launch of the final report of the Commission on Social Determinants of Health].  2008. Accessed online 6 January 2017.</ref>


Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.  
Many factors combine together to affect the health of individuals and communities. Whether a person is healthy or unhealthy is determined by his/her circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.


The determinants of health include:  
The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants, or things that make people healthy or not, include the following and many others:  


#the social and economic environment,
== Determinants of Health  ==
#the physical environment, and
#the person’s individual characteristics and behaviours.


The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinant include:  
The range of personal, social, economic and environmental factors that influence health status are known as determinants of health. These can be classified as:  


*Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.  
#The social and economic environment
*Education – low education levels are linked with poor health, more stress and lower self-confidence.  
#The physical environment
*Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
#The person’s individual characteristics and behaviours
*Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.
<br>
*Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.  
There are many commonly accepted determinants of health but there is no single definition. The Office of Disease Prevention and Health Promotion ('''ODPHP''') has broadly categorised the determinants of health<ref name="ODPHP">Office of disease prevention and health promotion. [https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health Determinants of Health]. Accessed online 6 January 2017.</ref> and these have been summarised below:
*Health services - access and use of services that prevent and treat disease influences health


Gender - Men and women suffer from different types of diseases at different ages.
=== 1. Policy-making ===


== Social and economic environment determinants of health ==
Policies at the local, state and federal level effect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.  Unfavorable conditions can result due to substandard policies and programmes, inadequate governance and unfair economic arrangements.<ref>Islam MM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376855/ Social determinants of health and related inequalities: confusion and implications]. Frontiers in public health. 2019 Feb 8;7:11.</ref>


The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. Health inequities are unjust and avoidable. In order to reduce health inequities, there is a need to address the wider socioeconomic and structural factors that influence how people become sick, what risk factors they are exposed to, how they access services, and how they use those services.  
=== 2. Social Factors ===


<br> Based on social and environmental conditions in which people live. According the to World Health Organisation the 9 social determinants of health are:  
Social and physical determinants of health reflect the conditions of the environment in which people are born, live, learn, play, work and age. Also known as social determinants of health, they impact a wide range of health, functioning and quality-of-life outcomes. They represent economic and political systems, physical and social environments, as well as health service access. Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life.<ref>Palmer RC, Ismond D, Rodriquez EJ, Kaufman JS. Social Determinants of Health: Future Directions for Health Disparities Research. Am J Public Health. 2019;109(S1):S70-S71. </ref>


#Stress
Examples include:
#Early life
#Social exclusion
#Work
#Employment
#Social support
#Addiction
#Food
#Transport


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*Availability of resources to meet daily needs, such as educational and job opportunities, living wages or healthful foods
*Social norms and attitudes such as discrimination
*Exposure to crime, violence and social disorder
*Social support and social interactions
*Socioeconomic conditions such as concentrated poverty
*Quality schools
*Transportation options
*Urbanisation and the built environment such as buildings or transportation
*Worksites, schools and recreational settings
<nowiki>**</nowiki> Poor health outcomes are associated with adverse conditions leading to social risk factors<ref>Alderwick H, Gottlieb LM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554506/ Meanings and misunderstandings: a social determinants of health lexicon for health care systems.] The Milbank Quarterly. 2019 Jun;97(2):407.</ref>
 
=== 3. Health Services ===
 
Both access to health services and the quality of health services can impact health. Barriers to accessing health services include lack of availability, high cost, lack of insurance coverage and limited language access. These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services as well as hospitalisations that could have been prevented.
 
=== 4. Individual Behaviour ===
 
Individual behaviours such as diet, physical activity, alcohol, tobacco and other drug use also play a role in health outcomes.
 
=== 5. Biology and Genetics ===
 
Some biological and genetic factors affect specific populations more than others. Examples of&nbsp;biological and genetic determinants of health include age, sex, inherited conditions and genetic make-up.<br>
 
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== Relevance to Physiotherapy  ==
== Improving Health Worldwide ==
WHO have identified three "common interventions" for improving health conditions worldwide:<ref name=":0">World Health Organization (2013). [http://apps.who.int/iris/bitstream/handle/10665/84213/9789241548625_eng.pdf;jsessionid=97F39CFE3967A7FE93BA46E18B4418E9?sequence=1 The economics of social determinants of health and health inequalities: a resource book (PDF)]. World Health Organization. ISBN 978-92-4-154862-5</ref>


In our contact time with our patients we spend a lot of time understanding thier health and social status, in other words we explore and determinants that might be affecting their health, and in particular ones that we can influence. &nbsp;The model we use to analyse and understand these determinants of health is the [[Biopsychosocial Model|biopsychosocial model]] of health care.  
==== 1. Education ====
A large number of studies have demonstrated a strong link between better education and better health,<ref>Knesebeck O et al. Education and health in 22 European countries. Social Science and Medicine, 2006, 63:1344–1351</ref> and education has been shown to be a reliable predictor of lower mortality rates.<ref>Muller A. Education, income inequality, and mortality: a multiple regression analysis. BMJ, 2002, 324(7328):23–25</ref><ref>Deaton A, Paxson C, eds. Mortality, education, income, and inequality among American cohorts. Chicago, University of Chicago Press, 2001</ref> The probability of being in good or very good health is higher for people with university or post-secondary education.<ref>Hurd M, Kapteyn A. Health, wealth, and the role of institutions. Journal of Human Resources, 2003, 38(2):386–415</ref>


[[Image:Biopsychosocial-model-of-health.PNG‎|center]]
==== 2. Social Protection ====
Countries with some sort of social protection (i.e. a safety net or social security system) show improved health and economic outcomes in circumstances where people become unable to earn a living.<ref>Chung H, Muntaner C. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy, 2007, 80(2):328–339</ref>
 
==== 3. Urban Development ====
The physical environment where communities live has a great impact on the health of the residents.<ref>Chung H, Muntaner C. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy, 2007, 80(2):328–339</ref><ref>Thompson S et al. Do urban regeneration programmes improve public health and reduce health inequalities? A synthesis of the evidence from UK policy and practice (1980–2004). Journal of Epidemiology and Community Health, 2006, 60(2):108–115</ref> Factors which have a negative impact on health include overcrowding, damp living conditions and crime (in particular fear of crime). The WHO concludes that health outcomes "are largely determined by the accessibility to adequate housing and to healthy and safe urban environments and by transport conditions".<ref name=":0" />
 
== Relevance to Rehabilitation ==
 
In our contact time with our patients, we spend a lot of time understanding their health and social status. In other words, we explore the determinants that might be affecting their health and in particular ones that we can influence. The model we use to analyse and understand these determinants of health is the [[Biopsychosocial Model|biopsychosocial model]] of health care.
 
[[Image:Biopsychosocial-model-of-health.PNG|center]]
 
It is essential that healthcare workers dedicated to improving health increase their effectiveness by addressing the “upstream” causes of health in the community and by engaging in ways to change the broad policies, systems and environments that shape the social and economic conditions that, in turn, so strongly influence health.&nbsp;Swain et al.<ref name="Swain">Swain et al. [http://u21health.org/s/Social-Determinants-of-Health.pdf Health Care Professionals: Opportunities to Address Social Determinants of Health]. 2014. WMJ, 113:6</ref> describe opportunities for the health-care professional to address social determinants of health. They suggest that to be most effective at improving the health of families and communities and to ensure the greatest impact for the investment of resources, health professionals need to expand their repertoire of skills and activities both with their individual patients and in the policy arena.
 
== Resources  ==
 
*[https://www.who.int/publications/m/item/health-in-the-post-2015-development-agenda-need-for-a-social-determinants-of-health-approach Health in the post-2015 development agenda: need for a social determinants of health approach: joint statement of the UN Platform on Social Determinants of Health].&nbsp;
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863696/ The Social Determinants of Health: It's Time to Consider the Causes of the Causes]  


== References  ==
== References  ==


<references />
<references />
[[Category:Physical_Activity]]
[[Category:Physical_Activity_Content_Development_Project]]
[[Category:Displaced Persons]]

Latest revision as of 18:55, 5 May 2023

Original Editor - Rachael Lowe

Top Contributors - Rachael Lowe, Wendy Walker, Naomi O'Reilly, Laura Ritchie, Kim Jackson, Jess Bell, Robin Tacchetti, Rucha Gadgil, Tarina van der Stockt, Vidya Acharya, Shaimaa Eldib and Carin Hunter  

Introduction[edit | edit source]

"Health care is an important determinant of health. Lifestyles are important determinants of health. But... it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place." WHO Director-General Dr Margaret Chan[1]

Many factors combine together to affect the health of individuals and communities. Whether a person is healthy or unhealthy is determined by his/her circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.

The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants, or things that make people healthy or not, include the following and many others:

Determinants of Health[edit | edit source]

The range of personal, social, economic and environmental factors that influence health status are known as determinants of health. These can be classified as:

  1. The social and economic environment
  2. The physical environment
  3. The person’s individual characteristics and behaviours


There are many commonly accepted determinants of health but there is no single definition. The Office of Disease Prevention and Health Promotion (ODPHP) has broadly categorised the determinants of health[2] and these have been summarised below:

1. Policy-making[edit | edit source]

Policies at the local, state and federal level effect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products. Unfavorable conditions can result due to substandard policies and programmes, inadequate governance and unfair economic arrangements.[3]

2. Social Factors[edit | edit source]

Social and physical determinants of health reflect the conditions of the environment in which people are born, live, learn, play, work and age. Also known as social determinants of health, they impact a wide range of health, functioning and quality-of-life outcomes. They represent economic and political systems, physical and social environments, as well as health service access. Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life.[4]

Examples include:

  • Availability of resources to meet daily needs, such as educational and job opportunities, living wages or healthful foods
  • Social norms and attitudes such as discrimination
  • Exposure to crime, violence and social disorder
  • Social support and social interactions
  • Socioeconomic conditions such as concentrated poverty
  • Quality schools
  • Transportation options
  • Urbanisation and the built environment such as buildings or transportation
  • Worksites, schools and recreational settings

** Poor health outcomes are associated with adverse conditions leading to social risk factors[5]

3. Health Services[edit | edit source]

Both access to health services and the quality of health services can impact health. Barriers to accessing health services include lack of availability, high cost, lack of insurance coverage and limited language access. These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services as well as hospitalisations that could have been prevented.

4. Individual Behaviour[edit | edit source]

Individual behaviours such as diet, physical activity, alcohol, tobacco and other drug use also play a role in health outcomes.

5. Biology and Genetics[edit | edit source]

Some biological and genetic factors affect specific populations more than others. Examples of biological and genetic determinants of health include age, sex, inherited conditions and genetic make-up.

Improving Health Worldwide[edit | edit source]

WHO have identified three "common interventions" for improving health conditions worldwide:[6]

1. Education[edit | edit source]

A large number of studies have demonstrated a strong link between better education and better health,[7] and education has been shown to be a reliable predictor of lower mortality rates.[8][9] The probability of being in good or very good health is higher for people with university or post-secondary education.[10]

2. Social Protection[edit | edit source]

Countries with some sort of social protection (i.e. a safety net or social security system) show improved health and economic outcomes in circumstances where people become unable to earn a living.[11]

3. Urban Development[edit | edit source]

The physical environment where communities live has a great impact on the health of the residents.[12][13] Factors which have a negative impact on health include overcrowding, damp living conditions and crime (in particular fear of crime). The WHO concludes that health outcomes "are largely determined by the accessibility to adequate housing and to healthy and safe urban environments and by transport conditions".[6]

Relevance to Rehabilitation[edit | edit source]

In our contact time with our patients, we spend a lot of time understanding their health and social status. In other words, we explore the determinants that might be affecting their health and in particular ones that we can influence. The model we use to analyse and understand these determinants of health is the biopsychosocial model of health care.

Biopsychosocial-model-of-health.PNG

It is essential that healthcare workers dedicated to improving health increase their effectiveness by addressing the “upstream” causes of health in the community and by engaging in ways to change the broad policies, systems and environments that shape the social and economic conditions that, in turn, so strongly influence health. Swain et al.[14] describe opportunities for the health-care professional to address social determinants of health. They suggest that to be most effective at improving the health of families and communities and to ensure the greatest impact for the investment of resources, health professionals need to expand their repertoire of skills and activities both with their individual patients and in the policy arena.

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Dr Margaret Chan. Launch of the final report of the Commission on Social Determinants of Health. 2008. Accessed online 6 January 2017.
  2. ↑ Office of disease prevention and health promotion. Determinants of Health. Accessed online 6 January 2017.
  3. ↑ Islam MM. Social determinants of health and related inequalities: confusion and implications. Frontiers in public health. 2019 Feb 8;7:11.
  4. ↑ Palmer RC, Ismond D, Rodriquez EJ, Kaufman JS. Social Determinants of Health: Future Directions for Health Disparities Research. Am J Public Health. 2019;109(S1):S70-S71.
  5. ↑ Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. The Milbank Quarterly. 2019 Jun;97(2):407.
  6. ↑ 6.0 6.1 World Health Organization (2013). The economics of social determinants of health and health inequalities: a resource book (PDF). World Health Organization. ISBN 978-92-4-154862-5
  7. ↑ Knesebeck O et al. Education and health in 22 European countries. Social Science and Medicine, 2006, 63:1344–1351
  8. ↑ Muller A. Education, income inequality, and mortality: a multiple regression analysis. BMJ, 2002, 324(7328):23–25
  9. ↑ Deaton A, Paxson C, eds. Mortality, education, income, and inequality among American cohorts. Chicago, University of Chicago Press, 2001
  10. ↑ Hurd M, Kapteyn A. Health, wealth, and the role of institutions. Journal of Human Resources, 2003, 38(2):386–415
  11. ↑ Chung H, Muntaner C. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy, 2007, 80(2):328–339
  12. ↑ Chung H, Muntaner C. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy, 2007, 80(2):328–339
  13. ↑ Thompson S et al. Do urban regeneration programmes improve public health and reduce health inequalities? A synthesis of the evidence from UK policy and practice (1980–2004). Journal of Epidemiology and Community Health, 2006, 60(2):108–115
  14. ↑ Swain et al. Health Care Professionals: Opportunities to Address Social Determinants of Health. 2014. WMJ, 113:6
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