The Determinants of Health

The Determinants of Health

Health 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.

Health is a multi-factorial phenomenon

The absence of symptoms does not connote healthfulness The presence of symptoms does not necessarily connote illness. There are varying degrees or states of health

The state of being healthy or unhealthy can be expressed in many ways or there are many factors to consider to determine the condition of health of an individual. Health Economics deals with the manipulation of these factors that will give people better health. This poses a problem for health planners since health is difficult to both qualify and quantify.

How do we manipulate health? What determines health?

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 Environmental Contamination Nutrient Dietary Intake Fertility Injury Health Outcomes __________

Mortality
Morbidity Nutritional Status Disability

 Health Outcomes are objective measures of health. They are the parameters used to measure the health condition of individuals, communities or countries.
Proximate determinants are factors that have a direct influence on health outcomes. Proximate means attached, near or direct

Health Outcomes
Economics seeks to maximize the output of any given input. It means that more goods should be produced and distributed for a minimum amount of resources used. Given this objective, the health planners are able to measure improvements in health.

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.

Health Outcome Measurements

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

Health Outcome Measurements

Cause Specific Death Rate (CSDR)

xF

Infant Mortality Rate (IFR) =

<1

x 1000

Health Outcome Measurements

Morbidity Rate measures the frequency of illnesses with specific population
Prevalence Rate (PR) =

X 1000

Incidence Rate =

xF

The preceding examples show that health can be and should be objectively measured. They also show how health is being objectively measured. These measurements are important because; 1. They give planners an objective idea of the health status of communities, regions or entire countries. 2. It can be used for monitoring and measuring the effectiveness of health activities and programs to improve health. This can be done before and after a program has been implemented.

Proximate Factors
Proximate factors are factors that directly affect the health status or outcomes of individuals or groups. These factors may be innate to a person, e.g. , nutrient intake and fertility. These are physiological 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

Proximate Factors and health programs developed

Proximate Factors Health Care Service Utilization Health Program s Developed OPLAN Bakuna Jollibee, OPLAN Alis Disease

Environmental Contamination

Anti-pollution campaign, Worker Health and Safety Programs

Nutrient Dietary Intake

Barangay Day Care Centers, Vitamin A campaign Responsible Parenthood Information Drive Dont Drink and Drive Campaign

Fertility

Injury

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.

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 Increased Incidence of workers lung disease

(Environmental contamination as proximate determinant)

(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)

Each of the proximate determinants and the underlying causes affect the outcomes in some way or another. It is important to remember that these may all be intervention points which can help improve health status or outcomes. However, it is also important to note 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.

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 better productivity, more specifically among workers. This then contribute to a better economy.