Determinants of Health

Objectives are

• Student should know--

• Health is multidimensional.

• Should able to tell-determinants of health.

• Health is affected- Genetic / Biological factors

Environmental factors.

Socioeconomic factors ,

Life style.

Determinants of Health

• Health is multi factorial.

• Some are inside the body-genetic/intrinsic

• Some are - External factors /environmental

• Interaction of them may be---

--health promoting

--deleterious.

Common Determinants of Health

• Genetic factors (biological)• Environmental factors• Life style

Behavioral & socio-cultural

• Gender & Age • Socioeconomic conditions

Education, Occupation, Income

• Health services –utilizationImmunization, Family welfare ,nutritional…

Other determinants of health -

• Food & agriculture

• Education.

• Science & technology.

• Standard of living.

• Social justice, equity, human rights.

• Govt Polices to raise stand of living

• Inter sectoral contributions

• Dissemination of information (IEC)

Biological determinants

• Genetic make-up (Heredity)

• It is permanent & can not be altered.

• Transmitted by hereditarily.

• No treatment.

• Many be Prevented to some extent.

Environmental factors-

• Internal environment/Micro

• External environment/Macro

Physical-air, water, soil

Biological-plants,animals,microbes

Social-culture,belifes,traditions-

Dynamic equilibrium is Health

Behavioral & socio-cultural (Life style)

• Depends on economic status

(rich & poor)

• Cultural valuesvegetarianism-Non-vegetarianism

• Social values

Status of women

• Personal habits

Smoking…..

• Behavioral pattern

High risk behavior

Life style

• Learnt by observations by –parents, teachers, peer groups, mass media…..

Includes cultural pattern, social value & behavior…

• The way people thinks & live

- developed through process of socialization& social interaction. (traditional lifestyles)

• So cultivate healthy lifestyles

like proper nutrition & sleep, exercise, avoid drug abuse,

Life-style makes the difference

• Malnutrition.• Population explosion.• Mental health problems.• RCH• Cancer.• Diabetes mellitus• Cardiovascular diseases• AIDS & STDs.• Environmental pollution.

Socioeconomic conditions

• Determined by-Income (per capita)LiteracyOccupationPurchasing capacity

• Indirectly by-religion & caste- Housing- Political support

Economy & literacy

• Determines quality of life (PQLI) by

-Employment ,housing, nutrition.

- Productive work promotes health

-Finally determine health status

-

Socioeconomic conditions---

• Per capita GNP

• GNP directed to wards health care

• Political commitment

• Efficient leadership

Health services

• Availability & utilization of health services

• Should include comprehensive services

• Need based essential

• Must reach to social periphery

• Equitably distributed

• Accessible at affordable cost

• Socially acceptable

Health services

• Should promote health & prevent illnesses.

Eg:- Immunization of children—

Provision of safe drinking water—

ANC-will reduce MMR & IMR.

• Services must reach to all sections.

Family welfare services

• Covers spectrum of personal & community services for treatment ,prevention & promotion of health

Like--- immunization, family planning,

MCH,ICDS, Nutritional….

Gender & Age

• Women’s affected by gender difference

• Nutrition & development

• Violence

• Social status

• Economic independence

• During reproductive age

• Aging –leads Geriatrics problem

Other factors

• Better IEC system

• Rural development

• Employment opportunities

• Increased wages

• Family support systems

• Inter-sectoral coordination between—

Depts. of education , agriculture, civil,

labor, environment, social welfare….

Indicators of health

• To measure health status.

• To compare

• To assess the health needs

• To plan & implement----

• To evaluate health care

Health is measured multi-dimensionally & indirectly

Health Indicators classified as….

• Mortality indicator

• Morbidity indicators

• Disability indicators

• Nutritional status indicators

• Health care delivery indicators

• Utilization rates

Health Indicators also classified as….

• Indicators of social & mental health.

• Socio-economic indicators.

• Health policy indicators.

• Environmental indicators.

• Indicators of quality of health.

Mortality Indicators

• Crude death rates

• Infant mortality rates

• Maternal mortality rates

• Child mortality rates.

• Proportional mortality rates.

Morbidity indicators

• Incidence rate

• Prevalence rate.

• Notification rate.

• Out patients attendance rate.

• Hospital admission rate

• Duration of stay in the hospital.

Disability rates

• Event typeNo of days of restricted activity.Bed disability days.Sickness absenteeism.

• Person typeLimitation of mobility.Limitation of daily activity.

Nutritional status indicators

• Incidence of LBW

• Incidence of LBW

• Anthropometric measurements of < 5

mid arm circumference

height & weight with age

Health care delivery indicators

• Doctor : Population. 1:2500

• Nurse: Population 1:5000

• Health worker: Population 1:3000

• Sub centers: Population 1:3000

• P H C : Population 1:30000

Indicators of social & mental health

• Rates of crimes--- murder, theft, suicides,

Prostitution, gambling, drug abuse….

• Rates of accidents.

• Rate of divorces, family violence

Socioeconomic indicators

• Growth rate of population.

• Per capita income / GNP.

• Percentage of people below poverty line.

• Level of unemployment.

• Dependency ratio.

• Literacy rate.

• Family size.

Health policy indicators

• Proportion of the budget (NGP) spent on…

Health services—

RCH, RNTCP, ICDS, Pulse polio

Health related services—

Water supply

Sanitation.

Nutrition

Housing.

Community development.

Environmental indicators

• Indicators relating pollution of air, water, noise, soil, radiation solid waste…

• Percentage of houses having ..

safe water supply.

adequate sanitary facilities.

• Thus there is no single comprehensive indicator to assess or to measure the health status of country.

• Each indicator reflects one aspect of health.

• Ideal indicator is yet to be developed.

Thus there is no single comprehensive indicator to assess or to measure the

health status of country.

Utilization rates

• Proportion of infants “fully immunized”

• Proportion of mothers with adequate ANC.

• Proportion of Deliveries conducted by TBA.

• “Bed occupancy” rate in the hospital.

• Coverage with insecticidal spraying.