NURSE AKINTAYO-USMAN, N.O.

NURSE TUTORS PROGRAMME,

UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

The Determinants of Health

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.

The Determinants of Health 2These include:

The physical factors

The chemical factors

The social factors

The person’s individual characteristics and behaviours.

Physical FactorsExamples of physical determinants are:

Natural environment, such as plants, weather, or climate change

Built environment, such as buildings or transportation

Worksites, schools, and recreational settings

Housing, homes, and neighborhoods

Exposure to physical hazards

Physical barriers, especially for people with disabilities

Aesthetic elements, such as good lighting, trees, or benches

Physical Factors 2 Exposures to contaminants in air, water, food and soil, are

associated with many chronic diseases and with emerging communicable diseases.

Climate change and the associated weather extremes will also affect health: hyperthermia from extreme heat, injury from extreme wind and rain.

Changing distribution of vectors and infectious agents-introducing disease to previously unaffected regions.

Chemical Factors Air pollutants can also cause climate change which will

affect communities differently.

People in urban centres do not enjoy good air quality. Indoor air may contain constituents such as asbestos, moulds, radon gas, carbon monoxide and methane that affect health.

E.g. in counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with state and national averages. Poor air quality can worsen asthma symptoms, especially in children.

Chemical Factors 2 ‘The sick building syndrome’ describes a range of ailments

related to living or working in closed buildings with poor air quality.

Another threat to healthy indoor air quality is tobacco smoke, especially for children living in the homes of smokers. These children experience more asthma and bronchitis; they are at a higher risk for sudden infant death syndrome and have more lung and ear infections than children living in homes without tobacco smoke.

Social FactorsExamples of social factors 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

Exposure to mass media and emerging technologies, such as the Internet or cell phones

Social Factors 2 Socioeconomic conditions, such as concentrated poverty

Quality schools

Transportation options

Public safety

Residential segregation

Culture - customs and traditions

Access to health services

Socioeconomic 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.

A person’s social status is defined by a combination of their wealth, education, occupation and lifestyle. Each of these, alone or in combination, can exert positive or negative influences on a person’s health.

The association between social status and health is now termed social inequalities in health.

Socioeconomic Status 2 Absolute poverty refers to having inadequate resources to

meet basic needs for shelter, nutritious food, clothing, and education. People living in poverty lack the resources and opportunities to make choices that promote good health. Being poor may also expose them to inferior physical environments that place them at risk for health problems. Absolute poverty is the leading health determinant in low-income countries; infants and children are particularly susceptible to its effects.

Social Factors- Education Low education levels are linked with poor health, more

stress and lower self-confidence.

Education also has a more direct influence on health in that it affects a person’s ability to navigate the health care system, to interpret health information and to communicate effectively with health professionals.

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‘Health literacy’ refers to the patient’s ability to understand health information and to follow guidelines for their treatment.

Social Factors- Employment Employed people are healthier, particularly those who have

more control over their working conditions.

The WHO recognizes fair employment and decent work as a cornerstone of health, and advocates for fair minimum wages, full employment, and occupational health and safety standards.

Work-related diseases, caused or exacerbated by the patient’s work, are derived from the amount of a person’s perceived control over demands at work, their work satisfaction, perceived levels of physical risk, and job security.

Social Support Network This refers to support from families, friends and

communities.

It is linked to better health.

It is a source of emotional reassurance and provides a safe place for a person to discuss his problems, which helps him to cope with adversity.

It provides information and practical support, such as knowing someone who can assist in a time of need. It can also support people in making healthier behaviour choices.

Health Services Access and use of services that prevent and treat disease influences

health.

Both access to health services and the quality of health services can

impact health.

Lack of access, or limited access, to health services greatly impacts an

individual’s health status. For example, when individuals do not have

health insurance, they are less likely to participate in preventive care

and are more likely to delay medical treatment.

Health Services 2 Barriers to accessing health services include:

Lack of availability

High cost

Lack of insurance coverage

Limited language access

These barriers to accessing health services lead to:

Unmet health needs

Delays in receiving appropriate care

Inability to get preventive services

Hospitalizations that could have been prevented

Individual Characteristics and Behaviours. Individual behavior also plays a role in health outcomes.

For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced.

Examples of individual behavior determinants of health include:

Diet

Physical activity

Alcohol, cigarette, and other drug use

Hand washing

Individual Characteristics – Biological and Genetic Makeup Inheritance plays a part in determining lifespan, healthiness and

the likelihood of developing certain illnesses, personal

behaviour and coping skills.

Some biological and genetic factors affect specific populations

more than others. E.g., older adults are biologically prone to

poorer health than adolescents due to effects of aging.

Sickle cell disease is a common example of a genetic determinant

of health.

Individual Characteristics – Gender Gender refers to "the array of socially constructed roles and

relationships, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis.“

Men and women suffer from different types of diseases at different ages.

Examples include the exploitation of women in the sex trade, underage marriage, or the work conditions in sweat shops in the garment industry. Single parents are almost always women, the lower income of women also affects their children.

Individual Characteristics – Early Childhood Development Early nutrition, physical development and fitness are

important, as is emotional development which, if positive, builds resiliency, and if negative, enhances vulnerability.

Timing of exposures and experiences can be critical.

For example, traumatic experiences in early childhood shape personality and have a lasting impact on how a person views his world, how he relates to others, and how he interprets events.

The impact of broken homes, chronic childhood stresses etc. have non-specific effects, acting mainly to increase emotional vulnerability in adult life.

Implication for Nursing Advances in health care have conferred immense benefits

on health and longevity for developed and many developing countries.

The invention of antibiotics, antisepsis, life-saving surgical procedures, as well as advances in nursing process, have all revolutionized the management of a wide range of diseases.

Health interventions (sanitation, communicable disease control measures, etc.) and disease prevention (immunization, tobacco control measures, and screening) have made major contributions to saving lives and improving health.

Implication for Nursing 2 Relatively simple measures, such as protecting water supplies,

often have the greatest impact on overall health. Similar historical declines occurred for polio, smallpox, and whooping cough, all of which responded dramatically to improvements in hygiene long before effective medical treatments were developed.

Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.

Implication for Nursing 3 The importance of holistic care to the client must be

emphasized- which can only be achieved with the use of nursing process.

Also, preventive care is a major aspect of nursing, which nurses should render to their clients.