framing the determinants

the determinants of the determinants
=social determinants of health
-inequality in access to health care is not the cause of inequality in health

smoking causes cancer but what causes people to smoke.. stress, work, drinking

measuring the population

understanding the effects of socio economic position and other determinants

identifying inequalities and inequities.. and why they should be reduced

any event, characteristic or other definable entity, that brings about a change for better or worse in health

income/employment/education (high, medium,low you have different exposures that promote different behaviours


housing and neighbourhood(who, where etc)

societal characteristics(racism,attitudes to alcohol or violence)-standing up to them
autonomy and empowerment-social cohesion

not just application of the individual perspective to whole population, but includes characteristics of the population itself

are also related to the context in which the population exists

downstream and upstream

operate at the micro (proximal) level/ (close to us) including treatment systems, and disease management

operate at the macro (distal) level, such as government policies and international trade agreements

near to the change in health status
near=directly associated with the change in health eg.lifestyle factors related to smoking
(change in myself quickly)

distant in time or place from the change in health
(cant change over night have to go through something)

upstream to reduce burden of victim blaming and try not to identify specific individuals

1.Age,sex factors (genetics)
non modifiable because genes and biology

rare among the population

influences likelihood of offspring developing a disease

influence of the environment

2. Individual lifestyle factors eg choices

importance of food, exercise and risky behaviours in relation to health outcomes (social gradient)

choices you make impact on likelihood that you will have a good or bad health

habits:lifestyle,values,dispositions of particular social groups learned through everyday habits - ability to chance behaviour may vary by social group

3. Social and community networks eg who do you hang with

families and friends play a role in developing normative behaviours

attitudes of people living and working in the local community influences the sense of what is normal/acceptable

social capital:value of social networks=bonds between similar groups . orivudes an inclusive environment for people from diverse backgrounds/civic participation-supportive communities

4. General socioeconomic, cultural and environmental conditions eg work/pay/fast food access/housing/healthcareserives

physical=water quality, clean air
built=buildings,roads, lights
cultural:beliefs, values that are accepted
biological:emerging toxins affecting populations
ecosystem: biodiversity, climate chnage
political:approches to improving pop health

natural:natrual enviroment that supports human life
human:skills,knowlde and physical/mental health:enable people to work and study social: norms and values of society, trust,law
financial:houses,buildings,make up countries physical assets

social and physical environmental conditions that influence choices and opportunities available

Capacity of an individual to act independently and make free choices

empowerment

framework to help you identify risk or protective factors and consider levels of intervention

non modifiable, other determinants are

factors

isolation

on factors at another (higher or lower) level

operate at different levels

down stream (proximal)

macro (national/global)