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 –utilization
Immunization, 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 values
vegetarianism-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)
Literacy
Occupation
Purchasing 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 type
No of days of restricted activity.
Bed disability days.
Sickness absenteeism.
• Person type
Limitation 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.