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An individual’s health is influenced by a range of factors, which are commonly referred to as the determinants of health. These determinants are the conditions, circumstances and environments in which people are born, live, learn, work and play and they have a large impact on the way a person grows and develops as well as on the choices they make. While each individual has some responsibility for their health behaviours, there is growing recognition that the context of people’s lives can also greatly determine their health. Each determinant is important in its own right but, at the same time, they are interrelated. Often the network of interacting determinants increases or decreases a person’s health status. The Determinants of health Influence on the health of individuals
Individual factors are those factors unique to each person that can determine their level of health. They include: the knowledge we have about health and the skills we possess that enable us to act in ways to promote better health the attitudes and values that we place on health and the importance of leading a healthy lifestyle genetic factors that increase the likelihood we may experience particular health problems Individual factors
Knowledge and skills The knowledge and understandings that we develop about protective and risk health behaviours, and about products and people available to support good health have an important influence on our ability to act in ways that contribute to good health. When we compare the health levels of highly educated and poorly educated people in Australia, those who are poorly educated are more likely to have serious chronic illness. They are also more likely to perceive their health as fair or poor. Our knowledge about health comes from a variety of sources — parents, siblings, peers, teachers, the internet and the media all play a part in conveying information about health. Previous experience can also contribute to what we know and understand about particular health problems. Having knowledge does not mean that people are able or willing to make healthy choices. Individual factors
Attitudes There is a strong link between knowledge and attitudes, with a person's level of knowledge likely to influence the attitudes they develop and the way they behave. For example, someone who has a detailed understanding of the illnesses associated with tobacco smoking is more likely to be against smoking and not smoke themselves. The attitudes we hold are influenced by families, peers, education, the media, our culture and the communities in which we live. Our sense of self-efficacy also has an influence on our attitudes and whether we feel capable of making lifestyle changes that may improve our health Individual factors
Genetics Our potential to achieve a certain level of health may be significantly influenced by genetics. A number of genetic disorders, such as muscular dystrophy and cystic fibrosis, lead to chronic ill health and decreased life expectancy. These diseases are caused by genetic information passed on by parents at conception. Genetics can also play an important role in a person's susceptibility to certain diseases or health problems. People with fair coloured skin, which is a genetically inherited trait, are at greater risk of developing skin cancer as their skin burns more easily and more quickly following exposure to the sun. Research has identified that diseases such as breast cancer, asthma, heart disease and diabetes have a genetic link, making those with a family history of these diseases more susceptible to developing the disease themselves. The genetic information that is passed on by our parents can also positively influence our health. The genes we inherit provide us with potential in terms of intellectual capacity, physical abilities and life expectancy. For example, hereditary factors have an effect on how fast we can run, how coordinated we are and how well suited we are for particular sports. Hereditary factors therefore have an influence on our sporting abilities and likelihood of successful participation. Individual factors
Sociocultural factors refer to the influence of a person’s family and peers, their religion and culture, and the media on the personal health practices they adopt for their health. These determinants exert some influence on a person’s life and are ever-present when people make health-related decisions. As with all determinants of health, sociocultural factors can have a positive impact on the choices we make but, conversely, they may make it difficult for a person to adopt health-enhancing behaviours. Sociocultural Factors
Family Research has shown that a person's family and their home environment can significantly influence their health and well-being. Families are responsible for ensuring physical needs such as safe housing, food, clothing and medical requirements are met while also providing emotional support such as love and care. Research has shown that being a part of a cohesive family acts to protect the health of children and young people, and helps them cope better when they experience stressors or tough times in their life (Young Australians: their health and well-being 2007). Children living in situations of violence, abuse or neglect are at risk of immediate physical injury and emotional distress and are likely to suffer adverse consequences on their long-term physical, emotional and social well-being. Sociocultural Factors
Peers Sociocultural Factors Peers have a powerful influence on the decisions people make relating to health and the type of behaviours they undertake. This influence may be beneficial to their level of health or can have a negative impact. Young people can be particularly influenced by the values, attitudes and behaviour of their peers as they seek to establish their identity and feel a sense of belonging. When peer groups share common interests and similar values it can be easier to make healthy choices. For example, being part of a peer group that enjoys being active and supports the participation of people regardless of their level of ability will help people feel comfortable and encourage them to join in sporting or recreational activities.
Media The powerful influence that the media can have on a person's opinions, beliefs and habits makes it an important sociocultural determinant of health. Electronic media such as television, movies and the internet, along with written forms of media such as newspapers and magazines, all play a significant role in disseminating information relating to health. For example, advertisements about skin cancer or stories on domestic violence seek to raise awareness and enhance people's understanding of health-related issues. It is crucial that any health-related information presented in the media is accurate, fair and balanced, as bias or inaccuracies can lead to misconceptions and confusion that can endanger someone's health. Sociocultural Factors
People’s health is influenced by the conditions in which they live. In order to function adequately and to feel safe and happy, we need to have a number of basic needs met in relation to our physical environment. Safe water; clean air; healthy workplaces; safe houses, communities and roads; and easy access to health services all contribute to good health. The government has a large role to play in providing positive environments for people’s health. Some environments have limited infrastructure, for example, poor public transport, limited facilities, few public recreation spaces and poor street lighting. These may be coupled with high levels of community violence resulting in people being afraid for their safety. Built-up areas in cities can be crowded and have greater levels of pollution and a lower quality of air and water. Environments such as these can hinder a person’s health in a number of ways. Environmental Factors
Geographic location can certainly have an impact on a person’s health and their ability to make wise health choices. Those living in areas that are isolated from major towns can find they have a lack of access to health services and to people who can provide them with help and guidance about various health issues. They may have to travel large distances to see a doctor and therefore, may neglect regular health check-ups such as pap smears, breast checks and bowel cancer screening. Having no close neighbours may limit social contact and opportunities for recreation, which are beneficial to health. Food choices are limited, particularly fresh foods, and some food items may not be available at all. People who live in rural and remote environments may also be subject to climatic conditions that can affect their health such as droughts, floods, fires and dust storms. The negative impact that the drought in rural Australia has had on people’s emotional health is quite severe, as people experience a loss of self-worth and feelings of hopelessness when they are unable to earn a living due to the weather conditions. Environmental Factors
Access to health services may also be restricted for those living in urban areas, due to overcrowding. An increase in the population in some areas due to more affordable housing has seen increased waiting times to see doctors, and to have medical procedures and gain referrals to health experts, which can affect the health of an individual. The design and development of urban areas in recent years has addressed some areas of concern regarding physical environments and their influence on the health of individuals and, in turn, of communities. The provision of bicycle and walking tracks and better public transport such as T-ways promote better health and gives people more choices to enable them to make good health decisions. Environmental Factors
Socioeconomic factors relate to a person's level of income, education and employment. In 2004 the World Health Organization stated that ‘the social conditions in which people live powerfully influence their chances to be healthy. Indeed factors such as poverty, social exclusion and discrimination, poor housing, unhealthy early childhood conditions and low occupational status are important determinants of most diseases, deaths and health inequalities between and within countries’. A person's socioeconomic status has a significant influence on the likelihood that they will be exposed to health risk factors, with those who are socioeconomically disadvantaged likely to face the greatest number of risks and therefore find it more difficult to experience good health. Analysis of health statistics collected by the Australian Institute of Health and Welfare has consistently found differences in rates of mortality, morbidity and life expectancy between those in the higher and lower socioeconomic groups within Australia. It appears that as people move down the social class hierarchy, their vulnerability to ill health increases. They live shorter lives, suffer more illnesses and have more risk factors for ill health present in their lives (see table 2.1). Socioeconomic factors
The health status of people in low socioeconomic situations is affected by a number of interrelated factors. Very often, people from low socioeconomic backgrounds can only obtain work in low-paid jobs that are associated with manual labour and are, therefore, exposed to greater risks and workplace stresses than those who work in other jobs. People from low SES backgrounds tend to have limited housing choices, which may mean they need to live in areas that are overcrowded, polluted, have high crime rates and limited access to health-care services—all elements which will have an impact on a person’s health status. Education is closely tied to socioeconomic status. Education contributes to health by equipping people with knowledge and skills for problem solving and helps provide a sense of control and mastery over their life circumstances. Low-income levels can result in reduced options and choices for problem solving. For example, not being able to afford private health cover may result in reduced health-care options, while only being able to shop for food in cheaper stores may limit the availability and choice of fresh fruit and vegetables. Socioeconomic factors
Write your own definition for each of the determinants of health and give an example of how they can influence a persons health for each definition. Questions
In your group you must race the other groups to complete the puzzle. The puzzle is a flow chart. There is a heading and sub-headings. The winning group will each get 20 Mr Thom Points!!!!!!!! Puzzle time
In your groups you are do write down how each of the following determinants could influence the following health behaviours: Mental Health Road Safety Body image Drug use Physical activity The Determinants of health
Many of the health problems that are currently prevalent in Australia are linked to the decisions people make about their health and the lifestyle that they lead. However, a person's level of health is not solely determined by individual choices. Nor does everyone have the same opportunity to easily make and carry out decisions that will improve their health. A range of social, economic, environmental and individual factors, which are often interrelated, all exert a considerable influence over the health choices we make and our chances of being healthy. People with economic, social and educational resources are in a better position to take action to promote their health than those who do not have access to these resources. If we have power and status within our social situation, we feel a greater sense of control over our life so are more likely to take action to improve it. Therefore the degree of control that we are able to exert over our health depends on the degree to which we can control or modify these influences. Not all Australians are able to exert the same degree of control over their health, which has resulted in inequalities arising in the health status of particular population groups. Those who experience considerable disadvantage, such as Aboriginal and Torres Strait Islanders, people from low socioeconomic groups and people living in rural and remote areas, find it hardest to exert any influence over the things that determine health, therefore they are likely to face the greatest difficulties looking after their health. The degree of control individualscan exert over their health
Health determinants can be classified as modifiable or non-modifiable, depending on the degree to which they can be changed, influenced or controlled by the individual. Modifiable health determinants Modifiable health determinants are those determinants that can be changed or controlled so they have a different level of influence on our health. Our ability to modify particular determinants of health and change our health behaviours depends on the sense of control or empowerment we feel we have over our lives. Control over our health increases when we believe we can: acquire information make choices manage a situation that may be threatening use the skills we possess. Modifiable and non-modifiable healthdeterminants
The mutual relationship between the individual and their social and economic circumstances is central to the control we are likely to exert over our health. Being in a position of socioeconomic advantage provides us access to physical and social resources such as education, money and health services that can make our life better. This access contributes to our sense of empowerment. People who feel in control of their lives are more likely to take control of their health. For some people, modifying the socioeconomic determinants that influence their health, such as education, employment and income, can be difficult. Their sense of empowerment and overall outlook on life can help them to overcome barriers created by their socioeconomic conditions and change their health behaviours. One of the most important factors that allows us to take control of our health is our sense of self-efficacy. As explained, self-efficacy refers to our belief in our ability to bring about change. The stronger our self-efficacy, the greater our levels of perseverance and persistence and feelings of control. If we have low self-efficacy we are more likely to feel powerless and produce negative self-evaluations that can lead to lower self-esteem. The health knowledge and skills that people possess is one area that can be modified to enable them to assert greater control over their health. Reliable and accurate information on issues such as how to prepare healthy meals, or ways to increase our level of activity is often available in places such as doctors’ surgeries, local newspapers and on the internet. Many health organisations offer information in the form of pamphlets, websites or public forums to enable people to improve their knowledge of particular health issues. For example, the Family Planning Association website contains a range of fact sheets on contraception, sexually transmitted infections and other sexual health matters. These organisations can also support the development of skills. For example, the Quit website offers suggestions on how to effectively plan to stop smoking and provides a free online Quit coach to support people who decide to give up. The provision of this information and support can allow people to gain a deeper understanding of issues that may affect their health and develop strategies to address these issues. Modifiable health determinates
However, the degree to which people can improve their knowledge varies. Not everyone will have the literacy required to be able to understand the information available, or to determine which information is credible and reliable. Nor will everyone have the same level of access to this information. Groups who experience the most disadvantage, such as the long-term unemployed, homeless or some indigenous people, are likely to find it most difficult to improve their health knowledge and skills due to their isolation from the community and their education level. People also need to possess an interest or desire to improve their health knowledge and skills in order for this to occur. Health is not always the central consideration when people make decisions; it is just one of a range of factors. For many people, the long-term consideration of health often takes a very distant second place to the immediate demands and pressures of daily survival. Others may be unaware of the risks present in their environment or the harms linked to their current lifestyle, so are not looking to learn more about their health and how it can be improved. A variety of barriers therefore exist that hamper people's ability to change their knowledge and skills. People's attitudes to health are another determinant that may be modified. Different experiences and events during our lifetime, such as being diagnosed with skin cancer or losing a friend in a road crash, may lead to a change in our health attitudes. Health promotion campaigns are a commonly used strategy that seek to change people's attitudes and challenge their beliefs. An example is the ‘Speeding. No one thinks big of you’ campaign which aims to make speeding socially unacceptable by questioning the belief that people are impressed when young males speed. Modifiable health determinates
Write down with the person next to year as many non-modifiable health determinants that you can think of. non-modifiable healthdeterminants
Age—a person’s age is a non-modifiable health determinant and, although age does not necessarily have to be synonymous with poor health, as people get older the likelihood of them developing certain diseases increases, for example, cardiovascular disease (CVD), diabetes and osteoporosis. Gender—as mentioned previously, a person’s gender can affect their health. Being male puts an individual at greater risk of developing a number of diseases and in many countries, including Australia, is linked to shorter life expectancy. non-modifiable healthdeterminants
Family history—most chronic diseases and many illnesses have family history as a prominent determining factor for their development. An individual’s chance of developing certain diseases and illnesses is greatly increased if they have someone in their family who has had that disease, for example, many different types of cancers, hypertension, diabetes, CVD and depression. Race/ethnicity—an individual’s race or ethnicity can be a determining factor of their health status. The risk of some diseases is more likely for people from certain races or ethnic backgrounds; for example, African Americans are more likely to suffer from sickle cell anaemia and Indigenous Australians are more likely to experience CVD, diabetes and glaucoma. non-modifiable healthdeterminants
Each of the determinants has an influence over the health of an individual to varying degrees. The level of this influence may change over time depending upon the life stage of the person, what is important to them at the time (values), and the extent to which they believe they can control the events and/ or circumstances which affect them (locus of control). A young child’s health is predominantly influenced by their family. Parents make health decisions for their children, shape their health-related values, choose the school they attend and decide where they live. The decisions a parent makes on behalf of a child are influenced by a number of health determinants, including their knowledge, skills and attitudes, their culture, their level of SES, their education and their immediate environment. When a child becomes an adolescent, the influences on their health broaden. There is a definite shift of influence from parents to peers and a young person’s peer group can work in positive or negative ways in relation to health. A young person will begin to develop their own values and beliefs in relation to health based on influences of the media, their teachers and their peers, and these may be different to those of their parents. The changing influence of determinantsthrough different life stages
Adulthood also can mean a change in the influence of the various determinants of health. Life experiences can affect an individual’s knowledge and skills, which in turn can affect their health behaviours. Adults tend to be less influenced by their peers and the media, and their individual attitudes may have a greater effect on their health. Socioeconomic factors such as employment and income may have a greater influence on an older person than sociocultural factors, for example, as they strive to pay their mortgage, provide for their family and find a work/life balance. Elderly people can find that environmental factors such as geographic location may have a greater influence on their health as they age. For example, if they become unable to drive and they live in an area that does not have adequate public transport options, they may become isolated from social contact and reliant on others to provide for their health needs, such as grocery shopping and medication provision. A person in a situation such as this can feel a lack of control over their ability to make health-enhancing decisions. The changing influence of determinantsthrough different life stages
Why is it that the health status of people with a low socioeconomic status is different to that of those with a high socioeconomic status? Health was once thought to be the sole responsibility of the individual, and health status the direct result of their behaviours and actions. While ultimately individuals do make decisions about their health, it must be acknowledged that many sociocultural and socioeconomic factors impact upon a person’s health, the meanings a person gives to health and the judgments they make relating to their health. It is becoming more and more apparent that health is socially constructed, which means that people develop their meanings of health depending upon their social circumstances and that this view of health shapes a person’s beliefs, behaviours and practices. Health as a social construct
Drinking alcohol Interrelationship of the determinants
The determinants do not operate in a vacuum… They function on multiple levels and interact with each other to interact with each other to influence health outcomes. Health as a social construct can be seen by looking at young peoples health behaviors around drinking alcohol. Lets have a look at the determinants in relation to you people drinking alcohol. Alcohol use
Despite an awareness of alcohol related harm, many young people engage in health-compromising behaviors. • Pleasure and hedonism are dominant values among generations X & Y, and drinking is perceived as being associated with enjoyment. Individual Determinant
Adolescents are constantly subjected to social and cultural messages from their family, peers, sporting organizations and the media that using alcohol, often at harmful levels is acceptable. • During this developmental stage young people are trying to find a sense of self and have a strong need to fit in. Drinking is seen as an activity that can foster a sense of social cohesion and solidarity among friends. Many young people are concerned with the immediate social consequences of alcohol rather than less immediate non social consequences. They would rather drink than not fit in. SOCIO CULTURAL DETERMINANT
-There is a close relationship between alcohol consumption and sport . young people can see intoxication modeled by their sporting role models. -YP are exposed to high levels of alcohol advertising and marketing. These advertisements encourages positive associations with alcohol and links drinking with attractive symbols and role models. SOCIO CULTURAL DETERMINANT
Communication technologies cab affect young peoples drinking by facilitating the organization of ‘big nites out’ – egfacebooketc • Geographic location may influence the drinking behaviors of young people . Hotels and clubs are traditional community meeting places and centers of activity, particularly in rural areas. Environmental DETERMINANT
Young people have high levels of expendable income due to part time jobs, which may mean that they have more opportunities to purchase alcohol. • The placement of a particular type of drink in movies and TV can give the impression that ‘Everyone is consuming it’ Socio-ECONOMIC DETERMINANT
Acknowledging that health is socially constructed certainly challenges the idea that each individual is purely responsible for their own health. It shows an understanding that the meanings of health change over time and that health can mean different things to different people in varying contexts. The lens through which we view a person’s health behaviours needs to be much broader than simply asking what is the person doing or not doing in relation to their health. We need to extend these questions to include an exploration of why they are engaging in certain behaviours. For example, poor nutritional habits may be much more than an individual’s decision to select and cook unhealthy foods. The choices the individual makes may be influenced by a lack of education about nutritious foods and how to prepare them; a low income, meaning a person cannot afford to purchase fresh and nutritionally sound food; and geographic isolation resulting in limited access to support and advice around nutrition. Challenging the notion that health is solelyan individual’s responsibility
In situations such as these, it becomes increasingly difficult for individuals to take full responsibility for their own health, and simply telling that person they need to change their diet will not bring about behaviour change. Good health can best be achieved through the combined efforts of both the individual and the wider community. Viewing health as a social construct recognises that society has a role to play in the achievement of good health, and that everyone has a right to good health despite their social or economic circumstances. Challenging the notion that health is solelyan individual’s responsibility
