Study Notes from Textbook

1. Determinants of Health

Definition of Determinants of Health: The World Health Organization (WHO) defines these as the range of personal, social, economic, and environmental factors that determine the health status of individuals or populations.

Social Determinants of Health: These are the specific conditions in which individuals are born, grow, live, work, and age.

Key Factors Influencing Health:

• Individual Factors:

  • Genetic Makeup: Inherited genetic markers that can predispose individuals to specific diseases.

  • Sex: Differences in health risks (e.g., childbearing risks for women).

  • Age: Health risks vary across the lifespan (e.g., risks for young children vs. older adults).

• Lifestyle and Behavior: Personal health practices such as eating habits, substance use, physical activity, and identifying illness.

• Socioeconomic Status (SES): Defined by work status, economic status, and education levels; better SES strongly correlates with better health outcomes.

• Cultural Influences: Attitudes towards healthcare access and restrictive gender roles that impact women’s health.

• Environmental Factors: Factors include indoor/outdoor pollution and access to clean water and sanitation.

• Policy and Programmatic Influences: Government investments in education and healthcare for all citizens.

Framework for Understanding Determinants:

1. Root Causes (Macro Level): Historical conditions, governance, wealth/education inequalities, and the natural environment.

2. Underlying Causes (Meso Level): Built environment, quality of education, and community policies.

3. Proximal Causes (Immediate Level): Material circumstances (income), behavioral factors, and psychosocial factors (social support).

2. Key Health Indicators and Terms

Health Status Indicators:

• Life Expectancy at Birth: The average additional years a newborn can expect to live, reflecting the population's overall health status.

• Infant Mortality Rate (IMR): The number of infant deaths under one year of age per $1,000$ live births.

• Neonatal Mortality Rate: Deaths of infants under $28$ days of age per $1,000$ live births.

• Maternal Mortality Ratio (MMR): The number of deaths due to pregnancy complications per $100,000$ live births.

  • Example: High-income nations like Sweden have an MMR of $4$, while low-income nations like Sierra Leone have reached $1,360$.

Important Health Definitions:

• Morbidity: Departure from a state of well-being (the state of being sick).

• Mortality: Death; expressed as the death rate per $1,000$ population per year.

• Disability: A temporary or long-term reduction in functional capacity.

• Prevalence: Total number of individuals with a specific condition at a specific time.

• Incidence Rate: The number of new cases of a condition during a specified time in a specific population.

Prevention and Classification:

• Primary Prevention: Measures taken before health issues arise.

• Secondary Prevention: Early identification of diseases.

• Tertiary Prevention: Managing disease after diagnosis to prevent progression.

• Communicable Diseases: Spreadable (e.g., influenza, HIV).

• Non-communicable Diseases (NCDs): Not spread by infectious agents (e.g., diabetes).

3. Global Health Status and Variations

Health status varies significantly across different demographics and income groups:

Variation by Country Income Group:

• Life Expectancy:

  • Low-income countries: Average of $63$ years.

  • High-income countries: Average of $81$ years.

• Infant Mortality Rate:

  • Low-income countries: $51$ per $1,000$.

  • High-income countries: $5$ per $1,000$.

Variation by Region:

• Communities in Sub-Saharan Africa and South Asia consistently exhibit poorer health outcomes compared to other regions.

• Child mortality in South Asia is approximately $50$ out of $1,000$, while in Sub-Saharan Africa, it is nearly $80$ out of $1,000$.

Variation by Age and Context:

• Life expectancy can fluctuate based on socio-political changes. For example, in Russia, male life expectancy dropped from $64$ years in $1985$ to $59$ years in $2001$, before rising to $67$ years by $2016$.

• Early childhood development is noted as a critical determinant for long-term health outcomes.