HLTB16 Lecture 6_ Determinants of Health and Health Behaviour
HLTB16 Lecture 6: Determinants of Health and Health Behaviour
David Schlueter, PhD
Health Inequality vs. Health Inequity
Health Inequality:
Refers to differences, variations, and disparities in health achievements among individuals and groups.
Health Inequity:
Refers to unfair health inequalities; outcomes stemming from injustice.
Examples of Health Inequity
Canadians in remote regions have limited access to nutritious foods compared to urban populations.
Health Equity:
Meant to rectify unfair systems causing these inequalities, aiming for opportunities and conditions conducive to health for all.
Health inequities originate from historical and social determinants.
Determinants of Health (WHO)
Health is determined by the context of people's lives rather than their individual choices.
Key determinants include:
Social and Economic Environment
Physical Environment
Individual Characteristics and Behaviors
Additional determinants:
Income and Social Status: Higher status correlates with better health; larger gaps lead to greater health disparities.
Education: Lower education levels linked to poor health outcomes.
Physical Environment: Clean air, water, and safe living conditions promote health.
Employment and Working Conditions: Employment generally promotes better health, especially with control over conditions.
Social Support Networks: Strong community and familial support leads to better health outcomes.
Culture: Influences health via customs, values, and community beliefs.
Genetics: Inherited traits affect health, lifespan, and likelihood of diseases.
Health Services: Access and utilization of healthcare services impact overall health.
Gender: Men and women experience different health outcomes based on various factors.
Psychosocial Factors Affecting Health Behavior
Health behavior is influenced by a variety of social factors.
Certain groups exhibit consistent disease patterns related to their social environment.
Public health interventions are better focused on modifying social environments rather than individual behavior change.
Unhealthy behaviors are often reinforced by social environments beyond individual control.
Major Social Determinants of Health
Health is affected by numerous societal characteristics identified by agencies like Health Canada and WHO.
Demographic Factors Impacting Health
Influence of Race, Gender, and Marital Status:
Racial minorities in the U.S. face higher mortality rates.
Males consistently display higher mortality rates than females.
Married individuals generally enjoy better health outcomes compared to unmarried individuals.
Socioeconomic Status (SES):
SES is the leading predictor of health, encompassing income, education, and occupation.
Health of Minority Populations
Race and Ethnicity Influence:
Health outcomes differ significantly; for instance, Black Americans have poorer health than white Americans.
Health status varies among Hispanic subgroups.
Native Americans typically report worse health outcomes than other demographic groups; Asian Americans generally have better health.
Whitehall Study Overview
Study followed British civil servants, revealing lower mortality in high-status jobs.
Higher employment grades correlated with healthier behaviors such as lower smoking rates and better diet choices.
Income and Social Status Effects
Social status combines formal occupation with perceived prestige, influencing mental health and physical conditions.
Variability in health impacts is interconnected with ethnicity, personality, and circumstances, complicating epidemiological outcomes.
Socioeconomic Disparities
Socioeconomic disparities are deeply rooted in history and require public health initiatives for improvement.
Understanding unique influences on various ethnic and racial groups is necessary for effective intervention programs.
Access to Care Disparities
Access to medical care significantly varies, particularly for lower socioeconomic groups, resulting in unequal health outcomes.
Even universal healthcare does not mitigate SES-based mortality disparities; the Whitehall study demonstrated this with similar coverage levels across employment grades.
Access to Care in Canada
Approximately four million Canadians lack access to family physicians despite a universal healthcare system.
Even when financial barriers are removed, accessibility issues persist based on geographical and social discomfort factors.
Geography and Access to Health Services
Economic efficiencies often lead to service clustering in urban areas, disadvantaging rural populations.
Innovations such as telemedicine and community health centers could enhance access for marginalized groups.
Impact of Stress and Social Support
Stress levels, heightened by socioeconomic status, affect health directly and indirectly.
Low social support is correlated with increased mortality rates and various health complications.
Education and Health Literacy
Parental socioeconomic status influences children's educational access, indirectly affecting health outcomes.
Health literacy assesses an individual's ability to navigate health systems and follow medical advice; a significant portion of Canadians struggle with health literacy.
Social Support Networks
Strong community ties foster resilience and better health outcomes on a population level.
SOCIAL CAPITAL reflects the trust and willingness to cooperate within networks, correlating with improved health and social conditions.
Employment and Occupational Health
Fair work and minimum wages are integral to health; unemployment severely impacts perceived health and mortality.
Job loss consequences vary significantly based on age, gender, and education levels.
Stress and Working Conditions
Work stress, especially when coupled with low control, can lead to health issues such as hypertension or migraines.
Job insecurity and dissatisfaction disproportionately affect lower-income households, exacerbating overall health complications.
The Physical Environment
Environmental factors significantly influence health, impacting everything from local air quality to global climate changes.
Climate change is linked to diverse health complications ranging from injuries to infectious diseases.
Individual and Public Health Services
Modern healthcare advancements have greatly enhanced public health, with crucial innovations in sanitation, disease prevention, and treatment techniques.
Gender and Sex Distinction
Sex: Biological attributes defining male and female; subject to variability.
Gender: Socially constructed roles and behaviors, influencing self-perception and societal dynamics.
Gender inequities in health arise from disparities in access and societal expectations, further exacerbated by research biases.
Cultural Influence on Health
Culture operates as a fluid system of ideas affecting health behaviors, beliefs, and interactions with health services.
The implications of cultural contexts are critical for addressing health disparities and assumptions.
Psychological Models of Health Behavior
Understanding psychosocial influences on health behavior may allow for more effective public health interventions.
Various models have emerged to explain the interactions between individual psychology and social environments.
Health Belief Model Overview
The Health Belief Model outlines factors influencing health-related behavior changes in response to threats:
Vulnerability assessment
Perceived severity and action barriers
Perceived efficacy of preventive measures
Health Belief Model Example
Misperceptions among low-income women regarding breast cancer illustrate HBM impacts; tailored counseling has been beneficial in improving screening rates.
Extending the Health Belief Model
The model encapsulates crucial influences on preventive behavior participation including motivation, cost-effectiveness, and triggering cues for behavior change.
Self-Efficacy Concept
Self-efficacy encompasses an individual's belief in their ability to exert control over their lives, influencing health behavior adoption.
Benefits of Self-Efficacy
High self-efficacy supports health-promoting behaviors, while feelings of helplessness can hinder individuals, particularly those attempting to quit harmful habits.
Transtheoretical Model Explained
A five-stage process delineating health behavior change:
Precontemplation
Contemplation
Preparation
Action
Maintenance
Steps in the Transtheoretical Model
Each stage requires tailored strategies to move individuals towards health behavior adoption, emphasizing awareness and action.
Ecological Model of Health Behavior
This model includes five influence levels on behavior change:
Intrapersonal
Interpersonal
Institutional
Community
Public Policy
Ecological Model Levels Overview
Each level provides potential intervention targets; interrelations exist between levels affecting health behavior outcomes.
Conceptual Models and Strategy in Health Behavior
These frameworks illustrate the complexity of health behavior factors and the necessity for multifaceted strategies in intervention.
Public Health Interventions Successes and Challenges
Public health strategies have thrived in infectious disease control but face obstacles in issues like obesity, which require multi-level strategies for effective intervention.
Clinical Course of Disease Phases
Discusses how social, environmental, biological, and lifestyle factors interplay within pre-clinical and post-clinical phases of disease progression.
Interactions Among Determinants
Health determinants and risk factors interact to form a causal web, highlighting their combined effects on health outcomes.
Modifying Risk Factors
Focused interventions target modifiable risk factors, yet complex causal webs necessitate addressing various interconnected factors.