The health of individuals and communities is determined by many different factors that we call the determinants of health.
Related article: How Understanding the Determinants of Health Influences How I Partner with Patients to Create Health.
I like to view the determinants of health as broken into three parts: Nature (genetic), Nurture (Environmental) and individual/behavioral determinants of health. Both nature and nurture work together to create an individual personality which being human has an independent will and makes choices. These choices can themselves influence nature and nurture. The three work together to determine health outcomes.
The environment includes the physical, social, economic, political, cultural, etc environment. This group of determinants is usually called the social determinants of health. Social determinants of health are the conditions under which people are born, grow, live, work, and age.
The Social Determinants of Health
Social determinants involve things we receive from society and things we must contribute to society. Social determinants of health are also called social and physical determinants of health.
- Social environment/support networks – Strong supportive relationships with family, friends, and communities are linked to better health.
- Culture and ethnicity – The beliefs of the family and community all affect health, customs, and traditions all affect individual health.
- Familial and other social support
- Linguistic and other communication capabilities
- Socioeconomic status/ Economic environment / Income and social status – higher income and social status are linked to better health.
- Employment, job security, and working conditions – people who are gainfully employed are healthier, “particularly those who have more control over their working conditions have better health”. U.N
- Education – low education levels are linked with poor health, more stress, and lower self-confidence.
- Health literacy
- Early childhood social and physical environment, including childcare
- Neighborhood safety and recreational facilities
- Health services – access and use of services that prevent and treat disease influences health.
- Access to medical care
- Access to nutritious food
- Access to clean water and functioning utilities (e.g., electricity, sanitation, heating, and cooling)
- Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health.
- Sexual identification
- Spiritual/religious values
- Housing and transportation resources
- Other social stressors, such as exposure to violence and other adverse factors in the home environment
- Policymaking
Genetic/Biological Determinants of Health
Nature (Genetics). Inheritance plays a smaller part in determining our proclivity for a disease.
Gender. Similar to genetics, sex is important.
Individual/Behavioral Determinants of Health
Personal choices/behaviors. Personal choices like eating a balanced diet, staying active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
This is an excellent video on the subject.
Further Reading
http://www.who.int/hia/evidence/doh/en/
https://www.ncbi.nlm.nih.gov/books/NBK19927/
https://www.aafp.org/about/policies/all/social-determinants.html
Am Fam Physician. 2017 Jun 1;95(11):695-696. Acting on Social Determinants of Health: A Primer for Family Physicians. https://www.aafp.org/afp/2017/0601/p695.html
Social Determinants of Health Policy. https://www.aafp.org/about/policies/all/social-determinants.html, Last Accessed 4/21/2018
http://en.healthnexus.ca/topics-tools/health-equity-topics/social-determinants-health
From the UN website: http://www.who.int/hia/evidence/doh/en/
https://www.cdc.gov/nchhstp/socialdeterminants/definitions.html
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