CQ1 – What does health mean to individuals? CQ2 – What influences the health of individuals?

1. PRELIMINARY HSC PDHPE CQ1 – What does health mean to individuals? CQ2 – What influences the health of individuals? CQ3 – What strategies help promote the health of individuals?

3. Critical Question 2: What influences the health of individuals? • The determinants of health

4. 1. The determinants of health • Since the early twentieth century, in general Australians have enjoyed continuously improving standards of health, including reductions in infant mortality and significant increases in life expectancy. Yet these health gains have not been shared equally. There still exists a large gap in health standards between the rich and the poor, for example. Some groups in society have a much greater chance of achieving their full health potential as a result of their life circumstances. These circumstances, or determinants, include individual, socio-cultural, socio-economic and environmental conditions. Determinants help explain and predict trends in health. For example, they provide reasons as to why some individuals and groups have better or worse health than others.

6. Figure 2.1 presents a conceptual framework of health developed by the Australian Institute of Health and Welfare. Within this framework the determinants of health are divided into four broad groups. The framework shows how one group of determinants can influence and determine the nature of another group of determinants. For example, an individual’s socioeconomic characteristics, such as education and employment, can influence that person’s health behaviours, mental well-being and issues relating to safety. These, in turn, can influence biomedical factors, such as body weight and glucose metabolism. At all stages, these various factors interact with the individual’s genetic make-up. Despite the general direction of these influences, they can occur in reverse. For example, the individual’s health can also influence his or her physical activity levels, employment status and wealth. • Not all health determinants are addressed in your PDHPE studies. In your studies we investigate the determinants that are modifiable and assist in reaching optimum health. These are discussed on the following pages.

7. Many factors influence the health of individuals and these factors can either protect health or place it at risk. Factors that increase the risk of ill-health, such as eating fatty foods, are known as risk factors. Factors that reduce the risk of ill-health, such as participating in physical activity, are known as protective factors. These factors do not exist in isolation. Instead, they have a combined effect. Together, they determine the health of individuals. • The determinants of health may vary in the level of risk they pose. High-risk factors include those that place a person at high risk of developing an illness. Smoking is an example; compared with a non-smoker, a smoker is at least 10 times more likely to develop lung cancer.

8. individual factors, eg knowledge and skills, attitudes, genetics • Knowledge, skills and attitudes • The ability to acquire knowledge about health and develop health-related skills is a powerful determinant of a person’s health. It enables a person to recognise health problems (in themselves or others), make choices about behaviours and access health services when required. • People’s health-related skills, health knowledge and attitudes towards health can influence their health behaviours, and consequently their present and future health status. Being informed about health risks can motivate people to choose health enhancing behaviours. • The increasing ability to access information electronically (via the Internet), has provided the general population with greater access to knowledge about health than ever before. Despite the greater access to information, many people still behave in ways that can harm their own health and that of those around them. People continue to smoke, for example, despite widespread media campaigns to raise awareness of the risks associated with smoking.

9. Genetics • Our heredity is determined by our chromosomal make-up; that is, the genes that were passed on to us by our biological parents. Certain diseases are known to be inherited. These include asthma, type-1 diabetes, heart disease and some cancers. Heredity is a risk factor for these diseases.

10. sociocultural factors, eg family, peers, media, religion, culture • Health inequities exist between different social groups in Australia. By examining the socio-cultural influences on different groups we can attempt to explain their health status.

11. Family • Family, including its structure, has a strong impact on the health and well-being of children and their parents. For instance, married people tend to be healthier and live longer than those who are unmarried. This may be because people who are healthy, or with determinants of good health (such as higher education or income), may make more attractive marriage partners. The health benefits are similar for married couples as well as couples in de facto relationships. Reasons for this protective effect may include greater material resources and social support provided by being part of a couple. Also one’s partners may provide encouragement to adopt healthy behaviours.

12. Family • Children and young people in lone-parent households have poorer health than those in two parent households. This increased risk in lone-parent households appears to be due to material disadvantage rather than the family structure itself, as these households are much more likely to experience unemployment and have low incomes. Inadequate family income is more common in single-parent families, and family breakdown can also have adverse social and health consequences for children and their parents.

13. Peers • Most individuals have a social need for acceptance. They therefore seek companionship, support, approval and acceptance from others. Young people are influenced by their peers. A person’s peers may have either a positive or negative effect on his or her decision-making. For example, peers may encourage individuals to adopt health-enhancing behaviours (such as participating in physical activity) or health-compromising behaviours (such as engaging in high-risk activities).

14. Media • The media have a huge role in shaping how we see the world. It influences our socialisation, values, development, opinions and knowledge. • The last decade has seen an increase in the volume of health information presented through the media. This is particularly true of television, with entire programs being devoted to good health and positive lifestyle behaviours. • The media exposes us to so much, often contradictory, information that it is easy to become overwhelmed. It is important to be discerning when receiving information through the media. The effect of the media can be subtle; affecting us even when we are not fully aware that it is doing so.

15. Religion • Religion has health-enhancing benefits, including social support, a sense of meaning and purpose, a belief system and a clear moral code. These benefits may also come from other sources. • Historically, certain religions have sometimes been used to justify hatred, aggression and prejudice. In some instances, religion can be viewed as judgmental, alienating and exclusive. For example, a religion may reject a young person who is same sex attracted. Although religious participation may foster beneficial social networks, the expected social relations may be a source of stress. Failure to conform to community norms may evoke open criticism by other congregation members or clergy. Young people may experience feelings of guilt due to their failure to meet religious expectations, such as to abstain from sexual relationships before marriage. Such influences can contribute to poor health. So, while religion may provide many health benefits, this may not be true in all circumstances and for all individuals.

16. Culture • Culture refers to accepted ways of behaving within a particular group in society. Culture can vary across and within ethnic groups and for many it is central to health and well-being. An ethnic group is characterised by a common history and origin, and a distinctive social and cultural tradition maintained within the group between generations. • Cultural factors can have both positive and negative impacts on health. In Australia, ethnicity may in some instances be strongly associated with low socio-economic status. Social exclusion and isolation affect the health status of some ethnic groups. Some are further affected by prior hardships. For example, refugees who have suffered trauma may experience continuing mental health problems.

17. Culture • Language difficulties and certain cultural health beliefs and practices have a significant impact on health literacy, including access to health services. For example, individuals who are unable to speak English may encounter problems when accessing health services or be unaware of available services. Health inequalities may exist between ethnic groups and within ethnic groups and both are important considerations. To meet the needs of people from ethnic minority groups, health services must increase access to culturally and linguistically relevant health promotion programs. They also need to develop functional health literacy for people from diverse cultural backgrounds.

18. Aboriginality • Aboriginality is a significant factor in determining health status. Health status among Indigenous Australians is poor in comparison with non- Indigenous Australians. Higher morbidity and infant mortality rates and a shorter life expectancy are examples of the compromised health status of Aboriginal and Torres Strait Islander people. • Indigenous Australians often face multiple social and cultural risk factors, such as unemployment, racism, geographic isolation, inadequate housing and watersupply, and lower levels of education.

19. Aboriginality • The change from a traditional lifestyle to a Western lifestyle is believed to have had a great impact on the health status of young Indigenous Australian people in particular. Changing sexual practices among both men and women in Indigenous Australian communities have contributed to high rates of sexually transmitted diseases and a lower age of childbearing among young Indigenous Australian women. Drug use, such as sniffing petrol and glue, is a major cause of death among Indigenous Australian youth in geographically isolated areas. Alcohol related problems (including suicide, motor vehicle accidents, violence and abuse) are the major health concerns of young Indigenous Australians. Because of close community links, many Indigenous Australians seek family advice on matters relating to health ratherthan consult health professionals.

20. Aboriginality • Many Indigenous Australians suffer from poor nutrition because of an introduced diet with a high sugar intake, as well as poor hygiene and living conditions. These lead to anaemia, a variety of skin conditions and other diseases. Diseases of the respiratory system, eyes and ears are more common among Indigenous Australians than among non-Indigenous Australians. • Mental illness is another health problem experienced in significant numbers by Indigenous Australians. Social factors such as unemployment, and conflict at school and with the police find young Indigenous Australians, particularly males, suffering from low self-esteem and feelings of marginalisation or isolation. These feelings may be expressed in the form of violence, aggression and suicide, and make these people vulnerable to developing a mental illness.

21. socioeconomic factors, eg employment, education, income • People or groups who are socially and economically disadvantagedtend to have worse health. Illness or disability can prevent a person from securing or maintaining employment, which generally results in reduced income. Health problems can also impair a person’s ability to continue or succeed in education.

22. Employment • Employment status — unemployment in particular — is strongly related to health status. Unemployed people have highermortality and more illness and disability than those who are employed. Lack of work can contribute to poor health in at least two ways: first, it reduces people’s ability to buy health related goods and services; second, it can have strong psychological and social impacts, such as alienation, poor self-esteem and stigma associated with unemployment. • Among people who are employed, there is a relationship between occupation and health. Generally, people working in manual and low-skilled jobs have poorer health, more disability and higher mortality than people in managerial / professional occupations. A large part of this inequality has been attributed to different levels of risk from exposure to physical hazards and to the psychosocial effects of lower levels of control in one’s job.

23. Education • Higher levels of education are related to higher income and better employment prospects. They can also affect health directly by providing knowledge and skills that allow a person to achieve a healthy lifestyle and gain better access to health services. • People who are educated and employed are in a position to be prepared to defer immediate pleasures so they can do better in the long term—whereas those who are disadvantaged are less likely to do so. If people are less likely to invest time and effort in, say, education, then they may also be less likely to engage in healthy behaviours or avoid health risks. This has been illustrated with smoking rates: as socio-economic status improves, the prevalence of smoking decreases.

24. Income • Income can have an impact on an individual’s level of health. Much of this relationship appears to be due to the association between income, education and occupation. People with a high level of education are more likely than others to be employed in a white-collar or professional job, and people in such occupations tend to have higher incomes than unskilled workers. High incomes increase access to goods and services that are beneficial to health, including health care, better housing and preventive health measures, such as joining a fitness centre and buying nutritious foods.

25. environmental factors, eg geographical location, access to health services and technology • Environmental factors that may affect human health, both positively and negatively, include many physical, chemical and biological conditions and agents. Safe human-made environments benefit the health and well-being of individuals and communities, as do clean air and water and fresh food. The natural environment can pose health risks from certain animals, plants, landscapes and natural disasters, such as flooding and drought. Human-caused changes to the environment can also be harmful. These include climate change and land degradation.

26. Geographic location • People living outside metropolitan regions vary in their ability to access health care services and information. Specialist diagnostic and treatment services are often unavailable in these areas. In addition, rural people may have lower incomes than city dwellers. Combined, these factors can make it difficult for rural residents to access health professionals. Issues relating to privacy and confidentiality of information in close-knit communities can result in residents choosing not to access certain health services. Common circumstances where this may be the case are teenage pregnancies, depression, and alcohol and drug addiction. • Social pressures can have an impact on rural young people, especially males, who tend to participate in risky behaviours involving motorcycles and farm vehicles. Their perception of risk as part of everyday life also leads to a greater involvement in unintentionally risky behaviours. For young rural males, the suicide rate is significantly elevated. Living in geographically isolated communities is associated with high levels of alcohol consumption and smoking and an increased risk of accidents and injury. People in rural areas are exposed to a variety of hazards. Operating farm and mining machinery poses risks, and the long distances to drive between towns or properties are among the reasons for the high road fatality rate in rural areas.

27. Access to health services • Some groups within the community may have difficulty accessing, understanding or using information about health. For example, people from non-English-speaking backgrounds may not assimilate new information as quickly as native English speakers, and they may therefore retain traditional beliefs and use traditional health treatments rather than making full use of the health services available. Studies have also shown that certain people from some non-English-speaking backgrounds are not as informed about risky health behaviours as their English-speaking counterparts. In some cases, those who come from countries where smoking is seen as the social norm are often not aware of the health and social problems associated with smoking.

28. Access to technology • Families in remote areas often have to travel hundreds of kilometres to access essential health and social support services for themselves and their children. This is costly in terms of time and money. In these areas, public transport is infrequent, expensive or non-existent for local and out-of-town travel. People in rural areas are at great risk of poor physical and emotional well-being due to limited access to health services. Mental health and counselling support services often do not exist in rural and remote communities. Also frequently lacking are early learning opportunities for children, family support and adult education opportunities, creating a great sense of social isolation. Therefore, in these communities reliable access to the Internet is required at an affordable cost. Despite the benefits that Internet access can provide people residing in rural and remote areas, rates of information technology adoption are frequently lower among this group than for those in metropolitan areas.

29. 2. The degree of control individuals can exert over their health • modifiable health determinants • People’s health behaviour is a major determinant of both their current and future health status. A person’s health behaviours are modifiable actions that affect his or her health either positively (for example, through physical activity) or negatively (for example, by smoking). • Determinants may vary in how easy they are to modify. There may be little that some individuals can do to modify certain determinants, thus limiting the influence that they can have on their own health. Age, for example, is a major risk factor for many conditions, but it is obviously not modifiable. Obesity, on the other hand, is also a risk factor for many conditions, but in many cases individuals are able to make changes that will help them to obtain a healthy weight.

30. non-modifiable health determinants • People can change individual behaviours. Individuals, however, have limited control over individual factors, such as heredity, and environmental factors, such as access to health care. These are non-modifiable health determinants. Factors that influence behaviour change can be divided into three general categories: predisposing, enabling and reinforcing factors. Our life experiences, knowledge, culture and ethnicity, and current beliefs and values are all predisposingfactors that influence behaviour. They are factors that predispose us towards certain behaviours, making us more or less motivated to act in a particular way.

31. They also include our age, sex, income, family background, educational background and access to health care. Young people have little or no control over these factors. Skills and abilities; physical, emotional and mental capabilities; community and government priorities and approaches to health; and health resources and facilities are enablingfactors. They may be positive or negative. Positive enablers encourage positive behaviour change. Negative enablers are barriers and work against the intention to change unhealthy behaviours. • Individuals have some control over enabling factors. Identifying positive and negative enabling factors and making alternative plans when negative factors outweigh the positive are part of planning for positive behaviour change. • Reinforcingfactors include the presence or absence of support and encouragement from important people or bodies in your life. These include employer actions and policies, health provider costs, community resources and access to health education.

32. the changing influence of determinants through different life stages • The influence of health determinants changes through the different life stages. Children of less affluent families are more likely to experience failure at school, work in the more disadvantaged sectors of the workforce, and experience unemployment early in their working lives. • In addition, poorer families are more likely to produce babies of lower birth weight. Children with a low birth weight have an increased risk of socio-economic disadvantage during childhood and adolescence and an increased risk of chronic disease in middle age. • The transition from school to work is regarded as having an influence on the determinants of health. People who enter less well paid employment are at greater risk of experiencing work insecurity and being exposed to physical and chemical hazards at work. • They are also more likely to live in less well constructed housing in more polluted neighbourhoods, and to retire on no more than the basic pension.

33. 3. Health as a social construct • Health is a social construct. It varies from one society to another. Each culture or society may define health differently, and these definitions are likely to change over time. A social view of health helps us to understand the range of health determinants influencing a person throughout the life stages and how these can contribute to poor health outcomes.

34. recognises the interrelationship of determinants • Health is a dynamic quality that is affected by a complex interrelationship between individuals and their physical, social, economic and political environments. Recognition of the interrelationship of the determinants of health is reflected in a social view of health. This sees health as being created in the settings where people live and work. It recognises the need for: • personal skills development • empowerment of communities to take action to promote health • the creation of social and physical environments that are supportive of health • an awareness of the impacts on health of public policies • health services that are orientated towards health promotion and the prevention of ill-health. • Theinterrelationship that exists between our social environments —the care and nurturing we receive when young, our interactions with others and our sense of inclusion—determine our health and well-being.

35. challenges the notion that health is solely an individual’s responsibility. • A social view of health recognises that health risk cannot be attributed solely to individual risk behaviours. Instead, it understands that a person’s health and well-being are associated with social institutions, such as families, communities, workplaces and the health care system. These institutions can support or diminish the health of the individual. For example, unemployment may lead to illness due to social isolation and the stigma associated with being jobless. Yet society also provides support networks that can assist people during this difficult stage.