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DETERMINANTS OF (ILL)-HEALTH

DETERMINANTS OF (ILL)-HEALTH. Dept. of Public Health Faculty of Medicine, Universitas Padjadjaran. Learning Objective:. explain and provide relevant examples of health determinants. Required reading:.

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DETERMINANTS OF (ILL)-HEALTH

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  1. DETERMINANTS OF (ILL)-HEALTH Dept. of Public Health Faculty of Medicine, Universitas Padjadjaran

  2. Learning Objective: • explain and provide relevant examples of health determinants Required reading: Detels R and Breslow L, eds. Oxford Textbook of Public Health, 4th edition. New York: Oxford University Press, 2002, pp. 83-87

  3. Defining Health • Everyone has some idea regarding what ‘health’ is • The structure of ones’ definition is contingent upon a number of issues: - experiences - current health - social/individual perspective - beliefs, values, morals - life time expectations

  4. WHO Definition of Health (1948) a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity Act No. 23 (1992) keadaan sejahtera dari badan, jiwa dan sosial yang memungkinkan setiap orang hidup produktif secara sosial dan ekonomis (a state of physical, mental and social well-being that enables any individual to achieve socially and economically productive life)

  5. The Health Continuum Ill-health ( - ) Well-being (+) 0

  6. The relationship b/w well-being & ill-health high WELL-BEING I IV low high ILL-HEALTH II III low

  7. The Public Health Context • Major transition in the health of human populations: - gains in life expectancy & declining fertility rate - transformation of major death & disease causes - increasing health inequalities b/w rich & poor • Health improvements in developed countries have resulted from: - changes in the social, economic & physical environment - changes in human ecology - deliberate public health & medical interventions

  8. The Public Health Context (cont’d) • Health improvements in developing countries have resulted from: - increased literacy - family spacing - improved nutrition - improved vector control - application of public health knowledge in sanitation, vaccination & the management of infectious diseases

  9. Perspectives on the Determinants of Health • The biomedical view • The lifestyle approach • The broad socio-economic approach • The population health view

  10. The BIOMEDICAL VIEW • Based on the strength of the molecular & genetic sciences • Characterized by adherence to ‘objective’ sciences & the search for causes of specific diseases in individuals & their constituents parts

  11. The LIFESTYLE APPROACH • Emphasized in the Lalonde Report (1974)  fields of health: - human biology - environment - lifestyle - health-care organization • The Report asserted that positive health was not attainable for the majority of the population through a concentration of public health funds on personal services

  12. Blum’s Theory (1974):

  13. The SOCIO-ECONOMIC APPROACH • Emphasized in the 1986 Ottawa Charter • Not gained widespread acceptance outside the public health and health promotion communities

  14. The POPULATION HEALTH VIEW • Emerged since the early 1990s, in response to the fiscal crisis affecting health-care systems worldwide • Central message: health in human societies, as opposed to individual health status, is powerfully influenced by the wealth-generating capacity of a nation & the manner in which this wealth is distributed

  15. The POPULATION HEALTH VIEW(cont’d) • the major determinants of human health status are cultural, social & economic • these factors are independent of medical care input at the population level • societies that enjoy a high level & relatively equitable distribution of wealth enjoy a higher level of health status • at the individual level, health status is determined by the social & economic environment & the way in which this environment interacts with individual psychological resources & coping skills

  16. The POPULATION HEALTH VIEW(cont’d) Limitations: • downplays the importance of targeted public health interventions & the effects of living & working conditions • underplays the importance of the current phase of economic globalization for public health practice • the lack of attention given to the importance of community involvement in health affairs

  17. Beaglehole’s Model of Health Determinants (2002) Global & ecological perspectives Genes Social, cultural, & environmental determinants Disease experience Health system influences Life course Gender perspective Health & well-being of populations Public health perspective

  18. Institute for the Future/IFTF (2003):

  19. For next week… • Each tutorial group has to select one case of either: - reproductive system - neuro-behaviour system - genito-urinary system - dermato-musculo-skeletal system • Discuss & review the potential corresponding determinants

  20. Thank you....

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