Determinants of (ill)health

1. Determinants of (ill)health Dadi S Argadiredja dr, DTM&H, MPH

2. Determinants: - Environment - Life styles - Socio political organization. - Biologic

3. Environment factor • The role and significance of the environment as determinants of health changed over the past hundred year - Before industrial revolution  war,nutrition > sanitation  small cities- rare outbreaks - Industrial society  housing become problem

4. - Before 18th centuries mortality gap < Pest, famine and war - Developing countries Air pollution,basic sanitation - Developed countries Man made env, indoor air pollution, building material on

5. soil (exp Radon) - Environment factors that affect health include the following: a. Life support  food, water, air b. Physical factors  Mechanical, Acoustical, Electrical, thermal, Ionizing, radiation c. Biologic factorsMicroorganism

6. toxins, biologic wastes,biologic antagonist (animal or plants), allergens - Psycho-social factors Crowding Demands, Physical time - Chemical factorsinorganic, or- ganic and Product complexes ( combustion product, Macromolecular

7. product, industrial waste, agriculture wastes including herbicides, pesti- cides and fertilizer) - Environmental field is full of hazards - Environmental complexity increasing as technology pro vide new product &process

8. - There is no save environment - Public policy will have to balan ce b/w economic and develop ment and optimally save env.

9. Life styles factor • Prominent factors: Smoking, licit & illicit drugs ( incl alcohol) ,exercise, diet, sexual practices - Major precursors of premature death 1980 USA 1) tobacco 2) overnutrition 3) alcohol 4)handgun 5)unintended pregnancies

10. - People who live alone higher mortality rates. - employed live longer - thin people live longer than fat - Life styles become more and more important. - Life styles and disease Diet coronary HD,stroke, Ca

11. Biologic factors - earlier centuries  dominant deter minants (plague, leprosy, small-pox) - if environment and lifestyles im- prove role of biologic factor < - among biologic factors pathogenic microorganisms are important - genetic factor  many research done.

12. - Gender .  for Ca Mammae women > 100x than men. women live longer than men death due to motor vehicle and homicide men > women in underdeveloped countries wo men have higher mortality rate than men. In developed coun-

13. tries reverse according to Stein and Maine cause by discrimination,low -paying and hazardous occu pation - it is difficult to separate biolo gic factors from environment, lifestyle and organizational factor

14. Sociopolitical organizational factors - responsibility of government to intervene - organizational factors are plentiful  impede effective delivery of needed services in preventive and therapeutic. Also preclude effective policy analyses and problem solving

15. at the state and community level - Poverty Low income people are consis- tently at a disadvantage. They have high rates of morbidi ty, mortality and dependency. Poverty and lack of education

16. affect the biologic dimension through malnutrition, Poverty has powerful impact on environment  degrading quality of housing, increase risk of injuries,excessive crowding etc