HEALTH DETERMINANTS

Joko Mulyanto CHEM 2 2012

DEFINITION
The underlying social, economic, cultural and environmental factors that are responsible for health and disease, most of which are outside the health sector. Not direct cause of the disease Proximal cause (Enabling, Reinforcing Factors)

SIGNIFICANCE OF HEALTH DETERMINANTS

The biomedical model of health. The concept of multiple determinants of health. Limited contribution of medical care in health status of population. Universal medical access is not sufficient. Growing recognition of other underlying determinant of health status.

MODEL OF HEALTH DETERMINANTS

Force-field health paradigm (Blum, Lalonde) Health field Model (Evans & Stoddard)

FORCE FIELD HEALTH PARADIGM

Heredity Environment Behavior Healthcare services

HEALTH FIELD MODEL

MAJOR HEALTH DETERMINANTS

Social environment Genetic endowment Physical environment Behavior Healthcare

SOCIAL ENVIRONMENT
Family structure Education Social network Social class Work setting Level of prosperity

Family Structure
Two-parents family is better than single parent family Nuclear family is better than extended family

Education
Independent effect on health status regardless the income Higher level education better health status. Young age education influence health behavior Mother education influence maternal and child health status

Social Network
An individuals integration into a self-defined community and the degree of connectedness to other individuals and to institutions. There is a strong inverse correlation between the number and frequency of close contacts and mortality from all causes, with odds ratios of 2:1 or higher and a clear doseresponse relationship (Berkman and Syme, 1979)

Social Class
A clear relationship between social class (based on job classification) and mortality. The relationship persists throughout the social hierarchy and is unchanged after adjusting for income and smoking.

Work Setting
Autonomy in job Involuntary unemployment

Level of Prosperity
Level of income independently and consistently correlated with mortality rate

GENETIC ENDOWMENT
Significant influence on health Risk predictor rather than certain cause. Schizophrenia, affective disorder Interaction with social and physical environment Susceptibility of the host

PHYSICAL ENVIRONMENT
Various way Exposure of hazardous material Safety at work and home Poor housing Overcrowding

BEHAVIOR
Individual response to external stimulus specially from environment Free-choice behavior Lifestyle: Pattern of behavior, and consistently endure for certain period. Socially influenced, culturally embedded, economically constrained

HEALTH CARE
Limited but not neglected Preventive and curative care

CONCLUDING COMMENT
Health is broad and determine by multiple factors. Healthcare it self will not sufficient to improve health of population

THANK YOU
2012