One way of understanding health is to look at the health outcomes within a population. These health outcomes can be measured through health indicators like life expectancy, infant mortality rates, weight, blood pressure, etc., which are known as health measures.
Health measures are not perfect because they are objective measurements that might only represent one aspect of health in the real world. For example, health outcomes don’t always represent health status because health itself is a subjective experience. This means that health can only be defined by the person who has it and not by an objective measurement like weight or blood pressure.
Another good example of why health measures are limited in representing health is because health behaviors are part of health, but health behaviors are sometimes different from what health measures report. People might exercise without gaining any weight or they might drink lots of soda yet have normal blood pressure. The same goes for mental health; some people might appear fine even if they are depressed deep inside, while others may seem really depressed on the outside when in fact they’re just sad and not depressed.
As health measures are limited in representing health, health determinants can be used as a way to understand health. Health determinants represent aspects of health that health measures might not capture, for example health behaviors and health beliefs. There is a wide range of health determinants that could influence health outcomes. For example, unhealthy behaviors like drinking alcohol or smoking will increase someone’s risk for developing some types of cancer. Another good example of a health determinant is socioeconomic status (SES). SES has been found to have an effect on how healthy someone is as seen by their likelihood to be obese, which increases with lower income levels even though those people might exercise frequently.
In order to measure the effect of different health factors on population-level health, health researchers use health inequities as a health determinant. Health inequities are health differences between groups of people that are unfair and avoidable. An example of this is the difference in life expectancy between male and female infants. Another good example is geographical health inequalities, which means there’s a health difference between counties within a country even though those counties have similar health determinants like access to health care or wealth/poverty levels.
Health inequities can be caused by social injustice on the macro level, for example government policy decisions being influenced by lobbying efforts from pharmaceutical companies who have different interests than ordinary citizens. This type of social injustice happens on the international level as well; for instance, high drug prices might make it impossible for poor countries to provide health care to their citizens.
Sometimes health inequities based on gender and race exist even though health determinants like socioeconomic status or geographical location are similar; this is known as horizontal health inequity, while health inequities based on SES, geographic location, and race/ethnicity can be called vertical health inequities.
While health measures might only represent one aspect of health in the real world and health behaviors aren’t always captured by them, health determinants provide a much more realistic way of understanding health. However, there is much work yet to be done when it comes to reducing different social injustices that cause health inequities.
Social Determinants of health are often misunderstood among health care workers, health policy makers and the public. They are sometimes misconstrued as simply lifestyle factors or health behaviours like smoking, drinking or drug use. However, there is a very important distinction between individual behaviors and social determinants of health.
Social Determinants of health can be defined as social characteristics that “interact with risk exposures and health-damaging behaviors to influence health” (World Health Organization [2]) . Social determinants of health explain how people act within their environment, the directions they pursue to satisfy needs, what choices one has available in order to get what they need; situations beyond their control help shape people’s lives. term “social determinants” goes beyond health care and health policy. It includes the economic, political and social structures we live in. [1]
Common examples of Social Determinants of health include: Income, Education level, Cultural values, Social support networks and Geographic location. [2]
Income is a classic example of an important social determinant. Examining health across countries demonstrates that health status varies with each nation’s average income level. Among the poorest 50 nations health statistics show high mortality rates for children under 5 years old (per 1000 births) ranging from 147 to 287 deaths per 1 ,000 live births in 2002-2003 . In contrast, among the wealthiest 50 nations child mortality was 30 per 1 ,000 live births .Research also shows that life expectancy increases with income.
It is also evident that health status varies among countries of similar average household income levels . Puerto Rico, for example , has a health profile similar to the poorest countries in the world with its high prevalence of obesity and diabetes. [1]
Educational level is another classic Social determinant of health. For decades health professionals have observed that health status differs between people who do or don’t go on to college after high school. Research shows that those with higher educational achievement tend to live longer and engage in healthier behaviours (such as not smoking) than those who do not continue their education after high school. [1]
Social support networks are yet another classic Social Determinant of health . There is evidence to suggest that health and health behaviours are influenced by the extent to which people have networks of family and friends who provide social support. For example, those with larger social support networks may be more likely to seek health care earlier when they need it or apply pressure on those around them to live healthier lifestyles. [1]
Cultural values as a Social Determinant of health is an interesting one . In some cultures health care practitioners work within a health paradigm that puts more emphasis on the religious, spiritual or other type of non-biomedical system. It can also show up in different expectations for health care between Western biomedicine and traditional healing systems such as aboriginal healing practices. Some believe that this difference can lead to health care professionals not understanding patients’ needs and health problems and health care professionals and patients not understanding each other’s perspectives (such as aboriginal health paradigms). [1]
Finally, Geographic location is a common Social determinant of health . Rural residents face different health risks than those who live in urban settings. Lack of access to health services such as primary health care facilities also contributes to poorer health status among rural residents. For example, Indigenous populations suffer from lower life expectancies , higher rates of infant mortality , lower cancer screening rates and heart disease compared with non-Indigenous groups. [ 1 ]
One major criticism of the Social Determinants approach to health inequities is that it does not provide policy makers with specific interventions that can be taken to reduce social inequalities in health. [ 1 ] [not true, see pg. 2]
Another criticism is that Social Determinants do not account for inequalities within countries . [ s s I that : and’s a problem?] It would be wrong to assume that health inequities only exist between countries of different income levels. Within wealthy nations health status varies considerably with ethnicity and income levels , leading many health professionals to embrace an approach called “population health”. [1]
Population health places less emphasis on the contribution of individual behaviours such as smoking or physical activity than it does on understanding how health risk factors such as tobacco use contribute to health outcomes at the population level (such as lung cancer).
