Determinants of health

1. Determinants of Health

2. Objectives are
•Student should know--
•Health is multidimensional.
•Should able to tell-determinants of health.
•Health is affected-Genetic / Biological factors
Environmental factors.
Socioeconomic factors ,
Life style.

3. Determinants of Health
•Health is multi factorial.
•Some are inside the body-genetic/intrinsic
•Some are -External factors /environmental
•Interaction of them may be---
--health promoting
--deleterious.

4. Common Determinants of Health
•Genetic factors (biological)
•Environmental factors
•Life style
Behavioral & socio-cultural
•Gender & Age
•Socioeconomic conditions
Education, Occupation, Income
•Health services –utilization
Immunization, Family welfare ,nutritional…

5. Other determinants of health -
•Food & agriculture
•Education.
•Science & technology.
•Standard of living.
•Social justice, equity, human rights.
•Govt Polices to raise stand of living
•Inter sectoral contributions
•Dissemination of information (IEC)

6. Biological determinants
•Genetic make-up (Heredity)
•It is permanent & can not be altered.
•Transmitted by hereditarily.
•No treatment.
•Many be Prevented to some extent.

7. Environmental factors-
•Internal environment/Micro
•External environment/Macro
Physical-air, water, soil
Biological-plants,animals,microbes
Social-culture,belifes,traditions-
Dynamic equilibrium is Health

8. Behavioral & socio-cultural
(Life style)
•Depends on economic status
(rich & poor)
•Cultural values
vegetarianism-Non-vegetarianism
•Social values
Status of women
•Personal habits
Smoking…..
•Behavioral pattern
High risk behavior

9. Life style
•Learnt by observations by –parents, teachers, peer
groups, mass media…..
Includes cultural pattern, social value & behavior…
•The way people thinks & live
-developed through process of socialization&
social interaction. (traditional lifestyles)
•So cultivate healthy lifestyles
like proper nutrition & sleep, exercise, avoid
drug abuse,

10. Life-style makes the difference
•Malnutrition.
•Population explosion.
•Mental health problems.
•RCH
•Cancer.
•Diabetes mellitus
•Cardiovascular diseases
•AIDS & STDs.
•Environmental pollution.

11. Socioeconomic conditions
•Determined by-Income (per capita)
Literacy
Occupation
Purchasing capacity
•Indirectly by-religion & caste
-Housing
-Political support

12. Economy & literacy
•Determines quality of life (PQLI) by
-Employment ,housing, nutrition.
-Productive work promotes health
-Finally determine health status
-

13. Socioeconomic conditions---
•Per capita GNP
•GNP directed to wards health care
•Political commitment
•Efficient leadership

14. Health services
•Availability & utilization of health services
•Should include comprehensive services
•Need based essential
•Must reach to social periphery
•Equitably distributed
•Accessible at affordable cost
•Socially acceptable

15. Health services
•Should promote health & prevent illnesses.
Eg:-Immunization of children—
Provision of safe drinking water—
ANC-will reduce MMR & IMR.
•Services must reach to all sections.

16. Family welfare services
•Covers spectrum of personal & community
services for treatment ,prevention &
promotion of health
Like---immunization, family planning,
MCH,ICDS, Nutritional….

17. Gender & Age
•Women’s affected by gender difference
•Nutrition & development
•Violence
•Social status
•Economic independence
•During reproductive age
•Aging –leads Geriatrics problem

18. Other factors
•Better IEC system
•Rural development
•Employment opportunities
•Increased wages
•Family support systems
•Inter-sectoral coordination between—
Depts. of education , agriculture, civil,
labor, environment, social welfare….

21. Indicators of health
•To measure health status.
•To compare
•To assess the health needs
•To plan & implement----
•To evaluate health care

22. Health is measured multi-dimensionally &
indirectly
Health Indicators classified as….
•Mortality indicator
•Morbidity indicators
•Disability indicators
•Nutritional status indicators
•Health care delivery indicators
•Utilization rates

23. Health Indicators also classified as….
•Indicators of social & mental health.
•Socio-economic indicators.
•Health policy indicators.
•Environmental indicators.
•Indicators of quality of health.

24. Mortality Indicators
•Crude death rates
•Infant mortality rates
•Maternal mortality rates
•Child mortality rates.
•Proportional mortality rates.

25. Morbidity indicators
•Incidence rate
•Prevalence rate.
•Notification rate.
•Out patients attendance rate.
•Hospital admission rate
•Duration of stay in the hospital.

26. Disability rates
•Event type
No of days of restricted activity.
Bed disability days.
Sickness absenteeism.
•Person type
Limitation of mobility.
Limitation of daily activity.

27. Nutritional status indicators
•Incidence of LBW
•Incidence of LBW
•Anthropometric measurements of < 5
mid arm circumference
height & weight with age

28. Health care delivery indicators
•Doctor : Population. 1:2500
•Nurse: Population 1:5000
•Health worker: Population 1:3000
•Sub centers: Population 1:3000
•P H C : Population 1:30000

29. Indicators of social & mental health
•Rates of crimes---murder, theft, suicides,
Prostitution, gambling, drug abuse….
•Rates of accidents.
•Rate of divorces, family violence

30. Socioeconomic indicators
•Growth rate of population.
•Per capita income / GNP.
•Percentage of people below poverty line.
•Level of unemployment.
•Dependency ratio.
•Literacy rate.
•Family size.

31. Health policy indicators
•Proportion of the budget (NGP) spent on…
Health services—
RCH, RNTCP, ICDS, Pulse polio
Health related services—
Water supply
Sanitation.
Nutrition
Housing.
Community development.

32. Environmental indicators
•Indicators relating pollution of air, water,
noise, soil, radiation solid waste…
•Percentage of houses having ..
safe water supply.
adequate sanitary facilities.

33. •Thus there is no single comprehensive
indicator to assess or to measure the health
status of country.
•Each indicator reflects one aspect of health.
•Ideal indicator is yet to be developed.

34. Thus there is no single comprehensive
indicator to assess or to measure the
health status of country.

35. Utilization rates
•Proportion of infants “fully immunized”
•Proportion of mothers with adequate ANC.
•Proportion of Deliveries conducted by TBA.
•“Bed occupancy” rate in the hospital.
•Coverage with insecticidal spraying.