DETERMINANTS OF HEALTH- RAM NAIK.M

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HEALTH SPECTRUM OF DISEASES DETERMINANTS OF DISEASE RAM NAIK. M 4 th Semester

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SPECTRUM OF DISEASE INTRODUCTION Health and disease lie along a single line of continuum. There is no single cut-off point.. The highest point corresponds to positive health. The lowest point corresponds to death.

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Concept Of Spectrum Of Health Health of an individual in not static. It is a process of continuous change, subject to frequent variations. As long as we are alive., there is some amount of health in us

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DETERMINANTS OF HEALTH

The Determinants of Health:

The Determinants of Health The factors that lead to differences in health status are collectively known as THE DETERMINANTS OF HEALTH.

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Health of an individual is based on Uncontrollable Factors (genetics, gender, predisposition to a disease) Controllable Factors (diet, smoking status, exercise levels)

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The determinants of health can sometimes be referred to as RISK FACTORS or PROTECTIVE FACTORS. Risk Factor – determinants which are detrimental to health (smoking) Protective Factors – Promote or enhance health (exercising)

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Biological Determinants Refer to the cells, tissues and systems of the body, their structure and how adequately they function

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Biological Determinants

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Biological Determinant Body Weight The effect of Body Weight on the health status Under weight Healthy weight range Over weight Obese Effect on Physical Health high blood pressure high blood cholesterol impaired glucose regulation CVD respiratory conditions Arthritis Effect on Social Health social marginalisation (being separated from the rest of society) Effect on Mental Health low self esteem

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RISK factors – those factors that are detrimental to health Many determinants interrelate Behavioural – excessive drinking Biological - overweight Social – lack of social connections

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PROTECTIVE factors – those factors that promote or enhance health Many determinants interrelate Behavioural – regular physical activity Biological- healthy body weight Social – belonging to a team

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Biological Determinant Genetics The effect of Genetics on the health status Sex Body type Hormone production Predisposition to disease Age

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Biological Determinant Body Type There is a greater chance of developing various diseases if you are overweight : CVD: ■ diabetes: gall bladder disease: ■ high blood pressure: osteoarthritis: ■ certain types of cancer (colon). If you are underweight you may be malnourished and develop: a compromised immune function: respiratory disease: digestive diseases: cancer: osteoporosis: increased risk of falls and fractures

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Biological Determinant Genetics Predisposition to disease “ A person may be at increased risk of inheriting a disease or condition if they have a biological parent who has had the disease.” Genetics can have an influence on a persons risk to certain conditions or diseases. Ex: If your parent has high cholesterol, you are at a higher risk of developing high cholesterol. Examples of diseases – genetic predisposition Alzheimer's disease (before the age of 65) Migraine headaches Type 1 & 2 diabetes CVD - High blood pressure, hypertension Certain cancers – (including breast and prostate)

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Biological Determinant Hormones Chemical messages to cells that cause changes in the body Hormones regulate many processes in the body and control many aspects of health Males Females Testosterone : Responsible for the production of male sex characteristics and production of sperm May decrease risk of heart disease Oestrogen: regulates the menstrual cycle Maintains bone density Menopause increases risk of osteoporosis Regulates fat distribution – hips and buttocks

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Biological Determinant Age Age influences many aspect of health Condition Influence of age Blood cholesterol The prevalence of high blood cholesterol increased with age to peak for females 65-74 and for males 55-64. Blood Pressure The proportion of males and females with HBP increases markedly with age. Obesity The rates of obesity have increased in all age groups with the most marked increase among 25 – 44 and 75 years and over. CVD The burden of disease attributed to CVD increases markedly with age, particularly 60 years and over. Diabetes The proportion of people with diagnosed diabetes increased with age and the highest prevalence rate was for the age 65 – 74. Mental Illness The burden of disease from mental illness for both sexes was greater in early to middle adulthood than at other ages.

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Biological Determinant Blood Pressure The effect of Blood Pressure on the health status High Blood Pressure Low Blood Pressure Effect on Physical Health CVD – heart attack, stroke Kidney failure Hypertension Contributing factors – biological, behavioural, social determinants Genetic predisposition Stress Poor diet (sodium) Smoking Excessive alcohol

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Biological Determinant Blood Cholesterol The effect of Blood Cholesterol on the health status Effect on Physical Health CVD – stroke, coronary heart disease Contributing factors– biological, behavioural, social determinants Lack of exercise Genetic predisposition Smoking Diet (saturated fat ) Excessive alcohol Animal products trigger cholesterol to be released into the body Low density lipoproteins (LDL) – “bad” High density lipoproteins (HDL) – “good”

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Biological Determinant Impaired Glucose Regulation The effect of Impaired Glucose Regulation on the health status Effect on Physical Health CVD type 2 diabetes Contributing factors for blood cholesterol – biological, behavioural, social determinants Lack of exercise Genetic predisposition Low LDL cholesterol Smoking Diet (high in triglycerides) High blood pressure Stress Pregnancy Excessive alcohol Overweight Preferred fuel for energy - Carbohydrate Blood glucose consistently high levels of insulin high also If this occurs over long period of time cells, resistant to action of insulin glucose does not enter cells. Known as insulin resistance or glucose intolerance

Behavioural Determinants: Refer to the choices people make in their lives that impact on health :

Behavioural Determinants: Refer to the choices people make in their lives that impact on health

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Behavioural Determinants

Activity :

Activity In groups come up with as many factors that can be associated with: Being Overweight or Obese Being Underweight

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Behavioural Determinant Physical Activity Protective Factors Risk Factors Physical ACTIVITY can assist with reducing the risk of: . . Physical INACTIVITY is associated with many health outcomes: . . . Physical activity can take many forms. All that is required is that the body is moving.

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Behavioural Determinant Physical Activity Protective Factors Risk Factors Physical ACTIVITY can assist with reducing the risk of: Obesity Stress relief – exercise produces endorphins(promote feelings of wellbeing) Weight bearing activity helps to keep muscular and skeletal systems strong, reducing the risk of conditions like osteoporosis. Physical INACTIVITY is associated with many health outcomes: Obesity – (use less energy therefore leading to an increase in body weight). Mental health issues (depression, anxiety & stress). Increased risk of osteoporosis. Physical activity can take many forms. All that is required is that the body is moving.

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Behavioural Determinant Developing & maintaining friendships The peer group is increasingly in influential during youth. Young people rely on each other more heavily . Protective Factors Risk Factors Influence other behaviours e.g. exercise and risk-taking activities (affecting physical health & development). Encourage social development by engaging youth in social activities (communication skills & social roles) Encourage and support each other (promoting mental health). Lead the youth to experience strong bonds with individuals outside the family (promoting emotional health). Influence other behaviours such as risk-taking behaviours & substance use (affecting physical health & development).

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Social Determinants Socio Economic Status Social Exclusion Food Security Housing Early Life Experiences Stress Access to Health Care Transport Work Social Determinants Refer to the determinants within the social environment that impact on health status

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Social Determinants Socio Economic Status SES – measure of an adult’s or family’s economic or social position within society relative to others High SES Medium SES Low SES

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Social Determinants Housing The housing environment is a significant determinant of health Promote good health or contribute to ill health Overcrowding impacts on mental health and creates unhygienic conditions infectious and parasitic diseases Noise and overcrowding impacts on sleeping conditions Lack of security – stress and anxious Design and safety – accidents and falls Pollutants – tobacco smoke, asbestos, dust, pet hair – asthma Hygiene – adequate hot and cold water and washing facilities Adequate water supply – safe for drinking Cooking facilities - conducive to eating a nutritionally sound diet.

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Social Determinants Work and Unemployment The type of work + ve or – ve effect on health Aspects of work that can affect health: Relationships at work – employer, colleagues, public, conflict Physical work space – UV exposure, heating and cooling, seating arrangements, tools and machinery Demands of the job Stress Long working hours: Heavy workload: Lack of job security: Harassment: Discrimination Depression: Anxiety: Fatigue: Headaches: Increase risk of CVD Work

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Socio-economic determinants Economic status Education Occupation Political systems

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Economic status : Per capita GNP Determines the purchasing power, standard of living, pattern of disease, behaviour in society. Important in seeking health care Education : Especially female education plays a role Map of illiteracy ~ map of poverty, ill-health and death Ex: Kerala

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RANK STATE 2001 CENSUS 2011 CENSUS 1 KERALA 90.86 93.9 2 MIZORAM 88.8 91.6 13 ANDHRA PRADESH 60.47 67.7 27 JHARKAND 53.56 67.6 28 BIHAR 47 63.8 LITERACY RATES

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Occupation : State of being employed promoted health Unemployed shows a high incidence of death and ill-health Loss of work ~ loss of income source, status. Political status : Determines concern and resource allocation, man power policy Degree of which health schemes are made available and accessible. % of GNP spent on health= quantitative indicator of political commitment 3% of GNP in India Target is at least 5% as per WHO

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Other factors Includes systems outside the formal health care system. Health related systems. Food and agriculture education, industry social welfare rural development Adoption of policies on socio-economic fields. Which would rise the standards of living

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