OSPAP Programme: Determinants of Health

OSPAP Programme: Determinants of Health

• The presentation is about determinants of health, specifically focusing on the concepts of biomedical and biopsychosocial models, Dahlgren and Whitehead's model, and social determinants of health

Biomedical Model of Health

• This model is dominant in Western cultures
• It assumes illness has a biomedical basis
• Health is seen independently of social, psychological, or behavioral influences
• Diagnosis and treatment are the main focuses
• Components include blood tests, physiological measurements, medications, and surgery
• The biopsychosocial model was proposed as an alternative by Engel in 1977

Dahlgren and Whitehead's Model

• This model, adapted from Wilson and Mabhala (2008), illustrates the interconnected factors impacting health
• It depicts general socioeconomic, cultural, and environmental conditions surrounding individuals.
• These factors include: Work environment/education; Agriculture/food production; Social and community networks; Individual lifestyle factors (age, sex, constitutional factors); Living and working conditions; Unemployment; Water and sanitation; Health care services; and housing.

Social Determinants of Health

• They affect health on multiple levels (national, community, and individual)
• They're made up of risk conditions, risk groups, risky behaviours, and risk factors
• Health inequalities are an important part of this
• Determinants are interconnected
• In 1991, the city of Toronto identified conditions that can be considered risk factors. These include: Poverty, Social marginalization, Poor housing; Unemployed; and Ethnic minority groups. Other risk conditions include: Lone parents, people with higher risk behaviours such as drug use, poor diet, and people with genetic factors such as hypertension.

Baggot (2004): Determinants of Health

• Proposes 6 key elements determining health: Health services, Biological factors, Genetic factors, Demographic factors, Environment, and Lifestyle

Lifestyle Factors

• This includes diet, smoking, alcohol use, drug abuse, and sexual lifestyle

Determinants of Health (WHO, 2017)

• The context of a person's life contributes to their health
• Determinants include social and economic environments, physical environments, and personal behaviours and characteristics
• Individuals don't fully control all determinants
• Social determinants account for 30-55% of health outcomes

Increasing Recognition of Health

• The WHO (1946) definition of health emphasizes complete physical, mental, and social well-being (not just the absence of disease)
• In the UK, the Marmot Review (2010) explored population health.

Fair Society, Healthy Lives

• Aim to understand health disparities across England (2020)
• Life expectancy in England has stagnated since 2010, and it follows a social gradient
• The more deprived an area, the shorter the life expectancy
• The Marmot Review offered six policy recommendations to address health inequalities

Six Policy Recommendations for Healthy Lives

• Support every child for a good start in life
• Promote opportunities for children, young people, and adults to reach their full potential
• Promote fair employment and good work practices
• Ensure a healthy standard of living for all
• Build on healthy communities
• Improve prevention of ill health

Wider Determinants of Health Tool (2017)

• A resource library to address health inequalities
• Wider determinants account for 40-50% of health outcomes variation
• Indicators are categorized into 7 domains: Natural and built environment; work and labor market; vulnerability; income; crime; and education.

Public Health Outcomes Framework

• Online resource: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework
• Focuses on national data surveillance and four domains: Wider determinants of health improvement, Health improvement, health protection, and healthcare public health.
• It uses various data sources to provide national and local info on population health.

Local Action on Health Inequalities

• Public Health England assembled a collection of documents in 2018 to support organizations funding and procuring services to reduce health inequalities
• Information is available on the following areas: Policies, guidance for addressing disparities, community engagement, data insights, and economic factors impacting health.

Role of Pharmacy

• Access to community pharmacies is higher in deprived areas (Todd et al., 2014)
• Healthy Living Pharmacies are designed to address health inequalities (NHS Portsmouth, 2010)
• Pharmacy data collection can contribute to public health intelligence (RPS, 2014)
• Pharmacists support health literacy, particularly concerning medication management (Roberts, 2015)