Determinants Of Health PDF

**DETERMINANTS OF HEALTH** Health is multifactorial. The factors which influence health lie both within the individual and externally in the society in which he/she lives. It is a truism to say that what man is and to what diseases he may fall victim depends on a combination of two sets of factors-...

**DETERMINANTS OF HEALTH** Health is multifactorial. The factors which influence health lie both within the individual and externally in the society in which he/she lives. It is a truism to say that what man is and to what diseases he may fall victim depends on a combination of two sets of factors- his genetic factors and the environmental factors to which he is exposed to. These factors interact and these interactions may be health-promoting or deleterious. Thus, conceptually, the health of individuals and whole communities maybe considered to be the result of many interactions. - **BIOLOGICAL DETERMINANTS** The physical and mental traits of every human being are to some extent determined by the nature of his genes at the moment of conception. The genetic makeup is unique in that it cannot be altered after conception. A number of diseases are now known to be of genetic origin e.g. chromosomal anomalies, errors of metabolism, mental retardation, some types of diabetes etc. The state of health therefore depends partly on the genetic constitution of man. Nowadays, medical genetics offers hope for the prevention and treatment of a wide spectrum of diseases, thus the prospect of better medicine and longer, healthier life. A vast field of knowledge is yet to be exploited. It plays a particularly important role in genetic screening and gene-therapy. Thus, from the genetic stand point, health may be defined as that "state of the individual which is based upon the absence from the genetic constitution of such genes as correspond to characters that take the form of serious defect and derangement and to the absence of any aberration in respect of the total amount of chromosome \*\*\*\* The positive health advocated by WHO implies that a person should be able to express as completely as possible the potentialities of his genetic heritage. This is possible only when the person is allowed to live in a healthy relationship with his environment- an environment that transforms genetic potentialities into phenotypic realities. - **BEHAVIOURAL & SOCIO-CULTURAL CONDITIONS** The term "lifestyle" is rather a diffuse concept often used to denote the way people live , reflecting a whole range of social values, attitudes and activities. It is composed of cultural and behavioural patterns and lifelong personal habits (e.g. smoking, alcoholism) that have developed through the process of socialization. Lifestyles are learned through social interactions with parents, peer groups, friends and siblings, through school and the mass media Health requires the promotion of healthy lifestyle. A considerable body of evidence has accumulated which indicates that there is an association between health and lifestyles of individuals. Many current day health problems especially in the developed countries (e.g. coronary heart disease, obesity, lung cancer, drug addiction) are associated with lifestyle changes. In developing countries such as India and Nigeria where traditional lifestyles still persists It may be noted that not all lifestyles factors are harmful. There are many that can actually promote health. Examples include adequate nutrition enough sleep, sufficient physical activity, etc. In short, the achievement of optimum health requires the adoption of healthy lifestyles. Health is both a consequence of an individual's lifestyle and a factor in determining it. - **ENVIRONMENT** It was a Hippocrates who first related disease to environment, e.g., climate, water, air, etc. Centuries later, Pettenkofer in Germany revived the concept of disease-environment association. Environment is classified as internal and external. The Internal environment of man pertains to each and every component part, every tissue, organ and organ system and their harmonious functioning within the system. Internal environment is the domain of Internal medicine. The external or macro-environment consists of those things to which man is exposed after conception. It is defined as all that which is external to the individual human host. It can be divided into physical, biological and psychosocial components, any or all of which can affect the health of man and his susceptibility to illness. Some epidemiologists have used the term "micro-environment" (or domestic environment) to personal environment which includes the individual's way of living and lifestyle e.g. eating, other personal habits (e.g. smoking or drinking), use of drugs, etc. It is also customary to speak about occupational environment, socio-economic and moral environment. It is an established fact that environment has a direct impact on the physical, mental and social wellbeing of those living in it. The environmental factors range from housing, water supply, psychosocial stress and family structure through social and economic support systems, to the organization of health and social welfare services in the community. The environmental components (physical, biological and psychological) are not water-tight compartments. They are so inextricably linked with one another that it is realistic and fruitful to view the human environment intoto when we consider the influence of the environment on the health status of the population. If the environment is favourable to the individual, he can full use of his physical and mental capabilities. Protection and promotion of family and environmental health is one of the major issues in the world today. - **SOCIO-ECONOMIC CONDITIONS** Socio-economic conditions have long been known to influence human health. For the majority of the world's people, health status is determined primarily by their level of socio-economic development, e.g. per capital Gross National Product (GNP), education, nutrition, employment, housing, the political system of the country, etc. Those of major importance are: Economic Status: there can be no doubt that in many developing countries, it is the economic progress that has been the major factor in reducing morbidity, increasing life expectancy and improving the quality of life, family size and the pattern of disease and deviant behavior in the community. It is also an important factor in seeking health care. Ironically, affluence may also be a contributory cause of illness as exemplified by the high rates of coronary heart disease, diabetes and obesity in the upper socio-economic groups i. Education: A second major factor influencing health status is education (especially female education). The world map of illiteracy closely coincides with the maps of poverty, malnutrition, ill health, high infant and child mortality rates. Studies have shown that education to some extent, compensates the effects of poverty on health, irrespective of the availability of health facilities ii. Occupation: the very state of being employed in productive work promotes health. This is because the unemployed usually show a higher incidence of ill health and death. For many, loss of work may mean loss of income and status and this can cause psychological and social damage iii. Political System: Health is also related to the country's political system. Often the main obstacles or challenges to the implementation of health technologies are not technical but rather political. Decisions concerning manpower policy, resource allocation, choice of technology and the degree to which health services are made available and accessible to various segments of the society are examples of the manner in which the political system can shape community health services What is needed is political commitment and leadership, which is oriented towards social development, and not merely economic development. If poor health patterns are to be changed, ten changes are to be made in the entire socio-political system in any given community. Social, political and economic actions are required to eliminate health hazards in people's working and living environments. - **HEALTH SERVICES** The term health and family welfare services cover a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health. The purpose of health services is to improve the health status of population. For instance, immunization of children can influence the incidence (number of new cases)/prevalence (number of old and new cases) of particular diseases. Provision of water can prevent mortality and morbidity from water-borne diseases. The care of pregnant women and children would contribute to the reduction of maternal and child morbidity and mortality. To be effective, health services must reach the social side-line/margin, equitably distributed, accessible at a cost the country and community can afford, and socially acceptable. All these are ingredients of Primary Health Care, which is seen as the way to better health. - **AGEING OF THE POPULATION** By the year 2020, the world will have more than One billion people aged 60 and over, and more than two-thirds of them living in developing countries. Although the elderly in many countries enjoy better health than previously, a major concern of rapid population ageing is the increased prevalence of chronic diseases and disabilities, both being conditions that tend to accompany the ageing process and deserve special attention. - **GENDER and OTHER FACTORS** Other factors include contributions to health that are derived from systems outside the formal health care systems. They include employment opportunities, increased wages, prepaid medical programmes and family support systems. In short, medicine is not the sole contributor to the health and well-being of population. The potential of intersectoral contributions to the health of communities is increasingly recognized