September 10, 2022

In this writeup, you will prepare a short written response about health determinants to the prompt below. Please save your file in .doc or .docx format. Your response should be comp

Overview:

In this writeup, you will prepare a short written response about health determinants to the prompt below. Please save your file in .doc or .docx format. Your response should be complete and your final document should comply with APA writing requirements.

Attachment: Charter 2 of ebook (the answer in this pdf)

Instructions:

Explain the differences between indirect and direct health determinants.
In your explanation, include key factors that influence those determinants.

Global_Health_101_—-_Chapter_2_Health_Determinants_Measurements_and_the_Status_of_Health_Gl….pdf

Courtesy of Mark Tuschman.

Skolnik, Richard. Global Health 101, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/indianatech-ebooks/detail.action?docID=5894023. Created from indianatech-ebooks on 2022-09-10 00:46:19.

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CHAPTER 2 Health Determinants, Measurements, and the Status of Health Globally

LEARNING OBJECTIVES

By the end of this chapter, the reader will be able to do the following:

■ Describe the determinants of health ■ Define the most important health indicators and key terms

related to measuring health status and the burden of disease

■ Discuss the status of health globally and how it varies by country income group, region, and age group

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M ▶ Vignettes

aria is a poor woman who lives in the highlands of Peru. She is from an ethnic group called Quechua. In Peru, poor

people tend to live in the mountains and be indigenous, be less educated, and have worse health status than other people. In Eastern Europe, the same issues occur among ethnic groups that are of lower socioeconomic status, such as the Roma people. In the United States, there are also enormous health disparities, as seen in the health status of African Americans and Native Americans, compared to white Americans. If we want to understand and address differences in health status among different groups, how do we measure health status? Do we measure it by age? By gender? By socioeconomic status? By level of education? By ethnicity? By location?

Yevgeny is a 56-year-old Russian male. Life expectancy in Russia in 1985 was about 64 years for males and 74 years for females. It then fell to about 59 years for males and 72 years for females in 2001, before rising again to 67 for males and 77 for females in 2016. What does life expectancy at birth measure? What are the factors contributing to the earlier decline in life expectancy at birth in Russia? What has happened to trends in life expectancy in other countries? Which countries have the longest and shortest life expectancies, and why?

Sarah is a 27-year-old woman in northern Nigeria. While women in high-income countries very rarely die of pregnancy-related causes and have a maternal mortality ratio of about 10 per 100,000 live births, the maternal mortality ratio for women in low-income countries like Sarah is about 500 per 100,000 live births. This is 50 times higher than that in the best-off country income group. What does the maternal mortality ratio suggest about a country?

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What does it say about the status of women in that country? What does it indicate about the access of women to obstetric and emergency obstetric care of appropriate quality?

Abdul is a 4-year-old in northern India. For every 1,000 children born in South Asia in 2016, about 50 will die before their fifth birthday. The rate of child death is even higher in sub-Saharan Africa. In the cohort of 1,000 children born there in 2016, almost 80 will die before they are five. These two regions have the worst child mortality rates.5

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▶ The Importance of Measuring Health Status

If we want to understand the most important global health issues and what can be done to address them, then we must understand what factors have the most influence on health status, as well as how health status is measured.

This chapter, therefore, covers two distinct but closely related topics. The first section concerns what are called the determinants of health. That section examines the most important factors that relate to people’s health status. The second section reviews some of the most important indicators of health status and how they are used.

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▶ The Determinants and Social Determinants of Health

Why are some people healthy and some people not healthy? When asked this question, many of us will respond that good health depends on access to health services. Yet, as you will learn, whether or not people are healthy depends on a large number of factors, many of which are interconnected, and most of which go considerably beyond access to health services.

The World Health Organization (WHO) defines the determinants of health as the “range of personal, social, economic and environmental factors which determine the health status of individuals or populations.” WHO defines the social determinants of health as the “conditions in which people are born, grow, live, work and age.”

There has been considerable writing about the determinants and social determinants of health, which different organizations depict in a range of ways. The next section builds on the work of a number of actors and agencies. It briefly discusses the determinants and social determinants of health and how they influence health. It is essential to understand these concepts if one wants to understand why people are healthy or not and what can be done to address different health conditions in different settings. FIGURE 2-1 shows one way of depicting the determinants of health.

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FIGURE 2-1 The Determinants of Health

Reproduced from Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to

promote social equity in health. Stockholm, Sweden: Institute for Futures Studies.

Retrieved from

http://www.iffs.se/media/1326/20080109110739filmZ8UVQv2wQFShMRF6cuT.pdf

The first group of factors that helps to determine health relates to the personal and inborn features of individuals. These include genetic makeup, sex, and age. Our genetic makeup contributes to what diseases we get and how healthy we are. One can inherit, for example, a genetic marker for a particular disease, such as Huntington’s disease, which is a neurological disorder. One can also inherit the genetic component of a disease that has multiple causes, such as breast cancer. Sex also has an important relationship with health. Males and females are physically

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http://www.iffs.se/media/1326/20080109110739filmZ8UVQv2wQFShMRF6cuT.pdf

different, for example, and may get different diseases. Females face the risks involved in childbearing. They also get cervical and uterine cancers that males do not. Females have higher rates of certain health conditions, such as thyroid and breast cancers. For similar reasons, age is also an important determinant of health. Young children in low- and middle-income countries often die of diarrheal disease, whereas older people are much more likely to die of heart disease, to cite one of many examples of the relationship between health and age.

Individual lifestyle factors, including people’s own health practices and behaviors, are also important determinants of health. Being able to identify when you or a family member is ill and needs health care can be critical to good health. One’s health also depends greatly on how one eats, or if one smokes tobacco, drinks too much alcohol, or drives safely. We also know that being active physically and getting exercise regularly is better for one’s health than is being sedentary.

The extent to which people receive social support from family, friends, and community also has an important link with health. The stronger the social networks and the stronger the support that people get from those networks, the healthier people will be. Of course, culture is also an extremely important determinant of health.

Living and working conditions also exert an enormous influence on health. These include, for example, housing, access to safe water and sanitation, access to nutritious food, and access to health services. Crowded housing, for example, is a risk factor for the transmission of tuberculosis. The lack of safe water and sanitation, coupled with poor hygiene in many settings, is one of the major risk factors for the diarrheal disease that is associated with so much illness and death in young children. Nutrition is central to health, beginning at conception, and families have to be able to

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access appropriate foods to promote good health. Of course, even if other factors are such important determinants of health, one’s health does depend on access to appropriate healthcare services. Even if one is born and raised healthy and engages in good health behaviors, access to health services of appropriate quality is important to maintaining good health. To address the risk of dying from a complication of pregnancy, for example, one must have access to health services that can carry out an emergency cesarean section if necessary. Even if the mother has had the suggested level of prenatal care and has prepared well in all other respects for the pregnancy, in the end, certain complications can only be addressed in a healthcare setting.

PHOTO 2-1 The circumstances in which people live have a profound impact on their health. This is a slum in Jakarta,

Indonesia. In what ways would living here influence the health of the slum dwellers?

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A range of socioeconomic factors, including culture, education, and socioeconomic status, are important determinants of health. The broader environment is also a critical health determinant. Socioeconomic status refers to a person’s economic, social, and work status. It is highly correlated with educational attainment. People with higher educational attainment have better economic opportunities, higher socioeconomic status, and more control over their lives than people of lower educational status. As one’s socioeconomic status improves, so does his or her health.

More specifically, education is a powerful determinant of health for several reasons. First, it brings with it knowledge of good health practices. Second, it provides opportunities for gaining skills, getting better employment, raising one’s income, and enhancing one’s social status, all of which are also related to health. Studies have shown, for example, that the single best predictor of the birthweight of a baby is the level of educational attainment of the mother. Most of us already know that throughout the world there is an extremely strong and positive correlation between the level of education and all key health indicators. People who are better educated eat better, smoke less, have less obesity, have fewer children, and take better care of their children’s health than do people with less education. It is not a surprise, therefore, that they and their children live longer and healthier lives than do less well- educated people and their children.

Culture also exerts a profound impact on health. Culture shapes how one feels about health and illness, how one uses health services, and the health practices in which one engages. In addition, the gender roles that are ascribed to women in many societies also have an important impact on health. In some settings, women may be treated more poorly than men and this, in turn, may mean that women have less income, less education,

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and fewer opportunities to engage in employment. All of these militate against their good health.

The environment, both indoor and outdoor, is a powerful determinant of health. Related to this is the safety of the environment in which people work. Although many people know about the consequences of outdoor air pollution for health, fewer people are aware of the consequences of indoor air pollution to health. In many low- and middle-income countries, families, and usually women, cook indoors with poor ventilation, thereby creating an indoor environment that may be full of smoke and that increases the risk of respiratory illness and asthma. The lack of safe drinking water and sanitation is a major contributor to ill health in poor countries. In addition, many people in those same countries work in environments that are unhealthy. Because they lack skills, socioeconomic status, and opportunities, they may work without sufficient protection from hazardous chemicals, in polluted air, or in circumstances that expose them to occupational accidents.

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PHOTO 2-2 The lack of access to safe water and sanitation causes people to seek water from unsafe sources and is a major risk factor for child deaths. Children are shown here washing their dishes in a river. What can be done to improve access to safe water and sanitary disposal of human waste in

resource-poor environments?

Courtesy of Mark Tuschman.

The approach that governments take to different policies and programs in the health sector and in other sectors also has an important bearing on people’s health. People living in a country that promotes high educational attainment, for example, will be healthier than people in a country that does not promote widespread education of appropriate quality because better- educated people engage in healthier behaviors. A country that has universal health insurance is likely to have healthier people than a country that does not insure its entire population because the uninsured may lack needed health services. The same would be true, for example, for a country that promoted safe water supply for its entire population, compared to one that did not.

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As we think about the determinants of health, we should be aware that increasing attention is being paid to the social determinants of health. In 2005, WHO created a Commission on the Social Determinants of Health. WHO published the commission’s report in 2008. The report highlighted some of the following themes :

■ Health status is improving in some places in the world but not in others.

■ There are enormous differences in the health status of individuals within countries, as well as across countries.

■ The health differences within countries are closely linked with social disadvantage.

■ Many of these differences should be considered avoidable, and they relate to the way in which people live and work and the health systems that should serve them.

■ People’s life circumstances, and therefore their health, are profoundly related to political, social, and economic forces.

■ Countries need to ensure that these forces are oriented toward improving the life circumstances of the poor, thereby enabling them to enjoy a healthier life as well. The global community should also work toward this end.

We should also note the importance to health of child development, including the ways in which families nourish and care for infants and young children, beginning at conception. Being born premature or of low birthweight can have important negative consequences on health over the life course. There is a strong correlation between the nutritional status of infants and young children and the extent to which they meet their biological and intellectual potential, enroll in school, or stay in school. In addition, poor nutritional status in infancy and early childhood may be linked with a number of noncommunicable diseases later in life, including diabetes and heart disease. There is also considerable evidence that a range of stressors, including poverty, abuse, and

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discrimination, have a powerful impact on the health of children that may continue through adulthood.

Finally, as we think about the determinants and social determinants of health, it is important to consider how, directly and indirectly, different factors influence health. One framework for such consideration is shown in FIGURE 2-2. This framework places the determinants of health into three categories based on the directness of their influence on health: root causes at the macro/societal level; underlying causes at the meso/community level; and proximal causes at the immediate/interpersonal level. Viewing the determinants of health in this manner should also be helpful in assessing why health conditions exist and what can be done to address them.

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FIGURE 2-2 Selected Examples of Root, Underlying, and Immediate Determinants of Health

Modified with permission from Bouwman, L., Wentink, C., & Ormond, M. (2017, April

6). Global Health, W3 Tutorial 3: Determinants [Powerpoint Slides], Based on

Northridge.

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▶ Key Health Indicators It is critical that we use data and evidence to understand and address key global health issues. Some types of health data concern the health status of people and communities, such as measures of life expectancy and infant and child mortality, as discussed further hereafter. Some concern health services, such as the number of nurses and doctors per capita in a country or the indicators of coverage for certain health services, such as immunization. Other data concern the financing of health, such as the amount of public expenditure on health or the share of national income represented by health expenditure.

There are a number of very important uses of data on health status. We need data, for example, to know from what health conditions people suffer. We also need to know the extent to which these conditions cause people to be sick, be disabled, or die. We need data to carry out disease surveillance. This helps us understand if particular health problems such as cancer, influenza, polio, or malaria are occurring, where they are infecting people, who is getting infected, and what might be done to address these conditions. Other forms of data also help us to understand the burden of different health conditions, the relative importance of them to different societies, and the importance that should be given to dealing with them.

If we are to use data in the previously mentioned ways, then it is important that we use a consistent set of indicators to measure health status. In this way, we can make comparisons across people in the same country or across different countries. There are, in fact, a number of indicators that are used most commonly by those who work in global health and in development work. These are listed and defined in TABLE 2-1.

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TABLE 2-1 Key Health Status Indicators

The section that follows will examine these key indicators of health status in two ways, first by World Bank region and second by country income group. The graphics will reflect a number of points quite starkly:

■ There is a very strong correlation between country income group and health status. The lower the income group, the lower the status; the higher the income group, the higher the

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In this writeup, you will prepare a short written response about health determinants to the prompt below. Please save your file in .doc or .docx format. Your response should be comp

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