12/11/2014

DETERMINANTS OF HEALTH
DESY INDRA YANI
BAGIAN KEPERAWATAN KOMUNITAS
FAKULTAS KEPERAWATAN
UNIVERSITAS PADJADJARAN
2014

Outline
Determinants and causes of disease
Definitions of proximal and distal determinants,
and necessary and Sufficient causes
The nature of the relationship between poverty
and poor health
Critical account of the theory of the
epidemiological transition
Overview of the demographic characteristics and
disease patterns in different parts of the world.

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Determinant
determinant is used to refer to any factor,
whether an event, characteristic, or other
definable entity, that brings about, or
contributes to, a change in health.
A distal determinant is one that is remote, either
in position, time or resemblance to the outcome
of concern
A proximal determinant is one that is much
closer to the outcome of concern.

Distal and Proximal Determinants

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Determinants or causes?
the words are often used interchangeably and you may
see one used to help define the other
the word cause tends to be reserved for those factors
that have been rigorously evaluated there is strong
and consistent evidence that they lead to a specific health
outcome
It can be useful to consider causes as necessary and
sufficient
A necessary cause is one which must be present for the
health outcome to occur
The term sufficient cause is used to refer to a factor, or
more usually a combination of factors, that inevitably
produce a particular health outcome

Patterns of diseases over time and in

the world today
The theory of the epidemiological
transition
The theory of the epidemiological transition was
developed in order to provide an overall
framework for considering changes in population
fertility and mortality (demographic change), the
relationship of these to disease patterns, and the
relationship of both of these to economic, social
and technological changes

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The theory of the epidemiological

transition

Patterns of diseases over time and in

the world today
The two-way relationship between economic and
social development and health
It implies that the relationship between economic
and social development is one way, when there is
clearly a two-way relationship.
Measures aimed at reducing specific diseases,
while justified of course on the grounds of
relieving human suffering, are also an essential
part of a programme to promote economic and
social development.

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Patterns of diseases over time and in

the world today
The influence of globalization
The term globalization is used here to refer to the
increasing interconnectedness of populations through
the flow of services, money, goods, ideas and people
across national borders.
Globalization can have both positive and negative
consequences for health
(+) giving poor countries fair access to international
trade can have a major impact on economic growth and
improved standards of living and health
(-) the potential benefits of globalization are currently
failing to reach millions of the worlds poor, and some of
the current terms and conditions of trade work against
poor countries in favour of the rich.

Determinants of Health (Healthy

People 2020)
The range of personal, social, economic, and
environmental factors that influence health status
Determinants of health

Policymaking
Social factors
Health services
Individual behavior
Biology and genetic
Determinants of health reach beyond the boundaries of
traditional health care and public health sectors

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Determinants of Health
The concept of health determinants denotes an
encompassing and synthetic approach to
explaining the complex mechanism by which an
array of factors influences ones health

Determinants of Health
Historical context
The concept of health determinant has been
changing through history
Aristoles ethics and policy concept of health
was located in the broader field of living well, both
orally and socially. Aristole identifies 3 kinds of
resources for living well
Goods of the body
Goods of the soul
External goods

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Historical context
Mc Keown research introduces the concept of
health field where for quadrants are located with
determinants of greatest influence upon health:

Environment
Life style
Human biology
Health care organization

Historical context
Ottawa Charter for health promotion emphasized
the existence of broader social, economic and
environmental factors that affect health

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Some present facts

Health and sickness represent a resultant of
effects of risk factors and health determinants
throughout life , as well as certain effects of some
determinants during critical stages
Evans Model :

Social environment
Physical environment
Genetic 3ndowment
Individual response: behavior and biology

Some present facts

Health Canada:

Income and social status

Social support and networks
Education
Employment, working conditions
Social environments
Physical environments
Personal health, practice, and coping skills
Health child development
Biology and genetic endowment
Health services
Gender
culture

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On some of the most important determinants

Income and social status

Healthy child development
Genetic endowment
Health services
Message