6 Determinants of Health, Risk Factors, and Prevention

Determinants of Health

• What makes some people healthy and others unhealthy?
• How can we create a society in which everyone has a chance to live long healthy lives?

The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health.

Determinants of health fall under several broad categories:

• Social factors
• Health services
• Individual behavior
• Biology and genetics

It is the interrelationships among these factors that determine individual and population health. Because of this, interventions that target multiple determinants of health are most likely to be effective. Determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health.

Policymaking

Policies at the local, State, and Federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.

Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn, reduced rates of injuries and deaths from motor vehicle accidents.

Social

Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning and quality of life outcomes.

Examples of social determinants include:

• Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
• Exposure to crime, violence, and social disorder, such as the presence of trash
• Social support and social interactions
• Exposure to mass media and emerging technologies, such as the Internet or cell phones
• Socioeconomic conditions, such as concentrated poverty
• Quality schools
• Transportation options
• Public safety
• Residential segregation

Examples of physical determinants include:

• Natural environment, such as plants, weather, or climate change
• Built environment, such as buildings or transportation
• Worksites, schools, and recreational settings
• Housing, homes, and neighborhoods
• Exposure to toxic substances and other physical hazards
• Physical barriers, especially for people with disabilities
• Aesthetic elements, such as good lighting, trees, or benches

Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment.

For example, millions of people in the United States live in places that have unhealthy levels of ozone or other air pollutants. In counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with State and national averages. Poor air quality can worsen asthma symptoms, especially in children.^[2]

Health Services

Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.

Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.^[3]

Barriers to accessing health services include:

• Lack of availability
• High cost
• Lack of insurance coverage
• Limited language access

These barriers to accessing health services lead to:

• Unmet health needs
• Delays in receiving appropriate care
• Inability to get preventive services
• Hospitalizations that could have been prevented

Individual Behavior

Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced.

Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.

Examples of individual behavior determinants of health include:

• Diet
• Physical activity
• Alcohol, cigarette, and other drug use
• Hand washing

Biology and Genetics

Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging.

Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.

Examples of biological and genetic social determinants of health include:

• Age
• Sex
• HIV status
• Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
• Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
• Family history of heart disease

Social Determinants of Health

Social determinants of health are economic and social conditions that influence the health of people and communities. These conditions are shaped by the amount of money, power, and resources that people have, all of which are influenced by policy choices. Social determinants of health affect factors that are related to health outcomes. Factors related to health outcomes include:

• How a person develops during the first few years of life (early childhood development)
• How much education a persons obtains
• Being able to get and keep a job
• What kind of work a person does
• Having food or being able to get food (food security)
• Having access to health services and the quality of those services
• Housing status
• How much money a person earns
• Discrimination and social support

What are determinants of health and how are they related to social determinants of health?

Determinants of health are factors that contribute to a person’s current state of health. These factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature. Scientists generally recognize five determinants of health of a population:

• Genes and biology: for example, sex and age
• Health behaviors: for example, alcohol use, injection drug use (needles), unprotected sex, and smoking
• Social environment or social characteristics: for example, discrimination, income, and gender
• Physical environment or total ecology: for example, where a person lives and crowding conditions
• Health services or medical care: for example, access to quality health care and having or not having insurance

Other factors that could be included are culture, social status, and healthy child development. Scientists do not know the precise contributions of each determinant at this time.

In theory, genes, biology, and health behaviors together account for about 25% of population health. Social determinants of health represent the remaining three categories of social environment, physical environment/total ecology, and health services/medical care. These social determinants of health also interact with and influence individual behaviors as well. More specifically, social determinants of health refer to the set of factors that contribute to the social patterning of health, disease, and illness.

Why is addressing the role of social determinants of health important?

Addressing social determinants of health is a primary approach to achieving health equity. Health equity is “when everyone has the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance.” Health equity has also been defined as “the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages—that is, different positions in a social hierarchy.” Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities.

Risk Factors

What is a risk factor?

Risk factors are things in your life that increase your chances of developing a condition or disease. They can include things like family history, exposures to things in the environment, being a certain age or sex, being from a certain ethnic group, or already having a health condition. If you do have risk factors, your doctor or nurse will most likely want you to be screened or immunized at a younger age or more often than what is recommended. Check with your doctor or nurse to find out if you need to have specific health screenings and how often you will need them.

Understanding Risk Factors

Part of learning how to take charge of your health requires understanding your risk factors for different diseases. Risk fac­tors are things in your life that increase your chances of getting a certain disease. Some risk factors are beyond your control. You may be born with them or exposed to them through no fault of your own. Some risk factors that you have little or no control over include your:

• Family history of a disease
• Sex/gender—male or female
• Ancestry

Some risk factors you can control include

• What you eat
• How much physical activity you get
• Whether you use tobacco
• How much alcohol you drink
• Whether you use illegal drugs
• Whether you use your seat belt

In fact, it has been estimated that almost 35 percent of all U.S. early deaths in 2000 could have been avoided by changing just three behaviors:

• Stopping smoking
• Eating a healthy diet (for example, eating more fruits and vegetables and less red meat)
• Getting more physical activity

Having more than one risk factor

You can have one risk factor for a disease or you can have many. The more risk factors you have, the more likely you are to get the disease. For example, if you eat healthy, exercise on a regular basis, and control your blood pressure, your chances of getting heart disease are less than if you are diabetic, a smoker, and inactive. To lower your risks, take small steps toward engaging in a healthy lifestyle, and you’ll see big rewards.

Inheriting risk—your family health history

Rarely, you can inherit a mutated gene that alone causes you to get a disease. Genes control chemical reactions in our bodies. If you inherit a faulty gene, your body may not be able to carry out an important chemical reaction. For instance, a faulty gene may make your blood unable to clot. This problem is at the root of a rare bleeding disorder. More often, you can inherit genes from one or both of your parents that put you at higher risk of certain diseases. But having a gene for a certain disease does not always mean you will get it. There are many unknown factors that may raise or lower your chances of getting the disease. People with a family health history of chronic dis­ease may have the most to gain from making lifestyle changes. You can’t change your genes, but you can change behaviors that affect your health, such as smoking, inactivity, and poor eating habits. In many cases, making these changes can reduce your risk of disease even if the disease runs in your family. Another change you can make is to have screening tests, such as mammograms and colorectal cancer screening. These screening tests help detect disease early.

People who have a family health history of a chronic disease may benefit the most from screening tests that look for risk factors or early signs of disease. Finding disease early, before symptoms appear, can mean better health in the long run. Your family’s health history could be important for determining health risks for you and your children. Learn more about how to document your family’s health history and share it with your doctor. It is important to talk to your doctor or nurse about your individual health risks, even if you have to bring it up yourself. And it’s important for your doctor to know not just about your health, but your family health history as well. Come to health care visits armed with information about you, your children, siblings, parents, grandparents, aunts and uncles, and nieces and nephews, including

• Major medical conditions and causes of death
• Age of disease onset and age at death
• Ethnic background
• General lifestyle information like heavy drinking and smoking

Family Health History

Family health history can help your doctor make a diagnosis if you or your children shows signs of a disorder. It can reveal whether you or your children have an increased risk for a disease; if so, the doctor might suggest screening tests. Many genetic disorders first become obvious in childhood, and knowing about a family health history of a genetic condition can help find and treat the condition early.

Update your family health history information regularly and share new information with your doctor. Remember that relatives can be newly diagnosed with conditions between doctor’s visits.

The best way to learn about your family health history is to ask questions. Talk at family gatherings and record your family’s health information—it could make a difference in your child’s life.

Factors Affecting Human Health

Risk factors are those inherited, environmental and behavioral influences which are considered to increase the likelihood of physical or mental health problems in the future. After studying this session you will be able to describe health risk factors and explain their association with human health.

Health and human behavior

Behavior is an action that has a specific frequency, duration and purpose whether conscious or unconscious. It is what we do and how we act.

Health behaviors are those personal behavior patterns, actions and habits that people perform in order to stay healthy, in order to restore their health when they get sick and in order to improve their health status.

Types of health behaviors

In this section, you will learn about six different types of health behavior that people may perform — from the initial stages of preventing diseases up to their actions that may be associated with attempts to rehabilitate themselves after a bout of illness.

• Preventive health behaviors: These are actions that healthy people undertake to keep themselves or others healthy and prevent disease or detect illness when there are no symptoms. Examples include handwashing with soap, using insecticide treated mosquito nets and exclusive breastfeeding to age six months.
• Illness behaviors: These include any activities undertaken by individuals who perceive themselves to be ill. This would include recognition of early symptoms and prompt self referral for treatment.
• Sick-role behaviors: These include any activity undertaken by individuals who consider themselves to be ill, for the purpose of getting well. It includes receiving treatment from medical providers and generally involves a whole range of potentially dependent behaviors. It may lead to some degree of exemption from one’s usual responsibilities. For example a person who feels that he is ill might visit the nearby health center and receive tablets to be taken home, and might then not do as much work as normal.
• Compliance behaviors: This means the person will be following a course of prescribed treatment according to the instructions that the health worker has given them.
• Utilization behaviors: This is the sort of behavior that is described when people use their health services such as antenatal care, family planning, immunization, taking a sick person for treatment, etc.
• Behavior is an action that has a specific frequency, duration and purpose whether conscious or unconscious. It is what we do and how we act. People stay healthy or become ill often as a result of their own actions or behavior.

Preventive health behaviors are actions that healthy people undertake to keep themselves or others healthy. Examples include good nutrition and exclusive breastfeeding until the age of six months.

• Illness behaviors include any activities undertaken by an individual who perceives him or herself to be ill.
• Compliance behaviors are to do with following a course of prescribed treatment regimes.
• Utilization behaviors involve the utilization of health services such as antenatal care or family planning.
• Rehabilitation behaviors are the ways that people behave after a serious illness to get themselves better again.
• Determinants of health are the biological, environmental, behavioral, organizational, political and social factors that contribute either positively or negatively to the health status of individuals, groups and communities.
• Risk factors are those inherited, environmental and behavioral influences which are known or thought to increase the likelihood of physical or mental health problems. Risk factors increase the probability of morbidity and premature mortality, but do not guarantee that people with the risk factors will suffer the consequences.
• Non-modifiable (non-changeable or non-controllable) risk factors include factors such as age, sex and inherited genes — things that individuals cannot change or do not have control over.