What Are Determinants of Health and Why Should We Care?

When we think about the health of an individual or a population, the first things that come to mind are medical care and health care systems. Yes, the level of advances in medical care, affordability, and quality of care are very important determinants of the health of a population, but the research shows that there are very important other nonmedical determinants as well and we must look at the big picture. As McGinnis and his colleagues concluded in their article “The Case for More Active Policy Attention to Health Promotion” (McGinnis et al, 2002), deaths per year for the U.S. population can be attributed to the following domains:

• 40 percent - to behavioral patterns

• 5 percent - to the physical environment

• 15 percent - to social circumstances

• 10 percent - to deficiencies in medical care access and delivery

• 30 percent - to genetics

These estimates are the general frame of reference, and the percentages might be different for morbidity, but the research emphasizes how important other nonmedical domains of the health of a population are.

Here are some examples of those nonmedical health determinants:

• Physical Environment - Air Quality, Water Quality, Noise, Radiation

• Social Circumstances - Education, Income, Housing, Transportation, Access to Food

• Behavioral Patterns - Smoking, Physical Inactivity, Diet, Alcohol, and Other Drugs

Our following blogs will be dedicated to health care systems and medical care, but we thought it was very important to increase awareness about the health of a population. It is the result of complex interactions and by contributing to any of these interactions, we are contributing to the health of a population. Whether we are parents, teachers, researchers, builders, car designers, artists, farmers, physicians, business owners, government employees, politicians, or bankers, we all are affecting the health of a population. On the other hand, a healthy population contributes to other societal goals.

Here are some examples of the interrelationship between health and other societal goals by sector:

Economy and Employment

• Economic resilience and growth are stimulated by a healthy population. Healthier people can increase their household savings, are more productive at work, can adapt easily to work changes, and can remain in the workforce longer.

• Work and stable employment opportunities improve health for all people across different social groups.

Security and Justice

• Rates of violence, ill health, and injury increase in a population whose access to food, water, housing, work opportunities, and a fair justice system is poorer. Justice systems within societies must deal with the consequences of poor access to these basic needs.

• The prevalence of mental illness (and associated drug and alcohol problems) is associated with violence, crime, and imprisonment.

Education and Early Life

• Poor health of children or family members impedes educational attainment, reducing educational potential and abilities to solve life challenges and pursue opportunities.

• Educational attainment for both women and men creates engaged citizens and directly contributes to better health and the ability to participate fully in a productive society.

Agriculture and Food

• When health is considered in food production, manufacturing, marketing, and distribution, food security and safety are enhanced, consumer confidence is promoted, and more sustainable agricultural practices are encouraged.

• Healthy food is critical to people’s health; good food and security practices reduce animal-to-human disease transmission and support farming practices that have a positive impact on the health of farm workers and rural communities.

Infrastructure, Planning, and Transportation

• Optimal planning of roads, transportation, and housing requires the consideration of health impacts, which can reduce environmentally costly emissions and improve the capacity of transportation networks as well as their efficiency in moving people, goods, and services.

• Better transportation opportunities, including cycling and walking opportunities, build safer and more livable communities and reduce environmental degradation, enhancing health.

Environment and Sustainability

• Optimizing the use of natural resources and promoting sustainability, which can best be achieved through policies that influence population consumption patterns, can also enhance human health.

• Globally, one-quarter of all preventable illnesses are the result of the environmental conditions in which people live.

Housing and Community Services

• Housing design and infrastructure planning that take health and well-being into account and involve the community can improve social cohesion and support for development projects.

• Well-designed, accessible housing and adequate community services address some of the most fundamental determinants of health for disadvantaged individuals and communities.

Land and Culture

• Improved access to land can support improvement in health and well-being for indigenous people, as their health and well-being are spiritually and culturally bound to a profound sense of belonging to land and country.

• Improvements in indigenous health can strengthen communities and cultural identity, improve citizen participation, and support the maintenance of biodiversity.

Source: Closing the gap: policy into practice on social determinants of health. Discussion paper of the World Conference on Social Determinants of Health, 19–21 October 2011. Geneva, World Health Organization, 2011.