Expert Answer:NR 443 Determinants of Health

  

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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 a long, healthy life?
Healthy People 2020 is exploring these questions by:
Developing objectives that address the relationship between health status and biology, individual
behavior, health services, social factors, and policies.
Emphasizing an ecological approach to disease prevention and health promotion. An ecological
approach focuses on both individual-level and population-level determinants of health and
interventions.
About Determinants of Health
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:
Policymaking
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.
Back to Top
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. 1
Social Factors
Social determinants of health reflect the social factors and physical conditions of 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.
Don’t miss the Social Determinants of Health topic area and objectives.
Examples of social determinants include:
Availability of resources to meet daily needs, such as educational and job opportunities, living
wages, or healthful foods
Social norms and attitudes, such as discrimination
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
Back to Top
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
Don’t miss the Access to Health Services topic area and objectives.
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
Back to Top
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
References
Centers for Disease Control and Prevention. Achievements in public health, 1900–1999 motor-vehicle
1
safety: A 20th century public health achievement [Internet]. MMWR Weekly. 1999 May 14;48(18);369–74
[cited 2010 August 27]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4818a1.htm.
State of the Air [Internet]. Washington, DC: American Lung Association. Available
2
from: http://www.stateoftheair.org
.
Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report, 2008.
3
Rockville (MD): U.S. Department of Health and Human Services, AHRQ; 2009 Mar. Pub no. 09-002.
Available from: http://www.ahrq.gov/qual/nhdr08/nhdr08.pdf [PDF – 2.6 MB].
Additional Resources
Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through
action on the social determinants of health [Internet]. Geneva: World Health Organization; 2008 [cited
2010 May 10]. Available from: http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf [PDF –
4.3 MB]
.
Harris K, Holden C, Chen M. Background information on national indicators for social determinants of
health. Paper presented to the Secretary’s Advisory Committee on National Health Promotion and
Disease Prevention Objectives for 2020, National Opinion Research Center; January 5, 2010.
Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in health. Washington,
DC: National Academies Press; 2003.
U.S. Department of Health and Human Services. Draft report of the Secretary’s Advisory Committee on
National Health Promotion and Disease Prevention Objectives for 2020 on Social Determinants; revised
2009 Sep 9.
Wilkinson R, Marmot M, editors. Social determinants of health: The solid facts [Internet]. 2nd ed.
Copenhagen: World Health Organization; 2003 [cited 2010 May 26]. Available
from: http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf [PDF – 470 KB]
.
Grading Rubric
A
(100%)
Outstanding
or highest
level of
performance
Addresses all
aspects of the
initial
Answers the initial discussion
graded discussion question(s)
question(s)/topic(s), applying
demonstrating
experiences,
knowledge and
knowledge,
understanding of
and
concepts for the
understanding
week.
regarding all
16 points
weekly
concepts.
16 points
Integrates
evidence to
support your
discussion
from:
Integrates evidence

to support
discussion. Sources
are credited.*
( APA format not
required)

12 points
C
B
(76%)
(87%)
Competent or
Very good or
satisfactory
high level of
level of
performance
performance
Addresses
most aspects
of the initial
discussion
question(s)
applying
experiences,
knowledge,
and
understanding
of most of the
weekly
concepts.
14 points
Addresses
some aspects of
the initial
Minimally
discussion
addresses the
question(s)
initial discussion
applying
question(s) or
experiences,
does not
knowledge, and address the
understanding initial
of some of the question(s).
weekly
0 points
concepts.
12 points
Integrates
evidence to
support
discussion
from:
Integrates
evidence to
support
discussion only
from an outside
source with no
assigned mention of
readings assigned
OR online reading or
lesson.
lesson.
assigned
readings**
OR online •
lessons,
AND
at least one
outside
scholarly Sources are
source.*** credited.*
Sources are
credited.*
F
(0)
Poor or failing
or
unsatisfactory
level of
performance
10 points
Sources are
credited.*
9 points
Does not
integrate any
evidence.
0 points
A
(100%)
Outstanding
or highest
level of
performance
B
(87%)
Very good or
high level of
performance
C
(76%)
Competent or
satisfactory
level of
performance
F
(0)
Poor or failing
or
unsatisfactory
level of
performance

12 points
Responds to a
classmate
and/or
Responds to a
instructor’s
classmate
post furthering and/or
Engages in
meaningful dialogue the dialogue by instructor
with classmates or providing more furthering the
dialogue by
instructor before the information
and
adding some
end of the week.
clarification,
depth to the
14 points
thereby adding discussion.
much depth to
the discussion. 12 points
Responds to a
classmate
No response
and/or instructor post to another
but does not
student or
further the
instructor.
discussion.
0 points
10 points
14 points
Presents
information that
Presents
is not clear,
Presents
information
logical,
information
using clear and Presents
professional or
using
concise
information in
organized to the
understandable
language in an an organized
point that the
language but is
organized
manner (few
reader has
somewhat
Communicates in a manner
errors in
difficulty
disorganized
professional
(minimal
English
understanding
(some errors in
manner.
errors in
grammar,
the message
English
8 points
English
spelling,
(numerous
grammar,
grammar,
syntax, and
errors in
spelling, syntax,
spelling,
punctuation).
English
and
syntax, and
grammar,
punctuation).
punctuation). 7 points
spelling, syntax,
and/or
6 points
8 points
punctuation).
0 points
A
(100%)
Outstanding
or highest
level of
performance
PARTICIPATION:
Response to initial
question: Responds
to initial discussion
question(s) by
Wednesday, 11:59
p.m. M.T.
PARTICIPATION
Total posts:
Participates in the
discussion at least
three times on at
least two different
days.
B
(87%)
Very good or
high level of
performance
C
(76%)
Competent or
satisfactory
level of
performance
F
(0)
Poor or failing
or
unsatisfactory
level of
performance
0 points lost
-5 points
Student posts an answer to
the initial discussion
question(s) by Wednesday,
11:59 p . m. MT.
Student does not post an answer
to the initial discussion
question(s) by Wednesday, 11:59
p . m. MT.
0 points lost
-5 points
Posts in the discussion at least Posts fewer than three times OR
three times AND on two
does not participate on at least
different days.
two different days.
NOTES:
* Credited means stating where the information came from (specific article, text, or
lesson). Examples: Our text discusses…. The information from our lesson states…,
Smith (2010) claimed that…, Mary Manners (personal communication, November 17,
2011)…. APA formatting is not required.
** Assigned readings are those listed on the syllabus or assignments page as
required reading. This may include text readings, required articles, or required
websites.
*** Scholarly source – per the APA Guidelines in Course Resources, only scholarly
sources should be used in assignments. These include peer reviewed publications,
government reports, or sources written by a professional or scholar in the field.
Wikipedia, Wikis, .com website or blogs should not be used as anyone can add to
these. For the discussions, reputable internet sources such as websites by government
agencies (URL ends in .gov) and respected organizations (often ends in .org) can be
counted as scholarly sources. Outside sources do not include assigned required
readings.

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