Determinants of Health
Health does not exist in isolation. The factors, which influence health, lie both within the individual and externally in the society in which he or she lives. These factors interact and the result of these interactions may be health promoting or deleterious. Thus, the health of individuals and whole communities may be the result of much such interaction. Some of the important determinants of health are discussed below:
Determinants of Health
1. Hereditary
The physical and mental traits of every human being are to some extent determined by the nature of his genes at the moment of conception. This genetic makeup is unique, that it cannot be altered after conception. A number of diseases are considered as genetic disorder e.g. chromosomal anomalies, sickle cell anaemia, hemophilia, errors of metabolism, mental retardation, some types of diabetes, etc. The state of health therefore depends on the genetic constitution of man.
2. Environment
It was Hippocrates who first related disease to environment e.g., climate, water, food, air, etc. Centuries later Pettenkofer in Germany revived the concepts of disease- environment association.
The external environment consists of those things to which the man is exposed after conception. It is defined as “all that which is external to the individual human host”. It can be divided into physical, biological and psychosocial components, any or all of which can affect the health of man and his susceptibility to illness. It has a direct impact on the physical, mental and social well being of those living in it. If the environment is favourable to the individual he can make full use of is physical and mental capabilities.
3. Lifestyle
The term lifestyle implies ‘the way people live’, reflecting a whole range of social values, attitudes and activities. It is composed of cultural and behavioural patterns and lifelong personal habits (e.g. smoking, alcoholism) that have developed through the process of socialization. Lifestyle is learnt through social interactions with parents, peer groups, friends, siblings, and through school and mass media.
Health requires the promotion of healthy lifestyles; examples include adequate nutrition, enough sleep, sufficient physical activity etc. Health is both a consequence of an individual’s lifestyle and the factors determining it. Many current day health problems specially in the developed countries (e.g. coronary heart disease, obesity, lung cancer, drug addiction) are associated with lifestyle changes. India is going through the dual burden where, on one hand, there are problems related to undernutrition, while on the other hand there is problem of excess. In developing countries the risk of illness and death are connected with lack of sanitation, poor nutrition, personal hygiene, elementary human habits, customs and cultural practices. In short, the achievement of optimum health demands adoption of healthy lifestyle.
4. Socio-Economic Conditions
It has long been known that social economic conditions influence human health some of the important factors which determine the socio-economic conditions are:
a) Economic Status
The per capita GNP is the most widely accepted measure of general economic performance. The economic status determines the purchasing power, standard of living, quality of life, size of the family and the pattern of disease and deviant behaviour inthe community. It is also an important factor in seeking healthcare. Ironically, affluence may also be a contributory factor of illness as exemplified by the high rates of coronary heart disease, diabetes and obesity in the upper socio-economic groups.
b) Education
A second major factor influencing health status is education (especially female education). The world map of illiteracy closely coincides with the maps of poverty, malnutrition, ill health, high infant and child mortality rates. Studies indicate that education to some extent compensates the effect of poverty and health irrespective of the availability of health facilities. In India, Kerala is an example, Kerala has an estimated infant mortality rate of 10 compare to 34 for all India in 2016 (www.niti.gov.in) and major factor is the highest female literacy rate of 93.91% compared to 62.98% of all India.
c) Occupation
Unemployment shows a higher incidence of ill health and death. For many, loss of work does not only mean loss of income and status, but psychological and social damages also.
d) Political System
Health is also related to country’s political system. Often the main obstacle to the implementation of health technologies is not technical, but rather political. Recessions concerning resource allocation, manpower policy, choice of technology and the degree to which the health services are made available and accessible to different segments of the society are examples of the manner in which the political system can shape community health services.
e) Health Services
The purpose of health services is to improve the health status of population. The term Health and Family Welfare services cover a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health. Immunization of children can influence the incidence/ prevalence of a particular disease. Provision of safe water can prevent mortality and morbidity from water-borne diseases. The care of pregnant women and children would contribute to the reduction of maternal and child morbidity and mortality. All these are ingredients of what is now termed as ‘Primary Health Care’, which is seen as the way to better health.
f) Other factors
Other factors which influence the health of populations are beside the formal healthcare system. This would include opportunities, increase wages, prepared medical programmes and family support system. In brief, medicine is not the only contributor to the health and well-being of populations. The contribution of inter-sectoral programmes to the health of communities is increasingly recognised.