DETERMINANTS OF

HEALTH
Submitted By -

Sourav Sarkar
4th Year B.Sc Nursing
Sri Krishna Rukmini College of Nursing
Bangalore - 43
INTRODUCTION -

• Health is influenced by many factors and it is

multidimensional phenomena.

• In addition to the physical, mental and social factors, health

is influenced by environmental factors, i.e. socioeconomic
conditions, cultural patters, the political system, behaviour
pattern and the health care delivery system.

• Health is determined within the individual as well as the

environment in which the person lives.
DEFINITION OF HEALTH –

“A state of complete physical, mental

and social well-being and not merely
the absence of disease or infirmity”
- WHO
DEFINITION OF HEALTH PROMOTION -
▪ Health promotion is a process of activating communities, is a
process of activating communities, policy makers, professionals and
the policy makers, professionals and the public in favor of health
supportive public in favor of health supportive policies, systems and
ways of living. policies, systems and ways of living.

▪ It is carried out through acts of advocacy empowerment of people

and building empowerment of people and building social support
systems that enable people social support systems that enable
people to make healthy choices and live healthy to make healthy
choices and live healthy lives.
DEFINITION -
Determinants of health include the range of personal, social,
economic, environmental factor which determine the health status of
the population.

• Health is multifactorial.

• 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 these interactions may be

health-promoting or deleterious.
DETERMINANTS -
BIOLOGICAL

ENVIRONME
OTHERS NTAL

DETERMIN BEHAVIOUR
GENDER ANTS AL

AGING OF
THE SOCIOECO
POPULATIO NOMIC
N

HEALTH
SERVICE
1. Biological Determinants

2. Environmental Determinants

3. Behavioural Determinants

4. Socioeconomic Determinants

5. Health Services

6. Aging of the Population

7. Gender

8. Other Factors
1. Biological Determinants -
• 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.

• The genetic make-up is unique in that it cannot be altered after conception.

• A number of diseases are now known to be of genetic origin,

e.g. chromosomal anomalies, errors of metabolism, mental retardation, Some
types of diabetes etc.

• The state of health, therefore depends partly on the genetic constitution of

man. Now a days, medical genetics offers hope for prevention and treatment
of a wide spectrum of diseases, thus the prospect of better medicine and
longer, healthier life . A vast field of knowledge has yet to be exploited. It plays
a particularly important role in genetic screening and gene therapy.
• Genetic makeup is unique which cannot be altered.

• Diseases like chromosomal anomalies, errors of

metabolism, some types of diabetes etc are genetic in
origin.

• From genetic point of view ,Health may be defined as “the

presence in the genetic constitution of the genes that
correspond to normal characterization and to presence of
normal genes.

• Medical genetics offers hope for prevention and

treatment of widespread of diseases.
 High blood pressure (hypertension)

is a major risk factor for coronary heart disease, stroke, heart

failure and kidney failure.

 It accounts for 8% of burden of disease in Australia Blood

pressure

 High blood cholesterol is a major risk factor for coronary heart

disease and ischemic stroke.

 High blood cholesterol is estimated to cause around 6 per

cent of the total burden of disease among Australians blood
cholesterol
BODY WEIGHT:

 World Health Organization (WHO) has labelled obesity a global

epidemic

 Being overweight or obese increases the risk of developing type 2

diabetes, cardiovascular disease, high blood pressure, certain
cancers, sleep apnea, osteoarthritis, psychological disorders and
social problems

 7.6 per cent of the total burden of disease Body weight

2. Behavioural and socio-cultural conditions -
• The term "lifestyle” is rather a diffuse concept often used to denote "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 processes of
socialization. Lifestyles are learnt through social interaction with parents, peer
groups , friends and siblings and through school and mass media.

• Many current-day health problem especially in the developed countries (e.g.

coronary heart disease, obesity, lung cancer drug addiction) are associated with
lifestyle changes.

• It may be noted that not all life style factors are harmful. There are many that
can actually promote health. Examples include adequate nutrition, enough
sleep , sufficient physical activity etc.
3. Environment
• It is an established fact that environment has a direct impact
on the those living in it.

• The environmental, physical, mental and social well-being of

factors range from housing, water supply, psychosocial stress
and family structure through social and economic support
systems to the organization of health and Social welfare
services in the community.
DEFORESTATION :

According to UN conference in 1992 deforestation is defined as “ Land

degradation in arid, semi-arid and sub-humid areas resulting from
various factors including climatic variation and human activities.”

1) Shifting cultivation.
2)Mining and Dams
3) Commercial Logging Deforestation also occurs due to overgrazing
and conversion of forest to pasture for domestic animals .
4) Expansion of agribusiness that grows oil palm , rubber, fruit trees and
ornamental plants has also resulted in deforestation.
5) Governmental sponsored programs that resettle landless farmers on
forested sites have contributed to deforestation all around the world.
6) Other reasons includes fire, pest, etc.
CONTROL OF DEFORESTATION
• Reforestation:- Many countries in the world have started
reforestation and forestry, and East Asian nations are
leading in this regard. Many East Asian countries, including
China, have successfully managed to reverse
deforestation.

• Legislation :- By making suitable changes in the law, so

that cutting trees in a forest will not only lead to
deforestation being controlled in a major way, but its flow
may also be reversed.
• Wildlife Sanctuaries :-
Sanctuaries are very important, not only to save
wildlife, but to save trees as well. Sanctuaries go a
long way in protecting all wildlife.

• Commercial Forest Plantations :-

There can be special forest plantations for all the
wood that is needed for the industry. This way the
wood can be cut in a controlled and regulated
environment.
• Cities :-
All cities, let alone new cities, have to be
managed properly. Their expansion has to be
curtailed or at least done in a systematic
manner, so that there is enough green cover,
and new trees are planted where ever possible.

Incentive to Corporate :-
Tax cuts should be granted to corporations, to
get them actively interested in reforestation.
• Water Management :-

Improper water management affects

deforestation in a big way. If the wildlife doesn't
have water, then the entire ecosystem will
falter. The construction of new dams should be
planned properly, so that any one area isn't
deprived of water, while another area has
abundance of it.
 AIR POLLUTION

❑ DEFINITION:
Air pollution defined as any atmospheric condition in
which certain substances are present in such
concentrations that they can produce undesirable
effects on man and his environment.
The main sources of air pollution are:

(a) AUTOMOBILES:

Motor vehicles are a major source of air pollution throughout the

urban areas.

They emit hydrocarbons, carbon monoxide, lead, nitrogen oxides

and particulate matter.

In strong sunlight, certain of these hydrocarbons and oxides of

nitrogen may be converted in the atmosphere into "photochemical"
pollutants of oxidizing nature.
(b) INDUSTRIES:
Combustion of fuel to generate heat and power produces smoke,
sulphur dioxide, nitrogen oxides and fly ash.

Petrochemical industries generate hydrogen fluoride, hydrochloric

acid and organic halides.

Many industries discharge carbon monoxide, carbon dioxide, ozone,

hydrogen sulphide and sulphur dioxide.

Industries discharge their wastes from high chimneys at high

temperature and high speed.
(c) DOMESTIC SOURCES:

Domestic combustion of coal, wood or oil is a major source of smoke,

dust, sulphur dioxide and nitrogen oxides.

(d) TOBACCO SMOKE:

▪ The most direct and important source of air pollution affecting the
health of many people .
▪ Even those who do not smoke may inhale the smoke produced by
others ("passive smoking").
(e) MISCELLANEOUS:

❑ These comprise burning refuse, incinerators, pesticide spraying,

natural sources (e.g., wind borne dust, fungi, mold, bacteria)
and nuclear energy programmes. All these contribute to air
pollution.
TYPES OF AIR POLLUTION :

Air pollution can be divided into:

 Indoor air pollution (domestic level)

• Indoor air pollution is one of the most critical

global environmental problems,
• probably exposes more people worldwide to
important air pollutants than does pollution in
outdoor air.
• Rural people in developing countries may receive
as much as two-thirds (2/3) of global exposure to
particulates.
OUTDOOR AIR POLLUTION

• Worldwide it is estimated that 1.3 million people -- more than

half of them in developing countries -- die every year from
urban outdoor air pollution.

• Urban outdoor air pollution is a major environmental health

problem affecting people in both developed and developing
countries

• significant decreases in lung function, inflammation and pain

when breathing. chronic bronchitis and emphysema, as well
as people with heart disease. Exposure can trigger asthma
attacks and cause wheezing, coughing, and respiratory
irritation in individuals with sensitive airways.
CONTROL OF AIR POLLUTION

• Control and prevention of air pollution WHO has recommended

the following procedures for the prevention and control of air
pollution:

• Approaches to reduce indoor air pollution

• Approaches to reduce indoor air pollution education and

advocacy approaches to reduce indoor air pollution
 WATER POLLUTION

DEFINITION –

Water pollution can be defined as presence of solid, liquid or gaseous

contaminants in such concentration that may alter the quality of
water.  Water pollution is defined as the addition to water of an
excess material or heat that is harmful to the living organism or which
impairs the beneficial use of water.
Causes of Water Pollution The principal
sources of water pollution resulting from
exploration and production operations are:

1. Domestic waste

2. Sewage System

3. Solid Waste

4. Industrial Waste

5. Acid Rain

6. Oil Industry
Control measures
1. Stabilization of ecosystem
• Reduction of waste at source
• Burying of organic waste
• Fish management
• Proper use of water

2. Sewage Treatment Plant

3. Ion Exchange Method

4. Reverse Osmosis
Purification Of Water

• Purification of is done by TWO ways:

1. Natural Methods
2. Artificial Methods

NATURAL METHODS

• Natural Method includes :-

 Aeration
 Sedimentation
 Sunlight
 Dilution
 Oxidation
 Plants & Animals (Aquatic)
A. Purification of Water on Large Scale

• At Large scale, it is done by Filtration, which may be

i. Slow sand filtration

ii. Rapid sand filtration
iii. Desalination

B. Purification of Water on Small Scale / Domestic Level

• At Small scale or Domestic level, is carried out by:

i. Boiling
ii. Chemical disinfection
iii. Filtration
A. Purification of Water on Large Scale

• The purpose of water treatment is to produce water that is safe &

wholesome.
• The method of treatment to use depends upon the nature of
raw water & the desired standards of water quality. Ex: Ground
water (wells & springs) may need no treatment other than
disinfection.
• Surface water ( e.g River water) which tends to be turbid &
polluted, require extensive treatment.
• The components of a typical water purification system comprise
one or more of the following measure.
Purification of Water on Large Scale
• A typical water supply carries the following steps in Purifying the
water: I. Storage II. Filtration III. Disinfection
B. PURIFICATION OF WATER ON SMALL SCALE OR
DOMESTIC LEVEL

● Boiling is a satisfactory method for destroying disease organisms in

water, and it is equally effective whether the water is clear or
cloudy, whether it is relatively pure or heavily contaminated with
organic matter. Boiling destroys all forms of disease organisms
usually encountered in water, whether they be bacteria, spores,
cercariae, cysts, or ova.
● Chemical Disinfection - Chlorine is a useful disinfectant for drinking
water, and is effective against the bacteria commonly associated
with water-borne disease.
● Filtration There are two types of filter commonly used in the
treatment of household water supplies: the sand filter, which is
relatively coarse, and the ceramic filter, which is of a finer texture.
SEWAGE DISPOSAL
Objectives:

 At the end of this presentation you will have the idea

about different methods of sewage disposal.

 You will certainly be familiar with dilution and land disposal

methods of sewage disposal.

 You will know what sewage sickness means.

SEWAGE SYSTEMS

On site systems Sewage or effluent systems

• Treats the sewage in a septic tank so that most of the sewage
becomes effluent and is disposed of in an area close to the house or
buildings.
• Example: A septic tank and leach drains

Sewage or effluent system

A sewage or wastewater system disposes of the effluent from a
community at a central place usually called a sewage lagoon or
effluent pond. The sewage can be treated:
• in a septic tank at each building
• just before the lagoon in a large septic tank or macerator system,
or in the lagoon itself
 HOUSING

 Housing “ in modern concept includes

 the physical structure providing shelter, as well as

 the immediate surroundings and the related community

services and facilities In the past it was called as Human
settlement which was defined as- all places in which a
group of people reside and pursue their life goals. But the
size of settlement varies from a single family to millions of
people.
 WHO expert group (1961) on public health
aspects of housing prefers to use the term
residential environment, which is defined as the
physical structure including all necessary services,
facilities, equipment and devices needed or
desired for the physical and mental health and
social well being of the family and individual.
 HOUSING STANDARDS

 Social and economic characteristics such as family income,

family size and composition, standard of living, lifestyle, stage in
life cycle, education and cultural factors are taken into account.

 Because of cultural diversity and other factors such as climate

and social traditions, standard of housing varies from country to
country and from region to region.

 In short-there cannot be rigid, uniform standards

 The standards in India are those recommended by the

EHC(1947)
4. Socio-economic conditions

• Socio-economic conditions have long been known to

influence human health.

• For the majority of the world's people, health status is

determined primarily by their level of socio-economic
development, e.g. per capita GNP, education, nutrition ,
employment, housing, the political system of the country
etc.
Those of major importance are -

(i) Economic status :

• The per capita GNP is the most widely accepted measure of

general economic performance. the economic status ne
purchasing power, standard of the living, quality of life.

• Family size and the pattern of disease and deviant behaviour in

the community. It is also an important factor in seeking health
care.

• Ironically , affluence may also be a contributory cause of illness as

exemplified by the high rates of coronary heart disease, diabetes
and obesity in the upper socio-economic groups.
(ii) 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 effects of poverty on health. Irrespective
of the availability of health facilities.
(iii) Occupation :
• The very state of being employed in productive work promotes
health, because the unemployed usually show a higher
incidence of ill health and death.

• For many, loss of work may mean loss of income and status. It
can cause psychological and social damage.
(iv) Political system :

• Health is also related to the country's political system . Decisions

concerning resource allocation.

• manpower policy, choice of technology and the degree to which

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.

• The percentage of GNP of Spent on health is a quantitative indicator

political commitment.
 FOOD HYGIENE
• Food is a potential source of infection and is liable to contamination by
microbes, at any point during its journey from the producer to the
consumer.

• Food hygiene may be defined as the sanitary science which aims to

produce food which is safe for the consumer and of good keeping
quality.

• It covers a wide field and includes the rearing, feeding, marketing and
slaughter of animals as well as the sanitation procedures designed to
prevent bacteria of human origin reaching food stuff.
• Food hygiene in its widest sense, implies hygiene in the production, handling,
distribution and serving.

• WHO (1984) has defined food hygiene as all conditions and measures that are
necessary during production, processing, storage, distribution and preparation of
food to ensure that it is safe, wholesome and fit for human consumption.

• The primary aim of food hygiene is to prevent food poisoning and other food
borne illness.
 Pasteurization
 Pasteurization is a relatively mild heat treatment, in which food is heated to
below 100ºC.

 In low acid foods (pH>4.5, for example milk) it is used to minimize the
hazards from pathogenic micro-organisms and to extend the shelf life of foods
for several days.

 In acidic foods (pH< 4.5, for example bottled fruit) it is used to extend the
shelf life for several months by destruction of pathogenic micro organism and
enzyme inactivation.

 In this method minimal changes are caused to sensory characteristics or

nutritive value.
Different Methods of Pasteurization
Low-temperature hold method (LTH):  conditions of 63oC for 30
min before cooled to 7oC

High-temperature short-time (HTST):  conditions of 71.5oC for at

least 15sec before cooled to 10oC

Ultrahigh-temperature (UHT):  138oC for at least 2 seconds

 Extreme pasteurization  kills all microorganisms  keeping milk in

a closed, sterile container at room temperature
5. Health services:

• 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.

• The purpose of health services is to improve the health

status of population.

• For example, immunization of children can influence the

incidence/prevalence of particular diseases . 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.
6. Aging of the population:

• By the year 2020, the world ill have more than one billion
people aged 60 and over, and more than two-thirds of them
living in developing countries.

• Although the elderly in many countries enjoy better health

than hitherto, a major concern of rapid population aging is
the increased prevalence of chronic diseases and disabilities,
both being conditions that tend to accompany the aging
process and deserve special attention.
7. Gender:
• The 1990s have witnessed an increased concentration
on women issues. In 1993, the Global Commission on
Women's Health was established.

• The commission drew up an agenda for action on

women's health covering nutrition , reproductive health,
the health consequences of violence, aging.

• Life style related conditions and the occupational

environment. It has brought about an increased
awareness among policy makers of women's health
issues and encourages their inclusion in all development
plans as a priority.
8. Other factors:
• We are witnessing the transition from post industrial age to an
information age and experiencing the early days of two
interconnected revolutions, in information and in communication.

• The development of these technologies offer tremendous

opportunities in providing an easy and instant access to medical
information once difficult to retrieve.

• It contributes to dissemination of information worldwide, serving the

needs of many physicians, health professionals, biomedical scientists
and researches, the mass media and the public.
CONCLUSION:

• The majority of factor that contribute to ill health and health

inequities lie outside the traditional mandate of the health
sector.

• The social determinants of health must health must be

considered within health programs and across government
polices in order to reach broader societal.

• Policy makers and bureaucrats must be held accountable for

reducing health inequities.
THANK YOU
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