Health is multi factorial. The factors which influence health lie both within the individual and externally in the society in which we live. It is a truism to mention that what man is and to what diseases he may fall victim depends on a mixture of two sets of things his genetic factors and the environmental factors to which he is exposed. These factors interact and these interactions could also be health promoting or deleterious. Thus, conceptually, the health of individuals and whole communities may be considered to be the result of many interactions.Today we will be exploring various determinants of health
1. Biological determinants
The physical and mental traits of each person are to some extent determined by the character of his genes at the instant of conception. The genetic make-up is exclusive therein it can’t be altered after conception. A number of diseases are now known to be of genetic origin, e.g. chromosomal anomalies, errors of metabolism, retardation , some sorts of diabetes, etc. The state of health, therefore, depends partly on the genotype of man. Nowadays, medical genetics offers hope for prevention and treatment of a wide spectrum of diseases, thus the prospect of better medicine and longer, healthier life. The “positive health” advocated by WHO implies that an individual should be ready to express as completely as possible the potentialities of his genetic heritage. This is possible only the person is allowed to measure in healthy relationship together with his environment an environment that transforms genetic potentialities into phenotypic realities.It is considered as one of the vital determinants of health.
2. Behavioral and socio-cultural conditions
The term “lifestyle” is quite a diffuse concept often wont to denote “the way people live”, reflecting an entire range of social values, attitudes and activities. It is composed of cultural and behavioral 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 thru school and mass media. Health requires the promotion of healthy lifestyle. Many current-day health problems especially within the developed countries (e.g., coronary heart condition , obesity, carcinoma , drug addiction} are related to lifestyle changes. In developing countries where traditional lifestyles still persist, risks of illness and death are connected with lack of sanitation, poor nutrition, personal hygiene, elementary human habits, customs and cultural patterns. It may be noted that not all lifestyle factors are harmful. There are many that can actually promote health. Examples include adequate nutrition, enough sleep, sufficient physical activity, etc. In short, the achievement of optimum health demands adoption of healthy lifestyles. Health is both a consequence of a person’s lifestyle and an element in determining it.
3. Environment
Yet considered as major determinants of health ,It was Hippocrates who first related disease to environment, e.g., climate, water, air, etc. Environment is classified as “internal” and “external”. The internal environment of man pertains to “each and each part , every tissue, organ and organ system and their harmonious functioning within the system”. Internal environment is the domain of internal medicine. The external or macro-environment consists of these things to which man is exposed after conception. It is defined as “all that which is external to the individual human host”. It are often divided into physical, biological and psychosocial components, any or all of which may affect the health of man and his susceptibility to illness. Some epidemiologists have used the term “micro-environment” (or domestic environment) to non-public environment which incorporates the individual’s way of living and lifestyle, e.g. eating habits, other personal habits (e.g., smoking or drinking), use of drugs, etc. It is also customary to speak about occupational environment, socio-economic environment and moral environment. It is a longtime incontrovertible fact that environment features a direct impact on the physical, mental and social well-being of these living in it. The environmental factors range from housing, water system , psychosocial stress and family structure through social and economic support systems, to the organization of health and welfare services within the community. If the environment is favorable to the individual, he can fill use of his physical and mental capabilities. Protection and promotion of family and environmental health is one among the main issues within the world today.
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 (ii) Education (iii) Occupation (iv) Political system
5. Health services
The term health and family welfare services cover a good spectrum of private and community services for treatment of disease, prevention of illness and promotion of health. The purpose of health services is to enhance 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. To be effective, the health services must reach the social periphery, equitably distributed, accessible at a price the country and community can afford, and socially acceptable. All these are ingredients of what is now termed “primary health care”, which is seen as the way to better health. Health services also can be seen as essential for social and economic development. It is well to remind ourselves that “health care doesn’t produce good health”.
6. Ageing of the population
By the year 2020, the planet will have quite one billion people aged 60 and over, and quite 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 ageing is the increased prevalence of chronic diseases and disabilities, both being conditions that tend to accompany the ageing process and deserve special attention.
- Gender
The 1990s have witnessed an increased concentration on women’s 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, ageing, lifestyle 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.
Besides this there also many other factors that affect health directly or indirectly concluding the determinants of health.
Chief Editor, Nepal Health Magazine.
Early-career Public health professional
“A true believer of Prevention is better than Cure”