Determinants of Health

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What are the “determinants” of health? Discuss how the “determinants” of health impact on morbidity and mortality outcomes, using immunization as a public health measure as an example.

In society, there are many factors that influence an individual's overall health status, including social, biological and physical determinants. The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease. Access to free or low cost quality medical care is a fundamental human right, which significantly impacts on health outcomes. Despite medical advances, the majority of the world’s populations are denied this basic human right. Furthermore, public infrastructure programs such as water and sewerage treatment, access to public immunization programs, affordable medication, health promotion and preventative programs again are fundamental human rights, however economic reality dictates that these are generally only available to citizens of wealthy nations who are committed to the respect of human rights.

There are many health determinants, each influencing a person’s mortality and morbidity outcomes. The main determinants are biological health, the social and economic environment, physical environment, and individual attitudes, lifestyle choices and behaviors. In addition to all of these, there are social determinants of health which can impact a person’s overall health status, including stress, early life, ethnicity, gender, social exclusion, work, unemployment, social support, addiction, food, and transport. (Victorian Government 2011)

Variances are detected in the health status of groups according to a range of socioeconomic indicators. “The most disadvantaged groups have the poorest health and the highest exposure to health-damaging risk factors” (Victorian Government 2011). For example in Australia indigenous life expectancy for males is 11.5 years less than those of non-indigenous Australians, and for indigenous females it is 9.7 years lower than non-indigenous (ABS 2010). In a 2010 survey conducted by the Australian Bureau of Statistics, it showed that a high percentage of Indigenous Australians had little access to emergency services, police stations, school bus service, taxi services, and public swimming pools. (ABS 2010)

Lower socioeconomic communities commonly have poorer nutrition due to inability to afford fresh foods, less physical activity in leisure time, a higher prevalence of smoking, and more cases of alcohol abuse. These factors, along with less access to health information and promotion programs due to factors such as no internet access, transportation issues, motivation, intertwine to lead to poorer health outcomes. Therefore, it is clear that disadvantaged communities experience greater restrictions on ‘making healthy choices the easy choices’. (Marmot & Wilkinson 1999)

Being overweight due to lack of exercise and overeating can affect almost every determinant and aspect of health. Physical health is the one that is most clearly impacted, however the more subtle mental health implications can sometimes be overlooked. Obesity can contribute to poor self-image and self-esteem, lack of confidence, social anxiety and these factors can lead to social isolation, which then perpetuates the eating condition. The obese individual may comfort eat rather than risk perceived humiliation at their body size, and being overwhelmed by the challenge of exercising daily. The shame that may be experienced will further lead to comfort eating unless one is able to seek professional assistance to break the cycle. (Tuah 2011)

A food addiction can also affect work life, due to low energy levels leading to poor work performance, extra sick leave due to medical conditions from the obesity. Being overweight can affect morbidity and mortality outcomes, due to the high prevalence of high blood pressure, heart conditions, a higher risk of...
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