A model of the determinants of health proposed by Evans and Stoddart�the health field model�provides a broad conceptual framework for considering the factors that influence health in a community (Evans and Stoddart, 1990). Unlike a biomedical model that views health as the absence of disease, the field model includes functional capacity and well-being as health outcomes of interest (see Figure 1). The model also emphasizes general factors that affect many diseases or the health of large segments of the population, rather than specific factors that account for small changes in health at the individual level. It takes a multidisciplinary approach, uniting biomedical sciences, public health, psychology, statistics and epidemiology, economics, sociology, education, and other disciplines. Social, environmental, economic, and genetic factors are seen as contributing to differences in health status and, therefore, as presenting opportunities to intervene.
Although this type of model is not an entirely new paradigm, its implications for designing health improvement programs deserve attention. For example, the way in which (health) behavior is understood fundamentally changes. Rather than a voluntary act amenable to direct intervention, behavior can be seen as an intermediate factor that is itself shaped by multiple forces, particularly the social and physical environments and genetic endowment. At the same time, behavior remains a relevant target for intervention. The model also differentiates among disease, health and function, and well-being. They are affected by separate but overlapping factors, and therefore, indicators selected to monitor health improvement programs may need to differ depending on which outcome is of primary interest. The model also reinforces the interrelatedness of many factors. Outcomes are the product of complex interactions of factors rather than of individual factors operating in isolation. It was suggested that the interactions among factors may prove to be more important that the actions of any single factor.
Each of the factors included in the model is considered briefly in turn. FIGURE 1: A model of the determinants of health. Reprinted from R.G. Evans and G.L. Stoddart, "Producing Health, Consuming Health Care," Social Science and Medicine," 31:1359, with permision from Elsevier Science Ltd, Kidlington, UK.
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