1. A complex web of factors jointly determine the health status of human populations Determinants of Health

2. Social Determinants of Health Social determinants of health are the economic and social conditions under which people live which determine their health. Virtually all major diseases are primarily determined by a network of interacting exposures that increase or decrease the risk for the disease.

3. Each disease is a complex string of causative factors Example: Based in poverty and ignorance, intermediate causative factors such as unsafe water supply and insufficient food supply can result in poliovirus transmission through contaminated water, and lack of immunity to a child without vaccination results in infection, and subsequent paralysis

4. World Health Organization (WHO) Definitions of Health Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (1948) Health permits a socially and economically productive life.

5. Health Determinants Genetic Socio-economic –Access to adequate clean water, quality and quantity of food, sanitation, adequate housing –Access to education Psychosocial –Gender equality –Emotional support and nurture, safety –Cultural acceptance Environmental - presence and absence of factors National and regional infrastructure in electrification, communications, IT, sewage disposal, employment, transportation Health services access, quality, affordability of treatments, preventions and screening Health Promotion

6. Socio-economic determinants Working Definition of poverty: Lack of income, Lack of access to high quality nutrition Ignorance, Ill health, Disempowerment, Gender issues and Vulnerability

7. Measurements of economic levels of nations GDP (Gross Domestic Product)/capita : value of all goods and services produced in a country by nationals and foreign residents during one year divided by the mid year resident population of that year. GNP (Gross National Product)/capita : value of all goods and services produced in a country by the nationals in a country plus the income of nationals earned abroad divided by the mid year resident population of that year.

8. Food Macronutrients: Calories, Fat, Protein Minimum dietary energy needs for an adult is 1500 kcal per day ( ½ kg of rice, maize or wheat or 1½ kg of potato or cassava) or 3000 kcal for those doing manual labor, or in extreme cold. Micronutrients: Vitamins and Minerals Basket of cassava

9. Food Supply World food production can support 7 billion (about 2010) but more equitable distribution is needed for all to have food security As the income of countries increases diet changes from starchy cereals and root crops to low fiber, higher fat, sugar and animal product diets. Guatemalan Family, food for a week

10. 5 yr Child Survival Children are at there most vulnerable at 6 months when new food is introduced, the nutrient density needs to be high as their stomachs are small. They are exposed to new microbes, and are susceptible to infections 6 months to 5 years are the most vulnerable times

12. Water Minimum 5 liters safe water /person/day Water for drinking, food preparations, washing, cleaning In disasters, 20 liters per person per day prevents water borne disease One of the key elements of health Microbes, time and work to fetch water by women 1/5 of the world’s population (1.3 billion) do not have access to safe water Rawanda 2008

13. Water pump, Ghana

14. Sanitation Feces is a major route of transmission of communicable diseases 40% of the world (2.5 billion people) do not have sanitation Sanitation needs to protect from fecal contamination and insects from breeding on the excreta Using limited energy and water in resource poor environments Toilets in Herat, Afghanistan

15. Thembisa Township, Guateng South Africa

16. Housing 1.6 billion have precarious housing conditions failing to protect against elements, violence or theft 48% of the world is urbanized, more urbanization in higher income countries (78% in 2002 in high income countries) Soweto South Africa new housing 2008

17. Occupation Urban sector unemployment can be 50% in low income countries, as low as 5% in Japan and Luxemborg Informal sector to survive Occupational hazards and health risks Street market, South Africa

18. Unemployment as % of population, Forbes Management

19. Air Pollution Air pollution kills 3 million people/year. 90% in low and middle income countries. 50% from indoor pollution in rural areas of low income countries, particularly women. and girls involved in cooking. Outdoor pollution increases with industrialization. Andes, Peru Non-ventilated coking indoors with Llama dung

20. Other Environmental Determinants Traffic Global warming & climate change Acid rain Natural Disasters Environmental effects of energy sources such as hydroelectric power stations Waste disposal, toxic, radioactive waste Dam on the Yellow River, China

21. BEHAVIOR Individual handling of food and water before eating Tobacco: 1 billion smokers, 4% of global burden of disease. Smoking has decreased in high income countries, and increased in low and middle income countries over 20 years. Alcohol: Acute effects on traffic accidents and domestic violence. Long term effects alcohol dependency, liver disease. 4% of global burden of disease. Illegal drugs: VIOLENCE Sex: Unsafe sex accounts for 6% of global burden of disease, HIV major contributor Traffic: risk of fatal accident highest in densely populated urban middle income countries—roads condition, adequacy, vehicle condition

22. Gender Equity Women are at risk for maternal morbidity and mortality Women are marginalized, paid less, less often educated and do more work Women are subject to domestic violence and systematic discrimination

23. Health Services Access and utilization of health care varies jointly with the other determinants of health in most parts of the world Health services includes medical services (curative services for the sick), preventative and rehabilitative services. Quality, equality of quality Access by physical proximity and affordability to health services