Syllabus Content The determinants of health Individual factors eg. Knowledge and skills, attitudes, genetics Sociocultural factors eg. Family, peers, media, religion, culture Socioeconomic factors eg. Employment, education, income Environmental factors eg. Geographical location, access to health services and technology

The Determinants of Health Health determinants are the individual, socioeconomic, sociocultural and environmental factors that can have a positive or negative influence on the health of individuals or populations. Research has shown that health of individuals and communities is affected by a broad range of factors relating to the community, environment and social context in which people live, along with the health behaviours in which people adopt.

The Determinants of Health (cont.) Individual Factors Individual factors are those factors unique to each person that can determine their level of health. The include: Knowledge we have about health and the skills we possess that enable us to act in way to promote better health. Attitudes and values that we place on health and the importance of leading a healthy lifestyle Genetic factors that increase the likelihood we may experience particular health problems.

The Determinants of Health (cont.) Knowledge & Skills Knowledge and understandings that we develop about protective and health risk behaviours, health products and people available to support good health are an important influence on our ability to act in ways that contribute to good health. When we compare the level of education between highly educated people and poorly educated people in Australia, those with poorer education appear to suffer from chronic illness as well they are more likely to perceive their own health as fair or poor

Knowledge & Skills (cont.) The Determinants of Health (cont.) Knowledge & Skills (cont.) Health knowledge comes from a variety of sources – parents, siblings, peers, teachers, the internet and the media all of who play an important roll in conveying information to us. Previous experience can also contribute to what we know and understand about particular health problems, although having the knowledge does not always mean that people are willing to make healthy choices.

Knowledge & Skills (cont.) The Determinants of Health (cont.) Knowledge & Skills (cont.) Health literacy enables people to gain access to, understand and use information in ways that can promote or maintain good health. It also enables people to access the accuracy and reliability of information they may find.

The Determinants of Health (cont.) Attitudes Strong link between knowledge and attitudes, with a persons level of knowledge more likely to influence their attitudes they develop and the way they behave. Example someone who has a detailed understanding of the illnesses that are associated with tobacco smoking are more likely to be against tobacco smoking and not smoke themselves. The attitudes we develop are usually influenced by our family, peers, the media, education and the culture within our community.

The Determinants of Health (cont.) Attitudes (cont.) A person’s attitude towards health behaviours, their willingness to seek help and address any health concerns does play an important role in what they see as an important value that is placed on their health .

The Determinants of Health (cont.) Genetics Genetics refers to the characteristics, features or hereditary diseases that are genetically linked and are passed on within the family. There a number of genetic disorders, such muscular dystrophy and cystic fibrosis, which can lead to chronic ill health and a decreased life expectancy. These diseases can be caused by our genetic make up.

The Determinants of Health (cont.) Genetics (cont.) Down syndrome, which can affect a person’s physical development as well as intellectual functioning are the result of chromosomal abnormalities that can occur during pregnancy.

The Determinants of Health (cont.) Genetics (cont.) Our genetic make up can make us more susceptible to developing particular diseases such as breast cancer, asthma, heart disease and diabetes which have been linked to genetics. Genetic information that is passed on by our parents can be a positive influence on our health. These genes we inherit provide us with potential in terms of intellectual capacity, physical abilities and life expectancy. Example how fast we can run, how coordinated we are and how well suited we are to particular sports.

Sociocultural Factors The Determinants of Health (cont.) Sociocultural Factors Sociocultural factors: Relate to the society in which people live and the cultural practices and expectations that exist within these communities. Families, peers, media, religion and cultural group are the biggest influences on our level of health. Assumptions on how certain groups should look, think and behave can create pressure to conform that leads to risk taking.

The Determinants of Health (cont.) Family Research has shown that a person’s family and their home environment can significantly influence their health and well-being. Families are responsible for ensuring physical needs are meet such as food, safe housing, clothing and medical requirements, they also provide emotional support such as love and care.

The Determinants of Health (cont.) Family (cont.) Children living in situations of violence, abuse or neglect are at risk of immediate physical injury or emotional distress and are likely to suffer adverse consequences on their long term physical, emotional and social well-being Families who serve 3 meals a day which contain a variety of nutritious foods instill in their children the importance of healthy eating. Research has shown that children living with someone who smokes are more likely to take up smoking themselves.

The Determinants of Health (cont.) Family (cont.) Families are also an important source of information and support when people experience health related problems. They provide someone to talk to and gain advice off.

The Determinants of Health (cont.) Peers Peers have a powerful influence on the decisions people make relating to health and the type of behaviours they undertake. If peer groups share common interests and similar values it can be easier to make healthy choices e.g. being part of a peer group that enjoys being active and supports the participation of people regardless of their level of ability. This will help people feel comfortable and encourage them to join in.

The Determinants of Health (cont.) Peers (cont.) Making healthy choices can be difficult when the peer group is not supportive or when the values are held by those in the group differ from those held by the individual. Example, it can be difficult to maintain a decision not to drink alcohol if you attend a party where everyone else is drinking and you are commonly offered a drink or questioned about why you are not drinking.

The Determinants of Health (cont.) Media The media can have a powerful influence on a person’s opinions, beliefs and habits. The media is seen as a social cultural determinant of health. Electronic media such as TV, movies, internet, newspapers and magazines play an important role in spreading information about health e.g. skin cancer and domestic violence. It has the ability to raise awareness and enhances peoples understanding on a particular issue.

The Determinants of Health (cont.) Media (cont.) Information that is given by the media needs to ensure it is accurate, fair and balanced, as bias or inaccuracies can lead to misconceptions and confusion that can endanger someone's health. Research has shown that media images glamourising drug use can have a significant influence on a person’s attitude towards that drug and the likelihood they will use the drug. Example includes in the movies that associate smoking with positive personal qualities such as popularity, success and being cool.

The Determinants of Health (cont.) Media (cont.) Images conveyed through the media can also have a significant impact on expectations that society forms and the risk behaviours that result from these expectations. Males driving fast cars at high speeds, all night drinking sessions these images can lead to immediate long term health harms. The constant portrayal of images of people who are tanned, attractive and slim can contribute to what society sees as being the ideal body shape.

The Determinants of Health (cont.) Media (cont.) The media can assist to shift societies attitudes about particular health behaviours. Health promotion campaigns on TV and radio, such as those about drink driving, binge drinking are frequently used to raise awareness of these issues. They also act to reduce mortality and morbidity rates.

Religion The Determinants of Health (cont.) Religious beliefs are another sociocultural factor that can influence a person’s health decisions and behaviours. Beliefs relating to food, sexual activity and drug use are examples where religious faith can affect a person’s lifestyle choices. Some religious beliefs do not believe in sexual activity before marriage.

The Determinants of Health (cont.) Religion (cont.) Muslims, Seventh day Adventists and Buddhists forbid or discourage the consumption of alcohol, meaning that the risk of suffering health problems related to alcohol is reduced for people who adhere to these beliefs.

The Determinants of Health (cont.) Religion (cont.) Religion also has the ability to govern what foods can and cannot be consumed, based on religious belief. Having a strong religious faith can also benefit a person’s spiritual health and well-being, by adding meaning to their life, creating a sense of hope and optimism and providing support during times of adversity.

Culture The Determinants of Health (cont.) Culture can simply be described as ‘patterns of human activity including the values and knowledge shared by society’ Australia is often described as a multicultural society, referring to our diverse ethnic and cultural backgrounds Different cultural groups practice different eating patterns, daily rituals, religious patterns of physical activity, gender roles, patterns of employment, ways of communicating, family structures etc

The Determinants of Health (cont.) Culture (cont.) According to Australian Health 2008, the death and hospitalisation rates for people born overseas who migrated to Australia are generally lower than those people born here. Rates of disability and lifestyle related risk factors are also lower. Diet is a major contributing factor, with many migrant groups eating their traditional foods which often consist of highly nutritious, fresh foods. Example most Asian diets, consist of low fat foods such as rice, lean meats and vegetables.

The Determinants of Health (cont.) Culture (cont.) Language difficulties can be a barrier for cultures in terms of health. In terms of the Australian health cared system, a lack of fluency in English or cultural insensitivities can prevent or make it difficult for migrants to access the appropriate health care.

The Determinants of Health (cont.) Culture (cont.) Attitudes and beliefs about PA can restricts the level of participation in PA, particularly by women and girls. A survey in 2002 found that rates of participation in sports and PA were significantly lower in those born in a non-English speaking country compared to those born in Australia. Being an ATSI descent also had a significant influence on health. Indigenous people experience much poorer health than other Australians.

Socioeconomic Factors The Determinants of Health (cont.) Socioeconomic Factors Socioeconomic factors relate to a persons level of income, education and employment. Low socioeconomic status (low SES) has a detrimental influence on health in terms of poor health and disability, this affects education and employment opportunities. Education, income and employment are closely interrelated. Higher education usually leads to a higher paying job. A higher income also increases access to health services.

The Determinants of Health (cont.)

Employment The Determinants of Health (cont.) An individuals pattern of employment, including unemployment, is a major component of lifestyle. Reports have indicated that mortality rates are 50% higher for unemployed Australians than for those who are employed. Employment provides opportunities to be active, interactive with others and feel a sense of control over our lives, as well as ensuring financial security.

The Determinants of Health (cont.) Employment (cont.) Unemployment has been linked to a loss of confidence, limited social contract, feelings of depression, this can affect a person emotional and social health. Types of occupation can also determine health; such as manual jobs, trades and transport, which have higher rates of death and injury than clerical, managerial or professional occupations. The later group will be less physically active at work.

The Determinants of Health (cont.) Education Higher levels of education contribute to better health status for individuals and their families. Generally related to higher incomes and better employment opportunities. Education also provides people with greater knowledge and skills for accessing health services, facilities and information.

Income Income is closely related to education and occupation The Determinants of Health (cont.) Income Income is closely related to education and occupation Higher income provides access to better quality goods and services to support health. Examples include better housing, food health services and preventative health. Financial security can lead to greater sense of control over work and life that contributes to higher self esteem and emotional well being.

Environmental Factors The Determinants of Health (cont.) Environmental Factors Environmental factors are those things present in the environment in which people live and work that can affect their health in a positive or negative way. Factors that relate to environmental factors are; where you live, quality of air, food, water available, climate conditions. Poor building design, increasing level of pollution and climate change all contribute to poor health.

The Determinants of Health (cont.) Geographic Location Rural: defined by the Australian Bureau of Statics as populations between 5000 and 99 000. Remote: have populations of less than 5000 People living in rural and remote parts of Australia have poorer health outcomes than people living in major cities.

Geographic Location (cont.) The Determinants of Health (cont.) Geographic Location (cont.) People living in rural and remote areas normally have to drive long distances which can lead to accidents caused by speed, fatigue, animals on the road etc. They are also more likely to face harsh living and working conditions and experience severe climatic conditions such as extreme heat, drought and floods which can have a negative impact on both physical and emotional health. The remoteness of communities and the distance between people may make it harder to create or maintain social support. This may lead to poorer mental health and depression.

Geographic Location (cont.) The Determinants of Health (cont.) Geographic Location (cont.) Indigenous Australians make up a significant proportion of the population living in rural and remote areas. Current statistics estimate 24% of indigenous people live in remote areas, while 45% are in isolated areas. There a number issues that relate to Aboriginals who live in remote areas these include: disease outbreaks, contaminated water, and overcrowding. These factors contributing to ill health

Geographic Location (cont.) The Determinants of Health (cont.) Geographic Location (cont.) Living in cities and large built up areas may also have an affect a person health. High levels of air pollution, more motor vehicles and industrial complexes. Poor air quality resulting from the production and release of poisonous emissions from vehicles and heavy industry increases the risk of respiratory infections, asthma, bronchitis and CVD conditions. Traffic congestion can contribute to high levels of stress as motorists can become angry and frustrated, this also increase the chance of crashes.

Access to Health Services The Determinants of Health (cont.) Access to Health Services Some groups within the community may have difficulty accessing, understanding or using information about health.

Access to Health Services (cont.) The Determinants of Health (cont.) Access to Health Services (cont.) People who are geographically isolated have less access to health care and specialist treatment services. A range of health care options in rural and remote areas is less than in urban areas, such as access to screening programs and support groups, alternative health professionals (eg. Chiropractor, acupuncturist) and specialist treatment services.

Some people may have to wait longer for health care or travel long distances to receive the necessary health care. Those with ongoing conditions may be required to be away from home for long periods of time while undergoing treatment, result in distress and financial hardship.

Access to Health Services (cont.) The Determinants of Health (cont.) Access to Health Services (cont.) People from non-English speaking backgrounds may not assimilate new information as quickly as native English speakers. Studies have shown that certain people from some non-English speaking backgrounds are not as informed about risky health behaviours as their English speaking counter parts (eg. in some places smoking is seen as the norm so the are not aware of the health and social problems associated with smoking)

Access to Health Services (cont.) The Determinants of Health (cont.) Access to Health Services (cont.) People living in major cities can also experience difficulties accessing health care, especially those relying on the public transport system. Highly populated areas can have insufficient hospital beds available or long periods waiting to be treated.

Those without private health needing non-essential (eg Those without private health needing non-essential (eg. knee replacements) procedures may have a lengthy waiting period. Some health care treatment is not covered or only partially covered by Medicare, meaning not everyone can afford equal health care.

The Determinants of Health (cont.) Access to Technology Increasing use of technology, such as computers, mobile phones and electronic games, has impacted significantly on people’s health, particularly the health of young people. Studies have found that young people spend significant amounts of time involved in small screen recreation (watching TV, playing computer games, using the internet, etc) often at the expense of physical activity. Excessive small screen recreations are associated with increased risk of overweight and obesity.

Access to Technology (cont.) The Determinants of Health (cont.) Access to Technology (cont.) Advances in technology have helped address some problems associated with living in rural and remote areas. The internet allows people to access accurate health information and allows health professionals in rural and remote areas to keep up to date with the latest research and advances. Email, social network sites, skype, etc have reduced people’s sense of isolation by allowing them to keep in touch. This technology also allows doctors in rural and remote areas quickly and easily communicate with patients and consult with health care providers/specialists in different locations., which can reduce travel time.

Access to Technology (cont.) The Determinants of Health (cont.) Access to Technology (cont.) Scanners and digital imaging technology allows images to be sent to specialists in urban areas and reduces the amount of time the patient is required to spend away from family and work. Mobile phone technology and coverage has improved meaning a reduced time to get medical help or assistance.

Access to Technology (cont.) The Determinants of Health (cont.) Access to Technology (cont.) A number of difficulties still exist that limit or prevent the effective use of technology to support people’s health, such as: Lack of infrastructure in rural and remote areas can restrict access to fast and reliable technology The cost of purchasing a mobile phone or computer, software and connection fees (people living in rural and remote areas statistically have a lower income than those in major cities). Computer illiteracy and reduced access to support services such as technical support and repairs.

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Questions Create a mind map to help remember the Determinants of health. Environmental factors can greatly influence an individual’s health. Investigate why not all people have equal opportunities to achieve and maintain optimal levels of health and physical activity. Investigate how the determinants of health explain why some individuals and groups have better or worse health than others.