1. Pharmacy in Public Health: Determinants of Health Course, date, etc. info

2. Learning Outcomes Define health determinant in the context of an ecological framework Recognize that positive interactions result in health and negative interactions in disability or disease Identify health determinants Describe primary care and essential medications

3. Ecological Perspective Concerned with the environment surrounding the individual as well as the characteristics or behavior of the individual; the environment includes: – The social surroundings as well as physical surroundings of the community – State, national, and global environment

4. Environment surrounding the individual

5. Focus on Populations To describe the influence of the environment on health, the focus is on: – populations – comparing the health of a population in one set of environmental circumstances to a population in a different set of environmental circumstances

6. Indicators of Population Health Life expectancy Infant mortality Morbidity Mortality Median age

7. Life Expectancy and Infant Mortality Life expectancy is the average number of years that a person can expect to live at a given age, usually birth, based on current death rates. Infant mortality is the number of deaths of infants less than 1 year of age, calculated per 1000 births.

8. Life Expectancy and Infant Mortality Life expectancy and infant mortality are related – High infant mortality will result in low life expectancy from birth Examples: – Niger—infant mortality = 112.4; life expectancy = 56.9 years – Iceland—infant mortality = 2.9; life expectancy = 81.8 years

9. Morbidity Morbidity describes the level of disease in a population – May be expressed as a percentage of the population – e.g., 66% of the population are overweight or obese

10. Mortality Rate Mortality describes the number of people who die every year – Usually reported per 100,000 population – Usually standardized so that mortality rates can be compared across populations – Example—the mortality rate for cancer in Bolivia is 256 per 100,000 population and for Denmark, is 167 per 100,000 population

11. Median Age The age at which half the population is older and half younger – e.g. the median age for Guatemala is 18.2 (half the population is younger) – e.g. the median age for Italy is 42 (half the population is older)

13. Population measures of health, cont’d

14. Health Determinants The conditions or factors associated with health are known as health determinants. Depends on the interaction of the person with their environment – Positive interactions result in health or maintenance of health – Negative interactions result in disability and disease

15. Health Determinants Internal factors—characteristics of the individual – May be inherited or learned – May be physical, social, psychological, or behavioral External factors—characteristics of the community where the individual lives and works – May be physical, social, economic etc.

16. Framework for Describing Health Determinants

17. Individual Level Determinants of Health

18. Community Level Determinants of Health

19. Community Level Determinants of Health, cont’d

20. State and National Determinants of Health

21. Global Determinants of Health

22. Summary: Levels of Health Determinants

23. Roles for Pharmacists

24. Essential Medications

25. Summary Ecological framework Health determinant Levels of health determinants – Individual – Community – State and National – Global Pharmacists’ role in public health