Appendix 2

The Determinants of Health¹³

A population health approach measures and analyzes the full spectrum of factors - and their interactions - known to influence and contribute to health. Commonly referred to as the determinants of health, these factors include social, economic, and physical environments; early childhood development; personal health practices; individual capacity and coping skills; human biology; and health services.

INCOME, INCOME DISTRIBUTION, AND SOCIAL STATUS. Research indicates that income and social status are the single most important determinants of health. Studies show that health status improves at each step up the income and social hierarchy. In addition, societies which are reasonably prosperous and have an equitable distribution of wealth have the healthiest populations, regardless of the amount they spend on health care.

SOCIAL SUPPORT NETWORKS. Better health is associated with support from families, friends, and communities. Some studies conclude that the health effect of social relationships may be as important as established risk factors such as smoking, obesity, high blood pressure, and a sedentary lifestyle.

EDUCATION. Health status improves with the level of education and literacy, including self-ratings of positive health or indicators of poor health such as activity limitation or lost work days. Education increases opportunities for income and job security, and provides people with a sense of control over life circumstances - key factors that influence health.

EMPLOYMENT AND WORKING CONDITIONS. People who have more control over their work circumstances and fewer stress-related demands on the job are healthier. Workplace hazards and injuries are significant causes of health problems. Moreover, unemployment is associated with poorer health.

SOCIAL ENVIRONMENTS. Societal values and rules affect the health and well-being of individuals and populations. Social stability, recognition of diversity, safety, good human relationships, and community cohesiveness provide a supportive social environment which mitigates risks to optimal health.

PHYSICAL ENVIRONMENT. Physical factors in the natural environment such as air, water, and soil quality are key influences on health. Factors in the human-built environment such as housing, workplace safety, community and road design are also important factors.

HEALTHY CHILD DEVELOPMENT. The effect of prenatal and early childhood experiences on health in later life, well-being, coping skills, and competence is very powerful. For example, a low birth weight links with health and social problems throughout the lifespan. In addition, mothers at each step up the income scale have children with higher birth weights, on average, than those on the step below.

PERSONAL HEALTH PRACTICES. Personal practices such as smoking, use of alcohol and other drugs, healthy eating, physical activity, and other behaviours, affect health and well-being. Many of Canada's most common health problems are linked to these practices.

INDIVIDUAL CAPACITY AND COPING SKILLS. Social environments that enable and support healthy choices and lifestyles, as well as people's knowledge, intentions, behaviours, and coping skills for dealing with life in healthy ways, are key influences on health.

BIOLOGY AND GENETIC ENDOWMENT. The basic biology and organic make-up of the human body are fundamental determinants of health. Inherited predispositions influence the ways individuals are affected by particular diseases or health challenges.

HEALTH SERVICES. Health services, especially those designed to maintain and promote health, prevent disease and injury, and restore health, contribute to population health.

GENDER. Refers to the many different roles, personality traits, attitudes, behaviours, relative powers, and influences which society assigns to the two sexes. Each gender has specific health issues or may be affected in different ways by the same issue.

CULTURE AND ETHNICITY. Come from both personal history and wider situational, social, political, geographic, and economic factors.

It is acknowledged that culture and gender have a cross-cutting, influential effect on all the other health determinants.

This list of health determinants may evolve as population health research reveals new insights related to the factors and conditions that influence and contribute to health.

 

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