Social and Behavioral Determinants of Health

What is Health?
o It is a state of complete physical, psychological and social
well being
o We are not just preventing bad things from happening
o Not only looking at bad things but making good things
happen
o Millions of people are in poor health, in the U.S diabetes
for example, big chunk of population has diabetes.
o CDC report that there are basically 5 factors that account
for pre-mature immortality
Defining the Problem?
o Defining health or disease, why does it matter how we
define health or disease?
If looking through singe lens we may miss something
o Who is responsible for fixing, it if obesity is individual
problem, is individual responsible for fixing it, dont worry
about lunch nutrition, how we define the problem will guide
us on how we approach it.
Example: What is Addiction?
o Conflicting views, whether addiction is a disease,
scientifically it is a disease, but a lot of people think of it as
will power, why did you start using drugs, is it a personal
problem, do we need to look at drug policies. How we
define it will tell us how we approach it.
Determinants of Health: What makes us Healthy (Or Not)?
o Most people think of do you have good doctor, good health
care this is what most people think of in terms of what
makes us health or not
o The U.S leads the world in medical research and health
care spending
o For how much we spend we should be a whole lot more
healthier, if health care makes us healthy the more we
spend on it we should get more out of it
o The two that are next to each other is Cuba and U.S the
cost ration is tremendously different, spend 4500 dollars
more than Cuba to get more life expectancy.
Life Expectancy vs. Spending
o Outlier is United States
o This tells that health care doesnt really have correlation to
health

Infant mortality another key indicatory of the health of a

population
o U.S still has high infant mortality.
What does this tell us?
o We shouldnt funnel more money in health care and focus
on the broader aspects to help everybody out if we
targeted them
o When we talk about population base the most impact we
want to touch the most amount of people with the simplest
approach, it doesnt take a lot, dont have to achieve huge
outcome on individual level to make change in population
level
o Looking at the opposite spectrum from health, how do we
define disease? It is not just accounted by individual
deviations, genetic mutation, or a birth defect or hormonal
problem; those things are not sole determinant of disease.
There are so many other things if they will have cancer or
not, to provide basis for understanding, a medical model
must taken account sever things.
o You cant move individual from environment if someone is
living in poverty, without access to health foods, this has to
be taken into account, we are not just looking at disease as
biological indicator, but looking at genetics and behavior as
well
Life expectancy
o 30 year life expectancy gain, about 25 years of those are
attributed to Population Health, instead of teaching people
how to filter water at their house, we figured out to devise
sanitation at the population level, figured out how to
deliver safe water at population level.
o The changing in terms of the leading cause of death were
and where the gains were coming from , a lot of beginning
gains was sanitation, as later and further on 60s, and 70s
this is where we get into chronic disease, smaller life
expectancy gains with time, most of the gains, are the
population based approaches
Determinants of Population Health
Estimated Deaths Attributable to Social Factors in the US-200
o Dont need to know the numbers
Why should public health professionals care about social and
behavioral determinants?
o We have to understand what factors are contributing to the
problem, and know what we are trying to stop, what are
the factors that need to be considered.

o One of the reason we see bad life expectancy in US is

lower income and minorities, we have huge problem with
inequality
IOM Recommendations (2014)
o The institute of Medicine develop system by changing
social determinants, do attribution analysis, after going
through process of which determinant to look at, listed on
the slide, these are things that they recommended to
become standard when doctor performs screening and
want them in electronic health records
Determinants of Health
o Chart Pie dont need to memorize this
HIV Example
o It is an infectious disease, in medical approach it is antivirals very biological based approach, that doesnt work
with HIV, first of all we dont have anything that cures HIV,
we have to look at other ways to prevent HIV, Agent Host
Environment, reading the slide, you can intervene on any
of those level to eradicate the problem
o We can though intervene on some of these other factors,
environment is interacting, TOP causing HIV, BOTTOM
how we can intervene
o We can indirectly get at HIV not directly
o Nothing biological has to be done to get at it
Tuberculosis
o Thinking about who is responsible for health problem,
whats the cause of TB is it a bacterium, or is the
bacterium, or is it the environment, what causes the
environment, infectious agent is not where it starts, its is
the back story where it starts, point of class is to figure out
the back story
Disparities of Health
o The Socioeconomic Determinant
One of the interesting thing here is that there is a
gradient of disease and death related to income,
each up take in salary you get a little uptake in
health
Income and Health
o Reason why economics is related to health, HS diplomas
vs. College Diplomas
5-Tier Pyramid CDC model, Framework for Public Health Action
o largest impact with smallest individual response needed
comes from base of pyramid
Combating HIV/AIDS in Uganda

o Good examples that have had huge impacts on HIV

o Religious leaders are important
o Social Marketing
Health Promotion: Lessons Learned
o Lessons from field, research underlying causes, read from
slide
o Key actors at every level are the individuals you want to
reach, the community membrs, involving stake holders
straight from slide
o Monitor and evaluate, if not working go back and change it
Conclusion
o It requires changing at every level, it doesnt mean
intervention has to take place at every level, but it needs
to account each level
o This will be posted on Blackboard, wont keep all slides,
combine it with key vocabulary. Not quizzed on vocab and
statistics.