Determinants of (ill)health Dadi S Argadiredja dr, DTM&H, MPH
Determinants: - Environment - Life styles - Socio political organization. - Biologic
Environment factor • The role and significance of the environment as determinants of health changed over the past hundred year - Before industrial revolution war,nutrition > sanitation small cities- rare outbreaks - Industrial society housing become problem
- Before 18th centuries mortality gap < Pest, famine and war - Developing countries Air pollution,basic sanitation - Developed countries Man made env, indoor air pollution, building material on
soil (exp Radon) - Environment factors that affect health include the following: a. Life support food, water, air b. Physical factors Mechanical, Acoustical, Electrical, thermal, Ionizing, radiation c. Biologic factorsMicroorganism
toxins, biologic wastes,biologic antagonist (animal or plants), allergens - Psycho-social factors Crowding Demands, Physical time - Chemical factorsinorganic, or- ganic and Product complexes ( combustion product, Macromolecular
product, industrial waste, agriculture wastes including herbicides, pesti- cides and fertilizer) - Environmental field is full of hazards - Environmental complexity increasing as technology pro vide new product &process
- There is no save environment - Public policy will have to balan ce b/w economic and develop ment and optimally save env.
Life styles factor • Prominent factors: Smoking, licit & illicit drugs ( incl alcohol) ,exercise, diet, sexual practices - Major precursors of premature death 1980 USA 1) tobacco 2) overnutrition 3) alcohol 4)handgun 5)unintended pregnancies
- People who live alone higher mortality rates. - employed live longer - thin people live longer than fat - Life styles become more and more important. - Life styles and disease Diet coronary HD,stroke, Ca
Biologic factors - earlier centuries dominant deter minants (plague, leprosy, small-pox) - if environment and lifestyles im- prove role of biologic factor < - among biologic factors pathogenic microorganisms are important - genetic factor many research done.
- Gender . for Ca Mammae women > 100x than men. women live longer than men death due to motor vehicle and homicide men > women in underdeveloped countries wo men have higher mortality rate than men. In developed coun-
tries reverse according to Stein and Maine cause by discrimination,low -paying and hazardous occu pation - it is difficult to separate biolo gic factors from environment, lifestyle and organizational factor
Sociopolitical organizational factors - responsibility of government to intervene - organizational factors are plentiful impede effective delivery of needed services in preventive and therapeutic. Also preclude effective policy analyses and problem solving
at the state and community level - Poverty Low income people are consis- tently at a disadvantage. They have high rates of morbidi ty, mortality and dependency. Poverty and lack of education
affect the biologic dimension through malnutrition, Poverty has powerful impact on environment degrading quality of housing, increase risk of injuries,excessive crowding etc