Determinants of Health

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Determinants of health:
Are the conditions – and their distribution
among the population – that influence
individual and group differences in health
status. They are risk factors found in one's living
and working conditions (such as the
distribution of income, wealth influence, and
power), and individual factors (such as
behavioural risk factors or genetics) that
influence the risk for a disease, or vulnerability
to disease or injury.
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 The main determinants of health
Ecological Model
Takes into account the synergistic relationship of human behavior in their
environment at multiple levels

Dahlgren and Whitehead (1991)

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Determinants of health include:
• Socioeconomic, cultural and
environmental conditions
• Social and community networks
• Individual life styles and behaviours
• Human biology/ Genetics

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Income and social status

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Where can we apply public health
interventions on determinants of
health?

Source: Dahlgren and Whitehead

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 Applied if all are non-remediable
/un-controllable
factor applied if all are Controllable or remediable
factors

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 Health indicators

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 Health
determinants

? ?
Health status
Good Bad
Health Public health Health
Prevent Decision Prevent
Maintain Change
? ?
Keep Treat
Improve Intervene
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 Can health be measured?

How?

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Health indicator
• Indicator “indicare” which means to
announce
• “a piece of information which is part of a
specific management process, and has been
assigned a significance beyond its face value”

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Health indicator
• Health indicators are quantifiable
characteristics of a population which
researchers use as supporting evidence for
describing the health of a population

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Why we need health indictors?
Better
Information

Better
Decisions

Better
Health
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Health indicator
• Indicators can play an important role in
turning data into relevant information for
• decision-makers and the public. In particular,
they can help to simplify a complex

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• How health
indicators are
calculated?

Briggs et al
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Health indicators characteristics
• Can be measured uniformly nationally
and internationally
• Statistical validity
• Feasibility
• Can make changes

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 Types of health indicators
• General health status
• Specific disease
• Specific population
• Risk factors
• Health services/System
• Health economics

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 • Mortality: number of deaths (in general, or
due to a specific cause) in a population. “Crude
death rate”

Crude death rate.

Annual deaths / 1000
persons in year 2006
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Examples of types of health indicators

1. Mortality indicators
-crude death rate
-neonatal mortality rate
-infant mortality rate
-child mortality rate (under five mortality rate)
-maternal mortality rate
-proportional mortality rate
-case fatality rate
-cause specific mortality rate
-Life expectancy
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• Morbidity: is a diseased state, disability, or
poor health due to any cause. The existence of
any form of disease, or to the degree that the
health condition affects the patient

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2. Morbidity indicators
-Incidence and prevalence of specific diseases
-Notification rate: the number of cases of a specific
disease which have been diagnosed & notified to
authorities in one year divided by the total
population in the same year
-Hospital statistics: details of all admissions,
duration of admissions, readmissions, discharge
rates, outpatient appointments…etc
-Work or school absenteeism causes or diseases

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 Health measures
3. Disability indicators :
-Healthy Adjusted Life Expectancy (HALE): the
average number of healthy years an individual is
expected to live at birth (subtracting the years of
ill health from overall life expectancy)
-Quality Adjusted Life Year (QALY): the average
number of years an individual is expected to live
in perfect health (1 QALY= 1 year of life in
perfect health)

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• Years of Life Lost (YLL): the average years a
person would have lived if he or she had not
died prematurely. (Based on Mortality)

• Years Lived with Disability (YLD): the average

years a person would have lived with disability
due to a disease or certain health problem

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Health measures
• Disability-adjusted life year (DALY) is a measure
of overall disease burden, expressed as the
number of years lost due to ill-health, disability or
early death
• Developed by the World bank in 1990 and
adapted in 1996 by the WHO.
• DALYs are calculated by taking the sum of these
two components.

DALY = YLL + YLD

DALYs
Disability-adjusted life years out of
100,000 lost due to any cause in 2004

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4. Health behaviours/ habits/ risk factors :

• Smoking
• Physical activity
• Alcohol consumption
• Breast feeding

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5. Health care delivery indicators and services/ health
system:

• Number of hospital beds

• Number of doctors
• Number of Pharmacists
• Doctor-population Ratio
• Nurse-population ratio
• Population-bed Ratio

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6. Nutritional status indicators

• Maternal nutritional status for newborns

– Birth weight, length, & head circumference
• Nutritional status for pre-school children
– Weight: measures acute malnutrition
– Height: measures chronic malnutrition
– Mid-arm circumference: measures chronic
malnutrition
• Nutritional status for adults
– Underweight
– Obesity
– Anemia

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7. Health care utilization indicators, such as:
•Immunization coverage
8. Social & mental health Indicators, such as:
– Suicide
– Homicide
– Crimes
– Road traffic accident
– Domestic violence

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9. Environmental indicators:
– Air and water pollution
– Radiation
– Noise pollution

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10. socio-economic indicators:
-population growth rate
-per capita GNI (Gross National Income)
-dependency ratio defined as:
Number of people aged 0-14 plus people aged 65
and over/number of people aged 15-64
-literacy rates
-housing (household size and number of persons
per room)

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11. Health policy indicators
12. Quality of life indicators such as human
developmental index (HDI) that reflect life
expectancy at birth, mean years of schooling
and GNI per capita. Usually scaled from 0-1

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Health indicators resources
• WHO
• UNICEF
• Ministries of Health
• Gap minder
• Health Metrics Network

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