219 terms

Determinants of health


Terms in this set (...)

What is a determinant of health?
-Factors that combine together to affect the health of individuals and communities
examples include:
-Social status
-Social support networks
-Employment/working conditions
-Social environment
-Physical environment
-Personal health practices
-Coping skills
-Health services
-Healthy child development
what populations are effected by determinants of health?
Those in the north who do not have easy access to hospitals
what is stress?
-Our mental and physical responses to the demands placed upon us.
-can provide opportunities for personal growth and lead to personal satisfaction
can stress be positive or negative?
It can be either depending on how we chose to look at the situation. stress can be positive (eustress) or negative (distress), and our response to it can be either positive or negative.
transtheoretical model: stages of change
1) precontemplation
-no intention of changing.
2) contemplation
-recognize they need to change.
3) preparation
-close to taking action, what can they do to move into action phase.
4) action
-actually make the change.
5) maintenance
-requires vigilance, attention to detail, and long term commitment.
6) termination
-new behaviour has become an essential part of daily living.
what are the principals of medicare?
Public Administration: plans must be operated by a public (government) agency.

Comprehensiveness: all medically necessary medical and hospital services must be covered.

Universality: All insured residents are entitled to the same level of health care. entire population must be covered.

Portability: benefits must be portable from province to province.

Accessibility: All insured persons have reasonable access to health care facilities. In addition, all physicians, hospitals, etc, must be provided reasonable compensation for the services they provide.(in practice, no user fees)
dimensions of health and wellness
levels of prevention
-primary prevention
actions designed to stop health problems before they start
-secondary prevention
intervention early in the development of a health problem to reduce symptoms or to halt its progression
-tertiary prevention
treatment or rehabilitation efforts aimed at limiting the effects of a disease
super smart
Adjustable (or Attainable)
decision making
D Decide in advance what the problem is.
E Explore the alternatives.
C Consider the consequences.
I Identify your values.
D Decide and take action.
E Evaluate the consequences
factors influencing behaviour change
Predisposing factors:
e.g., sex, race, income, family education
Enabling factors:
e.g., skills; abilities; and physical, emotional and mental capabilities
Reinforcing factors
e.g., support and encouragement from significant others
access to health care is influenced by
The supply of providers
The supply of facilities
The person's health status
His or her geographical location
a social and economic order that encourages the purchase of goods and services in ever-greater amounts.
traditional (allopathic medicine)
-include primary care practitioners, registered nurses, nurse practitioners.
non traditional (non allopathic medicine)
Chiropractic Treatment
Massage Therapy
Acupuncture and Acupressure
Herbalists and Homeopaths
population health
-Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services.

-Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups.
public health agency of canada
aims for prevention and promotion to health protection, diagnosis, treatment and care -- and integrates and balances action between them.
model to improve health (3 questions)
1. on WHAT should we take action?
2. HOW should we take action?
3. WITH WHOM should we act?
what is public health?
-the science and art of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention.
-helps improve the health and well being of people in local communities and around the globe.
-works to prevent health problems before they occur
5 key functions of public health
-Health Promotion
-Disease Prevention
-Health Protection
-Population Health Assessment
an integrator?
-an entity that works to achieve improvements in health and well-being for an entire population in a specific geographic area.
-Promote prevention,
-Improve health and well-being
-Improve quality and reduce health care costs
health equity
implies that ideally everyone could attain their full health potential and that no one should be disadvantaged from achieving this potential because of their social position or other socially determined circumstance.
several broad catagories of DOH
-Policy making
-Social factors
-Health services
-Individual behaviour
-Biology and genetics (unmodifiable)
biological determinants of health
Biological factors that determine health may be classified as either endogenous or exogenous.
Include genetic heritage and immunity that is passively acquired from maternal antibodies passed across the placenta or transmitted in maternal milk. Genetic heritage is determined largely by responses to biological and physical environmental challenges to which human ancestors were exposed.
Exogenous biological determinants of health are the other living things with which humans interact. The most important are microorganisms; also significant are larger organisms that carry them.
sickle cell
-good example of a common genetic determinant of health
Examples of biological and genetic social determinants of health include
-HIV status
-Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
-Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
-Family history of heart disease
cardiovascular disease
-leading cause of death worldwide
-death rates are declining
-80% can be prevented through healthy diet, physical activity, avoiding tobacco, maintaining weight.
cardiovascular disease: risks you CANT control
cardiovascular disease risk factors: woman
premenopausal: unlikely unless there are risk factors like:
-high blood pressure
-kidney disease
-genetic predisposition to high cholesterol
-family history
-oral contraceptive use
post menopause: risk rises rapidly
type 1 diabetes
autoimmune disease that destroys the cells that make insulin
type 2 diabetes
-insulin production is deficient or the body is unable to utilize all the available insulin
-90-95% of all diabetes cases
-linked to obesity and physical inactivity
gestational diabetes
develops during pregnancy but may predispose to later type 2 diabetes.
risk factors of diabetes
-Mothers of babies weighing more than 4 kg
-African Canadians, First Nations, and Inuuit
controlling diabetes
-insulin drugs
-lifestyle changes: weight, diet, physical activity
cancer incidence and mortality
-lung cancer causes most death out of all cancers
-death rates declining for those under 70
-Age, sex, ethnicity, socioeconomic status, occupation and lifestyle affect cancer rates.
suspected cancer-causing genes present on chromosomes
what causes cancer?
-spontaneous errors during cell reproduction
-external agents enter cells and initiate cancerous growth (environmental factors - carcinogens)
risks for cancer
-biological factors
-occupational and environmental factors
-social and psychological factors
-chemicals in food
-infectious diseases
-medical factors
life style: risk
-anyone can develop cancer but mostly those over age 55
-lifetime and relative risk?
smoking: risk
-leading cause of preventable death in the world
-relating to many different cancers
-lung cancer is leading cause of cancer deaths
obesity: risk
-the more obese, the more you increase your risk of cancer
biological factors: risk
-genetic predisposition
-sex (eg. woman are more likely to get breast cancer)
occupational and environmental: risk
-workplaces account for a small percentage of all cancers
-carcinogens include: asbestos, nickel, chromate, benzene, arsenic, & vinyl chloride
-certain dyes, radioactive substances and ionizing radiation (e.g. X-rays)
social and psychological: risk
-negative emotional states may contribute to cancer
-stress, poor sleep, poor diet, depression
chemicals in food: risk
-sodium nitrate - nitrosamines
-pesticide and herbicide residues
infectious diseases: risk
-17% of new cancers worldwide will be attributable to infections
-may influence through chronic inflammation, suppression of immune system, or chronic stimulation
medical factors: risk
-prescription drug used in the 1940's to 1960's Diethylstilbesterol (DES) to manage morning sickness, caused missing limbs in children
-estrogen replacement therapy
-chemotherapy may increase risk of certain cancers
Implies how our thoughts influence our action
6 C's of decision making
-Construct (a clear picture of what must be decided upon)
-Compile (a list of requirements that must be met)
-Collect (information on alternatives that meet the requirements)
-Compare (alternatives that meet the requirements)
-Consider (the "what might go wrong" factor with each alternative)
-Commit (to a decision and follow through with it)
planned, structured, and repetitive bodily movements done to improve or maintain physical fitness
physical fitness
-a set of attributes that are either health- or performance-related.
-canada recommends 60 mins a day
benefits of regular physical activity
Improved Cardiorespiratory Endurance:
-Reduced Risk of Heart Disease
-Prevention of Hypertension
-Systolic and diastolic blood pressure
-Improved Blood Lipid and Lipoprotein Profile
Improved Bone Health:
-Osteoarthritis and osteoporosis
Improved Weight Management:
-Direct effect on metabolic rate
Improved Health and Life Span
-Prevention of Type 2 Diabetes
-Increased Longevity
-Improved Immunity to Disease
Improved Mental Health and Stress Management
designing your physical fitness program
-Warm-up and Cool-down
-Cardiorespiratory Endurance
-Resistance Training
-4% of canadians
lowers risk of:
-Heart disease
-Colorectal, ovarian, and breast cancers
-Hypertension (high blood pressure)
food additives
-Regulated by Health Canada
-General guideline: fewer chemicals, colorants, preservatives is better.
added to:
-reduce risk of food-borne illness
-prevent spoilage
-enhance look and taste
-enhance nutrient value
organic foods
-pesticide and chemical free
-health impacts unclear
health risks of obesity
-Atherosclerosis and coronary artery disease
-Colon cancer and breast cancer (post menopause)
-Type 2 diabetes
-Gallbladder disease
risk factors for obesity
-metabolic rate
-heredity and genetic factors
-psychosocial factors
persistent compulsive dependence on a behaviour or substance.
alcohol long term effects
-Effects on the Nervous System
-Cardiovascular Effects
-Liver Disease
-Other Effects (e.g., inflammation of the pancreas, decreased nutrient absorption)
Fetal Alcohol Spectrum Disorders (FASD)
Disorders relating to consumption of alcohol during pregnancy leading to lifelong developmental and cognitive disabilities.
-leading cause of developmental delay
-fetal alcohol syndrome (FAS)
-fetal alcohol effects (FAE)
cause of alcoholism
Biologic and Family Factors
-type 1 alcoholics
-type 2 alcoholics
Social and Cultural Factors
-peer pressure
-emotional or social problems
-family attitudes
-social factors (e.g., urbanization)
type 1 alcoholism*
-starts after age 25
-male and female both effected
-relatively mild alcohol dependence
-not commonly violent
-high psychological dependence
-commonly feel guilty and fearful of drinking problem
-treatment more successful
type 2 alcoholism*
-starts before age 25
-mainly male effected
-high alcohol dependence
-no guilt or fear of problem
-resistant to treatment
woman and alcoholism
-More women are drinking
-Almost as many women alcoholics as men
-Alcoholism starts later and progresses more quickly
-tend to receive less social support than men for treatment and recovery
-number 1 preventable cause of death
-canadians are smoking less
environmental tobacco smoke
Two types:
-mainstream smoke
-secondhand smoke (poses significant risk)
Passive smokers: people who breathe smoke from someone else's smoking
-Estimated to cause the most deaths of all environmental pollutants
-Exposed children have greater risk of developing respiratory problems
-Smoking is now illegal in many public places
-Most widely consumed drug in Canada
-May cause wakefulness, insomnia, irregular heartbeat, dizziness, nausea, indigestion
-Caffeine levels vary with product
Sociopolitical determinants of health
social determinants of health
are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.
todays family unit
-family structures are diverse
-family of origin impacts child's psychological, social and spiritual development
risk factors: housing
-Housing insecurity is linked to income insecurity which in turn leads to illness and premature death.
how do politics fit in with social determinants of health?
Social policy:
-min wage
-social assistance
-canadian pension plan
violence in Canada
• Violence: intentional behaviours that produce injuries, as well as the outcomes of these behaviours (the injuries themselves)
• Death and injury from violence results in physical, sexual, social, spiritual, and mental health problems
• In Canada, the most violent setting is the family; vulnerable groups include women, children, the elderly, and ethnic minorities
• Violence carries high social, emotional, and economic costs
factors related to violence
• Poverty
• Unemployment and hopelessness
• Lack of education and inadequate housing
• Poor parental role models
• Cultural beliefs that objectify women
• Lack of social support systems
• Discrimination
• Stress and economic uncertainty
-Neurobiological, psychological, and social factors enable suicide
-3,613 suicides in Canada in 2004
-men most at risk (ages 45-54 especially)
-Suicides account for 80% of all firearm deaths
-Rates among Aboriginal youth are 2-7 times higher than the Canadian population as a whole
-very high rates young aboriginal men (ages 15-24) - nearly 120 per 100,000
-second leading cause of death for those between ages 15 - 30
-3 times as many suicides as homicides
-Age - in general, older men have higher rates of completed suicide (although the increase in suicide in young men has narrowed this gap); younger people higher rates of suicide attempts
-Marital status - high rates of suicide attempts for single people; high rates of completed suicide for people who are widowed, separated, or divorced; risk also diminishes if person has children
-Race - high among Caucasians and aboriginal people
suicide: risk factors
-Physical illness
-Life stress - especially loss experiences
-Loneliness, isolation
-Previous attempts
-Suicide plan
-Family history
-Suicide sometimes occurs after improvement in mental health (they feel more capable)
government of canada works to:
-Develop and disseminate knowledge on mental health promotion and mental illness prevention;
-Provide leadership and governance;
-Develop social marketing campaigns; and
-Conduct surveillance on health trends in population
youth violence
• Most youth involved in violent crimes are ages 16-17 and their victims are between ages 12 and 17
• Assaults occur most commonly in public places, dwellings, or schools
• A high proportion of young offenders are jailed (versus the use of alternative methods)
• Aboriginal youth, youth from certain ethnic and cultural groups, and youth from lower income families are overrepresented in the justice system
• More than 95% of Canada's youth are never in trouble with the law
violence of hate
• Although Canada welcomes people from other cultures, prejudice and racism have always been a part of Canadian society
-Aboriginal people
-immigrants who differ physically and culturally from Northern European peoples
violence against woman*
• 29% of Canadian women have experienced domestic violence; 45% of assault cases result in physical injury
• Reasons for staying in violent relationships:
-financial dependence
-fear of retaliation
-hopefulness that the situation will improve
-bad times are worth the good times
-cultural or religious beliefs
-still loves her partner
domestic violence
• Between 1974 and 1992 in Canada:
-1,435 women killed by their husbands
-451 men killed by their wives
• 1998-2006: over 38,000 incidents of spousal violence reported to police.
Spousal violence
-two times as high in gay or lesbian couples
-three times as high in Aboriginal couples
• Only 27% of victims report to police
causes of domestic violence
• The use of force to control and maintain power over another person in the home including actual physical harm or psychological harm and the threat of harm
• Marital dissatisfaction predicts abuse better than any other variable
other factors include: alcohol abuse, communication problems, and personality disorders in males
• Support services may help couple understand the basis of the problem and stop the abuse
violence against children
• Perpetrators are often trusted individuals
• Child victims have a high risk of becoming perpetrators later
• Psychological violence
-assaults on personality, character, competence, independence, or dignity
-may result in depression, lower self-esteem, sub-optimal growth, and fear of offending the abuser
violence against men
• 39% of violent crimes in 1999 were males attacking males (6% were females against males)
• Men under age 34 are the most likely perpetrators in major assaults
• Overcoming violence is largely a male issue
elder abuse
• 4% of Canadians over 65 experienced some form of abuse
• Most prevalent abuses were: material (money or valuables), verbal aggression, physical abuse, or neglect
• Victim is female in 67% of cases
• Offender often a spouse or child of victim
• Only 13% lay charges
violence and health
• To understand and respond to violence, greater emphasis is needed on physical, social, and economic life conditions that will reduce it
• Violence is a barrier to health and a consequence of an unhealthy environment
environmental determinants
The physical environment is an important determinant of health. At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects, including cancer, birth defects, respiratory illness and gastrointestinal ailments.
primary environmental determinants
-Biological agents in the air, water, and soil

-According to the WHO, over 1 billion people are unable to meet their basic needs (food, water, shelter) because they lack income
components of the environment
PHYSICAL: air, water, soil, housing, climate, geography, heat, light, noise, debris, radiation, etc.

BIOLOGICAL: man, viruses, microbial agents, insects, rodents, animals and plants, etc.

PSYCHOSOCIAL: cultural values, customs, beliefs, habits, attitudes, morals, religion, education, lifestyles, community life, health services, social and political organization.
infectious vs chronic disease
-Short term
-Acute exposure
-May cause epidemic
-Long term
-Low dose exposure
-May alter genes (passing on defective genes to offspring)
-Effective management of the environment is needed to avoid at least 25% of all preventable diseases worldwide
-13 million deaths could be prevented annually if the environment were healthier
-Unsafe water and air pollution causes 4 million deaths annually in children under 5
-Promoting safe household water storage, better hygiene, and cleaner and safer fuels would reduce disease and death
-Thousands of Canadians are changing their habits and working to improve the environment
-Majority of population growth occurs in developing world
-Estimates for population growth depend on fertility rates and life expectancy
-As the world's population increases so does competition for the earth's resources
-North Americans consume more energy and raw materials per person than any other region of the world
4 types of pollution
sources of air pollution
• Sulphur Dioxide
• Particulates
• Carbon Monoxide
• Nitrogen Dioxide
• Ozone
• Lead
• Hydrocarbons
air pollution: photochemical smog
• Brown, hazy mix of particulates and gases
• Sometimes called ozone pollution
• Often occurs in areas of temperature inversion - layer of cool air trapped under a layer of warm air
• May result in: difficulty breathing, burning eyes, headaches, and nausea
• Long term: may cause serious effects, especially among vulnerable people
air pollution: acid rain
-Precipitation contaminated with acidic pollutants
• Sources of Acid Rain
-burning fossil fuels
• Effects of Acid Rain
-environmental damage
-respiratory problems
-leaching of metals out of the soil
-crop damage
-damage to monuments and structures
indoor air pollution
• Wood Stove Smoke
• Furnaces
• Asbestos
• Passive Smoke
• Formaldehyde
• Radon
• Household Chemicals
air pollution: ozone layer depletion
• Chemical produced when oxygen interacts with sunlight
• Protective membrane-like layer in earth's atmosphere
• Depletion of the ozone layer by chlorofluorocarbons (CFCs); production and importation now banned in Canada
air pollution: global warming
• Greenhouse gases produced by burning fossil fuels
• May be most economically disruptive and costly change of our modern society
reducing air pollution
• Need to change energy, industry, and transportation
• Encourage use of renewable resources such as solar, wind, and water power
water pollution: contamination
• Point source(directly poured into water) - specific entry point
• Non-point source - seep into waterways:
-Septic Systems
-Gasoline and Petroleum Products
water pollution: chemical contaminants
• Polychlorinated biphenyls (PCBs): toxic chemicals once used as insulating materials in high-voltage electrical equipment
• Pesticides*: chemicals designed to kill insects, rodents, plants, and fungi
• Trihalomethanes: synthetic chemicals formed as a by-product of water treatment
• Lead: mineral that can damage health
noise pollution
• Loud noises are common and are a source of physical and mental distress
• Short-term exposure reduces productivity, concentration, attention span, and may affect health
• Symptoms of noise related distress include: sleep disturbance, headaches and tension, and negative impacts on physical health
preventing hearing loss
• Play stereos at reasonable levels
• Wear earplugs for power equipment
• Establish barriers to noise
land pollution
• Solid Waste
-Reduce, reuse, recycle
-As much as 90% of garbage could be reused or recycled
• Hazardous Waste
-Solid waste that poses a hazard to humans or the environment
-The Canadian Environmental Protection Agency program to deal with hazardous wastes
-->elimination or reduction
• Substance is radioactive when it emits high-energy particles from the nuclei of its atoms
• Types of radiation: alpha particles, beta particles, and gamma rays
ionizing radiation
• Exposure is inescapable
• Can damage genetic material
• Most of us exposed to far less than "safe" maximum dosage
non-ionizing radiation
Little is known about the biologic effects of certain types of nonionizing radiation
nuclear power plants
• Account for less than 1% of total radiation exposure
• Proponents feel it is safe and efficient
• Concerns about disposal of nuclear waste and chances of a meltdown
food quality
• Food accounts for 80 to 95% of intake of the most persistent toxic contaminants
• Air contributes 10 to 15% and drinking water contributes very little
• Canada's food is some of the safest in the world
• Concerns about microbial and environmental contamination in food
• Individuals can take steps to reduce risk
tar pond kids
-Those living in close proximity reported more frequent environmental and health worries
-Depression in youth
environmental contaminants
Exposure to environmental contaminants has been associated with a variety of negative health outcomes
-Birth defects
-Respiratory illnesses
-Immunological disorders
How Health Professionals Can Improve Population Health and the Environment
-Understand how environmental health issues can be integrated across various sectors and Healthy People objectives.
E.g., eliminate elevated blood lead levels in children, reduce indoor allergen levels, increase use of alternative modes of transportation for work.
-Understand the correlation between educational status, physical environment, and health status.
-Contribute to national progress by working with public health and environmental health partners at the Federal, State, and local levels to achieve important environmental goals (e.g., reduce air toxic emissions) that will result in improved population health outcomes.
topic areas related to the environment
-Educational and Community-Based Programs
-Environmental Health
-Occupational Safety
-Respiratory Diseases
holistic concept of health
This concept recognizes the strength of social, economic, political and environmental influences on health
concept of disease
-Disease result from complex interaction between man, an agent and the environment.
-From ecological point of view disease is defined as "maladjustment of the human organism to the environment".
the epidemiological triangle
3 vertices:
-"agent" or microbe that causes the disease
-"host" or organism harbouring the disease
-"environment", or external factors that cause or allow disease transmission
biological hazards
-These are living organisms or their products that are harmful to humans.
a) water born diseases
b) food born diseases
c) vector born diseases
a) water borne diseases
1. Examples are polio virus, hepatitis A virus, Salmonella, Shigella, cholera, amoebic dysentery, Giardia, and Cryptosporidium.
2. These disease organisms are shed into the water in feces, and can produce illness in those who consume untreated, contaminated water.
3. Our municipal water treatment facilities are usually able to purify water by removing these agents or killing them by disinfecting the water.
b) food borne diseases
1. Examples of food-borne agents are the bacteria Salmonella, serotype enteritidis, Escherichia coli 0157:H7, as well as other agents.
2. To protect against food-borne diseases, sanitarians from local health departments routinely inspect food service establishments (restaurants) and retail food outlets (supermarkets) to verify that food is being stored and handled properly.
c) vector borne disease
-are those transmitted by insects or other arthropods
1. Examples are St. Louis encephalitis and La Crosse encephalitis transmitted by mosquitoes and plague and murine typhus transmitted by fleas.
2. Improper environmental management can cause vector-borne disease outbreaks.
chemical hazards: pesticides
-result from mismanagement or misuse of chemicals resulting in an unacceptable risk to human health
A. Pesticides are chemicals that have been manufactured for the purpose of reducing populations of undesirable organisms (pests)
1. Examples of categories of pesticides are herbicides and insecticides.
2. Most pesticides kill non-target organisms as well as the target, or pest species.
3. The wise use of pesticides can protect human health and agricultural crops.
chemical hazard: environmental tobacco smoke
is an environmental hazard produced by millions that smoke
1. Diseases associated with ETS include lung cancer and perhaps heart disease.
2. ETS contains 4, 000 substances.
3. The EPA has classified ETS as a Class A carcinogen.
4. Smoking has been increasingly restricted from public buildings and from many private work sites.
5. Regulation of smoking seems to be the best approach to controlling this pollutant
chemical hazard: lead
is a naturally occurring element that is used in the manufacturing of many industrial and domestic products
1. Health problems associated with the over exposure to lead are anemia, birth defects, bone damage, neurological damage, kidney damage, and others.
2. Exposure is by ingestion and inhalation.
3. Children are particularly at risk from eating peeling lead paint.
4. The prevalence of very high blood lead levels among young children declined significantly between 1984 and 1994 primarily because the removal of lead from gasoline.
5. Occupational exposure is a major source of lead intake for adults.
physical hazards
-include airborne particles, humidity, equipment design and radiation
-Radon contamination results from over exposure to radon gas.
1. Radon gas arises naturally from the earth and sometimes occurs at dangerous levels in buildings and homes
2. Breathing in radon gas can cause lung cancer.
3. Homes can be tested for the presence of radon gas for $20.
psychological hazards
-are environmental factors that produce psychological changes expressed as stress, depression, hysteria.

-When environmental resources can support no further growth, the population has reached the equilibrium phase and the environment is said to be at its carrying capacity
sociological hazards
-are those that result from living in a society where one experiences noise, lack of privacy and overcrowding.
-Population growth may be a sociological hazard.
site and location hazards
-Natural disasters are geographical and meteorological events of such magnitude and proximity to communities that they produce significant damage and injuries.
1. Examples are cyclones, earthquakes, floods, hurricanes, tornadoes, typhoons, and volcanic eruptions.
2. The magnitude of devastation of these events can sometimes be great.
3. Biological, psychological and sociological hazards may increase following a natural disaster.
In the built environment, factors related to housing, indoor air quality, and the design of communities and transportation systems can significantly influence our physical and psychological well-being.
Our political voice!
Environmental issues:
-Pollution and cancer prevention
-Green power; wind turbines
global health
Health problems, issues, and concerns that transcend national boundaries, which may be influenced by circumstances or experiences in other countries, and which are best addressed by cooperative actions and solutions
global health issues
Refers to any health issue that concerns many countries or is affected by transnational determinants such as:
-Climate change
-Malnutrition - under or over nutrition
Or solutions such as:
-Polio eradication
-Containment of avian influenza
-Approaches to tobacco control
historical development of term
Public Health: Developed as a discipline in the mid 19th century in UK, Europe and US. Concerned more with national issues.
-Data and evidence to support action, focus on populations, social justice and equity, emphasis on preventions vs cure.

International Health: Developed during past decades, came to be more concerned with
-the diseases (e.g. tropical diseases) and
-conditions (war, natural disasters) of middle and low income countries.
-Tended to denote a one way flow of 'good ideas'.

Global Health: More recent in its origin and emphasises a greater scope of health problems and solutions
-that transcend national boundaries
-requiring greater inter-disciplinary approach
Disciplines involved in Global Health
-Social sciences
-Behavioural sciences
-Biomedical sciences
-Environmental sciences
communicable diseases and risk factors
-Infectious diseases are communicable
-Dietary changes
-Lack of physical activity
-Reliance on automobile transport
key concepts in relation to global health
-The determinants of health
-The measurement of health status
-The importance of culture to health
-The global burden of disease
-The key risk factors for various health problems
-The organisation and function of health systems
multi dimensions of the determinants of health
>more susceptible to disease and less likely to recover
Cooking with wood and coal
>lung diseases
Poor sanitation
>more intestinal infections
Poor life circumstances
>commercial sex work and STIs, HIV/AIDS
Advertising tobacco and alcohol
>addiction and related diseases
Rapid growth in vehicular traffic often with untrained drivers on unsafe roads
>road traffic accidents
measurement of health status
>Cause of death
Obtained from death certification but limited because of incomplete coverage

>Life expectancy at birth
The average number of years a newborn baby could expect to live if current trends in mortality were to continue for the rest of the new-born's life

>Maternal mortality rate
The number of women who die as a result of childbirth and pregnancy related complications per 100,000 live births in a given year

>Infant mortality rate
The number of deaths in infants under 1 year per 1,000 live births for a given year

>Neonatal mortality rate
The number of deaths among infants under 28 days in a given year per 1,000 live births in that year

>Child mortality rate
The probability that a new-born will die before reaching the age of five years, expressed as a number per 1,000 live births
culture and health
The predominating attitudes and behaviour that characterise the functioning of a group or organisation
Traditional health systems
Beliefs about health
e.g. epilepsy - a disorder of neuronal depolarisation vs a form of possession/bad omen sent by the ancestors
Influence of culture of health
Diversity, marginalisation and vulnerability due to race, gender and ethnicity
the global burden of disease?
key risk factors for various health conditions
>Tobacco use
related to the top ten causes of mortality world wide
>Poor sanitation and access to clean water
related to high levels of diarrhoeal/water borne diseases
>Low condom use
HIV/AIDS, sexually transmitted infections
Under-nutrition (increased susceptibility to infectious diseases) and over-nutrition responsible for cardiovascular diseases, cancers, obesity etc.
The Organisation and Function of Health Systems
-A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health

-Most national health systems consist:
public, private, traditional, and informal sectors.
-Entry: oral
-Colonization: small intestine
-Symptoms: nausea, diarrhea, cramps, vomiting (digestive problems) associated with dehydration
-Face, feet, hands shriveled and turned blue; died in less than a day
-Index case is the point source, first person to become ill -woman soaked diapers in pail and empties pail into cistern pump
-John snow: identified cholera
psychosocial health
Encompasses the mental, emotional, social, and spiritual dimensions of health
people who are psychosocially healthy:
• Feel good about themselves
• Feel comfortable with other people
• Control tension and anxiety
• Meet the demands of life
• Choose a positive outlook
• Enrich the lives of others
• Cherish things that make them smile
• Value diversity
• Appreciate and respect nature
mental health
-The Thinking You
• Rational part of psychosocial health. The ability to:
-perceive things realistically
-use reasoning in problem solving
-interpret what is happening accurately
-evaluate situations effectively and react appropriately
• Sharp declines in rational thinking may indicate poor mental health
emotional health
-The Feeling You
• Subjective side of psychosocial health encompassing physiological arousal, feelings, cognitive processes, and behavioural reactions.
Ability to:
-respond appropriately to upsetting or uplifting events
-not let one's feelings overpower one's self
Outcomes of poor emotional health include poor social health and academic performance
social health
-Interactions with Others
• The ability to:
-interact with others individually or in groups
-use and provide social support
-adapt to a variety of social situations
• Aspects of social health, including the presence of social bonds and social supports, promote physical and mental health
• A lack of social health may result in acts of prejudice and bias towards individuals or groups
spiritual health
-an inner quest for well being
• Search for meaning, connectedness, energy, and transcendance
-Source of strength and hope
-Source of a sense of purpose
• Recognition of uniqueness, strengths and weaknesses, and place in the universe
• Spiritual health is connected to other dimensions of health
• Enhancing spiritual health is time consuming and requires effort
factors influencing psychosocial health
-external influences (we don't control)
-internal influences
External Influences (we do not control)
• Influences of the Family
-healthy versus dysfunctional
• Influences of the Wider Environment
-childhood environments
-access to services and programs
internal influences
e.g., personality traits, hormonal functioning, physical health • Self-Efficacy and Self-Esteem
self-efficacy: belief in ability to perform task successfully
self-esteem: sense of self-respect or self- worth
• Learned Helplessness vs. Learned Optimism
health indicator
An indicator is a single measure (usually expressed in quantitative terms) that captures a key dimension of health, such as how many people suffer from chronic disease or have had a heart attack. Indicators also capture various determinants of health, such as income, or key dimensions of the health care system, such as how often patients return to hospital for more care after they are treated.

"...a measure that helps quantify the achievement of a goal."
health indicators
Indicators allow us to make comparisons:
-over time (trends)
-geographic areas
-groups of people
>and focus on the most essential domains of health.
what makes a good indicator?
Data Power - high quality, available data
Proxy Power - central importance to health
Communication Power - that the meaning is transparent.
what are the bases for health indicators?
Health indicators are based upon conceptual models for what influences health status, based upon scientific research.

Models have evolved over time, as have definitions of health, but trace historical improvements in health, e.g., increases in life expectancy, declines in mortality due to infectious diseases.

Context is important: For example, in 1900 the leading causes of death were Pneumonia, Tuberculosis, and Diarrhea and Enteritis as compared to Heart Disease, Cancer, and Stroke in 2006.
current conceptual frameworks
Today's context:
Rate of healthcare spending is unsustainable, and, levels of spending not consistent with level of health. Ripe opportunities for increasing the return on investments in health through prevention.

Burden of chronic diseases (e.g., premature mortality, costs) and
Complex public health problems (e.g., violence, obesity, HIV), and health-related behaviors (e.g., smoking, diet, substance use)
The influence of social and environmental conditions on determining health outcomes, either directly or indirectly
Deep, persistent disparities in health
common frameworks for health indicators
1. Broad "Determinants of Health" - emphasizes the physical environment, social environment, health behaviors, medical care.

2. "Life Course" - emphasizes conditions/experiences early in life (e.g., 0-5) and interactions at developmental stages throughout life in optimizing our health "trajectory".

3. "Social Determinants" emphasizes educational, economic, and social conditions and interactions in shaping health.
how are health indicators used?
Indicators are powerful tools for monitoring and communicating critical information about population health.

Indicators are used to support planning (identify priorities, develop and target resources, identify benchmarks) and track progress toward broad community objectives.

Engagement of partners into civic and collaborative action (build awareness of problems and trends, generate interventions).

Inform policy and policy makers, and can be used to promote accountability among governmental and non-governmental agencies
who compiles health indicators?
-Reports are compiled at every jurisdictional level
-Provincial and local level - Health departments, foundations and philanthropic organizations, businesses, educational, law enforcement, human services providers, and other civic leaders, faith organizations, universities, media.
-National - Federal government/private partnerships.
-International - OECD, WHO
common health indicators
The most common health indicators are those related to birth and death:
-Life expectancy,
-Premature mortality (e.g., Years of Potential Life Lost or -YPLLs)
-Age-specific death rates (e.g., infants, teens)
-Cause specific deaths (e.g., lung, cervical cancer)
-Births to teens
-Very/Low birth weight
-Adequacy of prenatal care
-Social characteristics of parents (e.g, maternal educational attainment).

These are robust—high completeness of reporting, widely available through the Canadian Institute of Health Information (CIHI), and standardized so as to be are comparable across provinces and regions.
But, also limited.

-Morbidity/Health Status
-Health-related Quality of Life:
-Poor health days
-Self-rated health status

- Body Mass Index based on self-reported height and weight

-Diabetes, asthma, and other chronic diseases.
Canadian Hospital Reporting Project (CHRP)
This online resource provides a series of 21 clinical indicators (with risk-adjusted rates) and 9 financial indicators that allows hospitals to compare their performance against those of their peers and to learn from leading practices.
The Canadian Hospital Reporting Project (CHRP) is a national quality improvement initiative from the Canadian Institute for Health Information (CIHI). CHRP's interactive web-based tool gives hospital decision-makers, policy-makers and Canadians access to indicator results for more than 600 facilities from every province and territory in Canada.
where does CHRP data come from?
-Several CIHI data sources have been used to produce clinical and financial indicators. Clinical data is drawn from administrative health care databases, such as the Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), the Alberta Ambulatory Care Reporting System (AACRS) and the Hospital Morbidity Database (HMDB), as well as case mix grouping data. Financial data is drawn from the Canadian MIS Database (CMDB) and the DAD.
-Hospital profile data is sourced from the CMDB, the DAD and case mix tools.
-Community profile information comes from Statistics Canada.
how does CHRP measure hospital performance?
-An indicator is a single measure that represents a key dimension of health status, the health care system or related factors.
-Indicators can be used to identify potential opportunities for quality improvement and provide a basis for comparison between hospitals or between provincial, regional and national averages.
-CHRP indicators can represent either clinical aspects of the health care system (such as patient safety) or financial aspects of the health care system (such as administrative expenses).
-These results do not provide a final conclusion about hospital performance but can be used as the first step in an improvement process to identify areas for follow-up and potential improvements.
-NO single indicator should be used to judge a hospital; it is important to consider all aspects of performance.
CHRP indicators can be used to
-Identify opportunities to improve care;
-Compare hospital performance, as well provincial, regional and national averages; and
-Evaluate practices, policies and procedures.
CHRP indicators cannot
-Provide answers—they only raise questions;
-Explain disparities, variations or change; and
-Be interpreted in the absence of context and without further analysis.
Why is CHRP publicly releasing information?
-CHRP indicators provide comparative information about hospital performance across Canada.
-This information can help acute care facilities identify areas for quality improvement.
-It enables them to foster learning and sharing of best practices, which can inspire conversations among hospital decision-makers, policy-makers and the public that can increase health system accountability and lead to better care for patients.
-Canadians can use information like this to learn more about their local hospital and about the broader health care system.
-supports transparency and accountability in the health care system.
social indicators
Physical environment:
Area-based measures, e.g., income/poverty, population density
Access to public transportation, housing
Environmental pollution, e.g., air and water quality.

Social environment:
Income (individual/family)
Education (e.g., high-school graduation rates, students reading/doing math at grade level)
Social support and connectedness.

Child and family focused:
Parental educational attainment
Parent practices (e.g., breastfeeding, reading to child, regular meal/bedtimes)
Access to services such as early developmental screening
Family social environment (e.g. parent stress, depression
Gaps in Data Sources or Measures
Examples of indicators that lack of systematically collected and standardized data:

Early life - developmental outcomes at the time of kindergarten entry and conditions throughout childhood and youth, e.g., obesity.

Later life - community care and support, long term care, quality and availability of services.

Social environments, e.g., neighborhood characteristics, quality of social interactions.
Health System Performance Indicators
-All Canadians have access to health care services...BUT..
May have to travel
-Rural health provider supply, linguistic or cultural barriers to getting care

-Total health expenditures
-Health as share of Gross Domestic Product (GDP)
-Prescription drug costs
-Payments to hospitals, facilities
-Comparisons of resources used per patient between hospitals/areas

Quality of care
-Effective care - receipt of recommended screenings, -treatment, readmission rates.
-Patient Safety - medical error
measuring what matters
-Indicators are powerful
-What we count and measure, influences how we make policy decisions
If we don't measure wellbeing, in all of its dimensions, it doesn't count...leaving Canadians to:
-Gauge wellbeing using a narrow set of economic indicators
-Misinterpret wellbeing or use surrogate measures
-Ignore policy options that will fundamentally improve wellbeing
why a new measure of well being?
-Promote a shared vision of what really constitutes sustainable wellbeing and the elements that contribute to or detract from it;
-Measure national progress toward, or away from, achieving that vision;
-Understand and promote awareness of why society is moving in the direction it is moving;
-Stimulate discussion about the types of policies, programs, and activities that would move us closer and faster toward achieving wellbeing;
-Give Canadians tools to promote wellbeing with policy shapers and decision makers so as to account for why things are getting better or worse; and
-Add momentum to the global movement for a more holistic way of measuring societal progress.
vision of canadian wellbeing
To enable all Canadians to share in the highest wellbeing status by identifying, developing and publicizing statistical measures that offer clear, valid and regular reporting on progress toward wellbeing outcomes Canadians seek as a nation.
living standards
measures the quality and quantity of goods and services, both public and private, available to the population, and the distribution of these goods and services within the population.
healthy populations
measures the physical and mental health of the population - experiencing disease, disability and delaying death, people's life circumstances, and care people receive.
community vitality
measures the strength, activity and inclusiveness of relationships among residents, private sector, public sector and civil society organizations that work to foster individual and collective wellbeing.
democratic engagement
measures the participation of citizens in public life and in governance; the functioning of Canadian governments with respect to openness, transparency, effectiveness, fairness, equity and accessibility; and the role Canadians and their institutions play as global citizens.
report highlights: living standards
Canadians experienced a widening of income and wealth inequalities
The fight against poverty has stalled since 1981; some poverty reductions were not nearly as large as the increase in wealth inequality
Between 1981-2008, the incidence of long-term unemployment is higher now than in 1981
Since 1981, many dimensions of living standards in Canada have not improved, despite a 53.0% surge in GDP per capita
Frayed social safety net provides less support for the disadvantaged (e.g. welfare benefits, employment insurance less generous re: qualifications period, coverage, duration of benefits)
report highlights: healthy populations
Life expectancy rates are among the best in the world; a closer look at health indicators reveals a more mixed picture
-Canadians are living longer but not better
-Canadians are increasingly likely to develop a chronic disease or mental illness during their lifetime

For more than a decade, merely 65% of Canadians have declared their overall health very good or excellent. Self-rated health is considerably lower than it was 10 years previously
-This decline is most marked among Canadian teenagers - a drop of 11.9%

Health disparities between Aboriginal and non-Aboriginal Canadians have narrowed somewhat but still remain unacceptably large

Higher incomes and higher levels of education are associated with longer life expectancy and better self-reported health.
-The positive impact of income and education is most marked among women.
report highlights: community vitality
-Canadians have strong social relationships with their families and communities
>Positive trend of most of the indicators suggests that the wellbeing of Canadians, as measured by the quality of their relationships, is improving over time.
-We are well-equipped to deal with current and future challenges
-The size of Canadian's social networks has declined since the mid 1990s; Canadians are reporting smaller numbers of close relatives and close friends
-A growing number of Canadians report that they provide help to others (83% of Canadians in 2004)
-Over half of Canadians believe that people can generally be trusted
-In 2004, 4.1% of Canadians reported experiencing discrimination because of their ethnicity, race, culture, skin colour, religion or language, a decline from 7.1% in 2002; significantly higher for visible minorities
report highlights: democratic engagement
-Fewer Canadians are voting. Turnout in the most recent federal election, in 2008, was the lowest in Canadian history at 59.1%, down more than 10 percentage points from 1993.
-Participation rates in formal political activities are extremely low. The number of people volunteering for law, advocacy and political groups has hovered at about 2% or less throughout the past decade, and hours volunteered dropped by 15% from 2004 to 2007.
-Canadians aren't satisfied with their democracy. Between 40-45% said they were not satisfied with how democracy works in Canada. (2004 and 2006 surveys)
-An overwhelming majority of people say that federal government policies have not made their lives better. Only 12% said their lives had been improved by federal policies when last surveyed in 2006.
-Women and minorities are underrepresented in the political process. Since 1997, the percentage of women in Parliament has remained relatively steady - and low - at about 20%.
the 5 D's of old
-Many older adults function well without assistance
-Recognize that they have limits placed on their time living
Health promotion activities can be focussed on the elderly
-Aging or ageing is a process that accumulates changes in organisms or objects over time. It begins at birth.
-Human aging process involves multidimensional changes on -physical, psychological, cultural and social levels.
Subjectively it is a term associated with the older adult
-a socially constructed way of thinking about older persons based on negative attitudes
-stereotypes about aging and a tendency to structure society based on an assumption that everyone is young, thereby failing to respond appropriately to the real needs of older persons
definition of aging?
Old and aging depends on the age and experience of the speaker.
Chronological age - number of years lived
Physiologic age - age by body function
Functional age - ability to contribute to society
Frail elderly characteristics
-poor mental and physical health
-low socioeconomic status
-mostly female -possible isolated living conditions
-more, and longer hospital stays
-more money spent on drugs and health care
Life Events: Age-Related Changes Affecting Psychosocial Function
-Chronic illness and functional impairments
-Decisions about driving a car
-Death of family and friends
-Ageist attitudes
-Milestone in an older adult's life
-Influence of societal attitudes
-Time of adjustment
-Change in social status
-Adjustment to retirement
-Reasons for relocation of the older adult
-Types of moves
-Relocation to a nursing home
>Transfer trauma/transplantation shock
>Need to address psychosocial issues
>Involvement in decision making
Chronic Illness and Functional Impairments
-Coping with chronic illness and decrease in function
-Potential loss of independence
-Adjustments in daily living
-Consequences of chronic illness
Decisions About Driving a Car
-Emotionally charged issue
-Loss of autonomy and independence
-Effects on a person's life
-Family involvement
-Avoidance of the decision to stop driving
-New psychosocial challenges when an older adult stops driving
-Women are more often widowed.
-Significant consequences of widowhood
-Effect of the loss
death of friends and family
-Inevitable change with aging
-Increased awareness of their own mortality
-Potential for a negative effect on psychosocial wellness
ageist attitudes
-Acceptance of being old
>Denial is common.
-Effects of ageism
-Age-determined expectations for social behaviors
Factors That Influence Psychosocial Function in Older Adults
-Religion and spirituality are increasingly important resources.
-Cultural factors influence definitions/ perceptions of all aspects of psychosocial functioning.
-Culture-bound syndromes: culturally specific disorders associated with psychosocial characteristics of a particular group
Promoting Wellness in Older Adult
-Wellness is an evolving and integral part of health care
-Holistic care
-Age-related changes are inevitable, but most problems are caused by associated risk factors (ie lifestyle)
-Interventions can focus on eliminating risk factors (ie safety)
-Health promotion
-Nursing interventions can result in wellness outcomes
>allows person to function at their highest level despite age related changes or risk factors
Functional Consequences
-Observable effects of actions, risk factors, and age-related changes that influence the quality of life or day-to-day activities of older adults
Age related changes and risk factors combine to cause negative functional consequences
Nurses holistically assess and then initiate interventions that minimize or counteract the negative functional consequences
(ie eye sight)
-To facilitate the highest level of functioning in the older adult with the least amount of dependency
-Providing atonomy
Age-related changes
-Physiological processes that increase the vulnerability of older adults to the negative impact of risk factors
-Holistic perspective
(ie nurse may help with coping strategies)
Risk Factors
-Illness and disease
-Adverse medication effects
-Cumulative and progressive (ie smoking)
-Effects are exacerbated by age-related changes (ie OA)
-May be dismissed as age related rather than treatable (ie hypothyroid or medications)
Rowe and Kahn (1987)
Successful aging implies a balance between:
-Low probability of disease and disease related disability,
-High cognitive and physical functioning, and;
-Active engagement with life.
3 theoretical perspectives
Biological age-functional capacities
Sociological age-roles and behaviours
Psychological age-behavioural capacities and ability to adapt
life expectancy and life span
-Life expectancy - the number of yrs that will probably be lived by the average individual born in a particular year.
-The life expectancy of individuals born today in the Canada is 79.9 yrs.
-Life span - the upper boundary of life; the maximum number of yrs an individual can live.
-120 years is maximum
-Socio-economic status
nursing goal
To develop a combination of preventative and therapeutic approaches that will allow people to age in good health
-There are 4,320 centenarians living in Canada.
-The number is projected to increase to 45,000 by 2046.
-Many centenarians are quite healthy in their old age.
-Rapid growth in the older population will likely lead to a variety of societal changes.
Gender Differences in Longevity
-Life expectancy for females is 81.4, males 75.7.
-By age 45, females begin to out number males.
-By the time adults are 70-74 yrs of age, more than 53.4% of the population is female.
-Life expectancy differences are likely due to health attitudes, habits, lifestyles, & occupation.
-Biological factors may play a role, as females outlive males in virtually all species.
A Holistic Perspective on Aging and Wellness
-Inherit good genes
-Avoid oxidative damage (smoking)
-Social interactions
-Close personal relationship
-Reject stereotypes
Family Health Teams in the Province of Ontario
-Family physicians supported through blended payment models
-Interprofessional care teams
-Nurses -Dietician
-NPs -Pharmacist
-Electronic Medical Record
-Emphasis on training future family physicians in this setting
pressures on our system
Canada's aging population
-Senior citizens will outnumber children in about a decade
-Health of baby boomers is declining
-Increasing chronic disease
-Healthcare spending is increasing
-Wait times are a major issue
-Political debates over private sector role in healthcare delivery
trends in health care
-The number of acute-care hospitals and acute-care hospital beds decreased from 1995 to 2013.
-Medical advances have led to more procedures being done on an out-patient basis, and to a rise in the number of day surgeries.
-The length of time a person could be expected to live (life expectancy) is widely used to show health status. As of 2002, the average life expectancy at birth for Canadians was 82.1 years for women and 77.2 years for men, which is among the highest in the industrialized countries.
-Services such as home care and long term care facilities are not able to meet the demand
Governance through Shared Responsibility
-Federal government sets and administers national principles
-13 provincial/territorial governments plan, finance, manage, evaluate health services
-100+ health regions coordinate care delivery over a set geographical area
-900+ hospitals manage care
-Approximately 400,000 healthcare professionals deliver care
health care in canada
-The main concern of the Canadian
Governments is the "high" cost of health care.
-The main concern of the Canadian public
is access to health care. common theme for exam**