GLPH 171: Social and Physical Determinants of Health and Disease
Module 1: What is Health?
Section 1: What is Health?
Medicine: health is the absence of illness.
WHO: health is a state of complete physical, social, and mental well-being and not simply an
absence of disease or infirmity.
Examples of social well-being: positive social influences on a person’s life, like having friends,
feeling connected to family, living in a community to which one feels connected, feeling
engaged with one’s neighbourhood or community.
Social well-being likely includes social cohesion, support, a sense of belonging, and connection.
Illness arises from the interplay between external factors,
such as environment, and internal factors, such as
genetics.
Thinking Broadly About Health
Describe how each of the following groups might be
affected if a broad definition of health (like that of WHO)
were used in Canada.
Patients: no impact, however, many family physicians
feel their role includes finding financial or material
resources for patients who lack adequate income or
housing.
Policy Makers: might decide to redistribute medical care
to increase resources for certain groups or in certain
geographic areas.
Medical Care Providers: part of knowing one’s patients is not just to know their liver or blood
tests, but to know who they are, how they live, the constraints on their life, and their social
circumstances.
Medical Researchers: could consider who the person is with the disease and their social
circumstances, rather than just their disease.
Section 2: Determinants of Health and Interconnected Web
Health of individuals is determined by a number of interconnected
factors such as;
➔ The social and economic environment
, ➔ The physical environment
➔ A person’s individual biology and behaviour
Social determinants can be thought of as the conditions in which people are born, grow, live,
work, and age; they play a key role in a population’s health.
Various Levels of Health Determinants: social determinants of health act at various levels.
Individual Household Community National International
Biological or The social and Level of Size of the country; Global economic
genetic; age; economic status development; rural or population; level of scenario and
parity; birth of the urban; stratified or development; type of dominant economic
order; household homogenous; having governance; structure of the ideologies; balance
education; within the health resources or health system; extent to of power between
employment; community; the not; inheritance which dependent on the various geo-political
decision-maki household’s norms; norms for global market; nature of forces; health sector
ng power; access to place of residence health policies and contours reform; international
marital status. resources. after marriage. of health sector reform human rights regime.
packages.
How can employment (social
determinant) positively affect
health?
One explanation may be that
having a stable employment
can provide a person with
access to healthcare, a sense of
purpose and fulfillment, social
interaction, or a reliable
income, all factors that could
positively influence health.
How could it negatively affect
health?
Unstable work can create income insecurity. Poor working conditions increase the risk of injury,
increase stress, and overall negatively influence health.
Section 3: Introduction to Research Methods
Definitions of Epidemiology:
, ➔ The study of distribution, determinants and deterrents of morbidity (illness, disease,
injury) and mortality (death) in human populations.
➔ Epidemiology uses probability and statistical reasoning to study “how and why different
patterns of health and disease occur among various subgroups in a population.
➔ Epidemiological information can be used to prevent disease and promote health.
Social epidemiology is the branch of epidemiology that studies the social distribution and
determinants of health.
Independent Variable: those being examined as predictors of an outcome.
Dependent: the outcome.
Causation: changes in an independent variable lead to changes in a dependent variable. For
example, people who are unable to breath will die.
Correlation: a relationship between two or more variables that does not infer causality. For
example, all people who breathe will eventually die.
Criteria for Causation:
1. A strong association between variables to rule out other explanations.
2. Must be demonstrated repeatedly.
3. The cause should occur before the effect.
4. Increased exposure should increase the chance or magnitude of the effect.
5. Must be plausible.
6. Must not contradict other knowledge.
7. Is verifiable by experiment.
Two variables may be correlated, but this does not indicate that one variable causes the other.
Interaction: when the magnitude of an association between an independent and a dependent
variable varies according to the level of a third variable, which is within the causal pathway.
Confounding: occurs when the independent variable you are
studying appears to cause or lead to an outcome but only
because it is associated with another unmeasured independent
variable and that second variable is really the predictor of the
outcome.
Section 4: Interventions to Improve Health
Downstream Interventions vs. Upstream Preventions
Module 1: What is Health?
Section 1: What is Health?
Medicine: health is the absence of illness.
WHO: health is a state of complete physical, social, and mental well-being and not simply an
absence of disease or infirmity.
Examples of social well-being: positive social influences on a person’s life, like having friends,
feeling connected to family, living in a community to which one feels connected, feeling
engaged with one’s neighbourhood or community.
Social well-being likely includes social cohesion, support, a sense of belonging, and connection.
Illness arises from the interplay between external factors,
such as environment, and internal factors, such as
genetics.
Thinking Broadly About Health
Describe how each of the following groups might be
affected if a broad definition of health (like that of WHO)
were used in Canada.
Patients: no impact, however, many family physicians
feel their role includes finding financial or material
resources for patients who lack adequate income or
housing.
Policy Makers: might decide to redistribute medical care
to increase resources for certain groups or in certain
geographic areas.
Medical Care Providers: part of knowing one’s patients is not just to know their liver or blood
tests, but to know who they are, how they live, the constraints on their life, and their social
circumstances.
Medical Researchers: could consider who the person is with the disease and their social
circumstances, rather than just their disease.
Section 2: Determinants of Health and Interconnected Web
Health of individuals is determined by a number of interconnected
factors such as;
➔ The social and economic environment
, ➔ The physical environment
➔ A person’s individual biology and behaviour
Social determinants can be thought of as the conditions in which people are born, grow, live,
work, and age; they play a key role in a population’s health.
Various Levels of Health Determinants: social determinants of health act at various levels.
Individual Household Community National International
Biological or The social and Level of Size of the country; Global economic
genetic; age; economic status development; rural or population; level of scenario and
parity; birth of the urban; stratified or development; type of dominant economic
order; household homogenous; having governance; structure of the ideologies; balance
education; within the health resources or health system; extent to of power between
employment; community; the not; inheritance which dependent on the various geo-political
decision-maki household’s norms; norms for global market; nature of forces; health sector
ng power; access to place of residence health policies and contours reform; international
marital status. resources. after marriage. of health sector reform human rights regime.
packages.
How can employment (social
determinant) positively affect
health?
One explanation may be that
having a stable employment
can provide a person with
access to healthcare, a sense of
purpose and fulfillment, social
interaction, or a reliable
income, all factors that could
positively influence health.
How could it negatively affect
health?
Unstable work can create income insecurity. Poor working conditions increase the risk of injury,
increase stress, and overall negatively influence health.
Section 3: Introduction to Research Methods
Definitions of Epidemiology:
, ➔ The study of distribution, determinants and deterrents of morbidity (illness, disease,
injury) and mortality (death) in human populations.
➔ Epidemiology uses probability and statistical reasoning to study “how and why different
patterns of health and disease occur among various subgroups in a population.
➔ Epidemiological information can be used to prevent disease and promote health.
Social epidemiology is the branch of epidemiology that studies the social distribution and
determinants of health.
Independent Variable: those being examined as predictors of an outcome.
Dependent: the outcome.
Causation: changes in an independent variable lead to changes in a dependent variable. For
example, people who are unable to breath will die.
Correlation: a relationship between two or more variables that does not infer causality. For
example, all people who breathe will eventually die.
Criteria for Causation:
1. A strong association between variables to rule out other explanations.
2. Must be demonstrated repeatedly.
3. The cause should occur before the effect.
4. Increased exposure should increase the chance or magnitude of the effect.
5. Must be plausible.
6. Must not contradict other knowledge.
7. Is verifiable by experiment.
Two variables may be correlated, but this does not indicate that one variable causes the other.
Interaction: when the magnitude of an association between an independent and a dependent
variable varies according to the level of a third variable, which is within the causal pathway.
Confounding: occurs when the independent variable you are
studying appears to cause or lead to an outcome but only
because it is associated with another unmeasured independent
variable and that second variable is really the predictor of the
outcome.
Section 4: Interventions to Improve Health
Downstream Interventions vs. Upstream Preventions
