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PUBH 3100 Human Disease and Prevention

Week 5 – Determinants of Health: A Framework for Reaching Healthy People 2020

Goals

NARRATOR: Determinants of Health, a Framework for Reaching Healthy People 2020 Goals. What makes some people healthy, and others unhealthy? How can we create a society in which everyone has a chance to live long, healthy lives? These are just a couple of the important questions that Healthy People 2020 explores. The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health include biological and genetic makeup, individual behavior, social interactions and norms, the physical environment, and access to health services. For example, stress, discrimination, education, housing, and unemployment are all determinants of health. Healthy People 2020 places new emphasis on the social determinants of health, while continuing to address the full-range of determinants. Health starts in our homes, schools, and communities. Let's take a closer look at how determinants of health can affect our lives. Meet Carla, a six-year-old African-American girl. Carla lives in an urban area. She doesn't have any parks or playgrounds close to her apartment building, so she does not get enough daily physical activity. Carla takes the bus to school and back. Her grandmother stays with her after school. Carla typically watches four hours of TV a day. Now picture an intervention that can change Carla's determinants of health. A group of parents work with the school board and the local YMCA to keep the gym at Carla's school open later on weekdays, and on days when the school is closed for vacation. This provides community members with a safe space to exercise and play. Now Carla's grandmother meets her at the gym after school. Carla's physical activity level increases as she spends more time playing with friends at the gym and walking around the track with her grandmother. She is spending her after-school hours at the gym, which means she's also watching less TV. Let's look at another example. Meet James, a 76-year-old Caucasian man. James lives in a low-income neighborhood, surrounded by convenience stores and fast food restaurants. James has to take the bus to get to the closest grocery store. Diabetes runs

in his family, and James was recently diagnosed with Type II diabetes. What type of intervention may benefit James? How about a subsidized farmers market within walking distance to James' apartment? The city health department and a statewide farmers organization create a local farmers market program in James' community. The program is subsidized by the city, which allows farmers to sell fruits and vegetables at a lower cost. The farmers market program targets high density, low-income neighborhoods like James'. Now James walks to the farmers market each week, increasing his physical activity level. He's eating more fruits and vegetables now that he can afford them. James is also eating less canned food higher in sodium. James' new diet and increased physical activity are helping to keep his blood sugar under control. These examples show how determinants of health can impact our lives, and how working together we can improve the health of individuals and communities. Public health interventions typically target one or more determinants of health, through information, policies, and programs. Each intervention is designed to produce a specific health outcome or outcomes. As we saw with Carla and James, an intervention can have multiple outcomes including positive behavior change, reduction in diseases, conditions, and their risk factors, fewer injuries, improved well-being and health-related quality of life, and increased health equity and reduced health disparities. This is at the core of the Healthy People 2020 framework. Every intervention has a life- cycle of its own, a continual process of improvement made up of four phases-- assessment, monitoring, evaluation, and dissemination. Through this cycle, an intervention can be refined for greater effectiveness. Healthy People 2020 places renewed emphasis on determinants of health, health equity, and healthy development throughout all stages of life. By addressing determinants of health and promoting health equity and healthy development across the lifespan, Healthy People 2020 provides a framework for a society in which all people can be healthy-- both now, and for generations to come. For more information, go to healthypeople.gov.