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In the spring of 1997, we asked readers, "What
do you need to be healthy?" This was WellSpring's
first introduction of the concept "Determinants of Health" and marked a
shift in Alberta Centre for Well-Being's thinking about physical
activity, active living and health.
"Health Determinants" is the generic term given
to the full range of personal, social, economic and
environmental factors known to have a bearing on health1.
These factors, most of which fall outside the health care sector,
do not act in isolation; their complex interactions have a significant
impact on the health status of individuals and populations.
Between four and twelve health determinants are identified in
the literature, depending on the source. Health Canada's Population
Health Promotion (PHP)2 model is frequently cited,
and researchers agree that the following list of health determinants is
a well-documented starting point.3
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This issue of WellSpring emphasizes important
implications of health determinants for physical
activity and Active Living. Taking a national lead, the Coalition
for Active Living has recently published the Position Statement
on Physical Inactivity, which provocatively re-frames the problem of
physical inactivity from a personal to a public health perspective. The
paper calls for broader intersectoral strategies that balance
individual behavior change strategies with environmental strategies for
change. The Coalition's goal is to create social and physical
environments that foster greater physical activity participation for
all.
Our Research Corner focuses on the influence of
income, one of the most challenging determinants, for physical activity
participation of Albertans. Of interest to practitioners, Tish
Doyle-Baker reflects on the usefulness of the health-determinants
concept for educating fitness leaders, and poses important
questions about future leadership training programs that build
on this perspective. At the organizational level, Rick Turnbull,
shows how the Canadian Intramural Recreation Association strives
to make policy and practical links between intramurals, recreation and
determinants of health. Emma Smith explores the challenges of
biological-based barriers and affirms the benefits of being active,
despite limiting conditions or disabilities. Sandy
O'Brien Cousins identifies the physical activity patterns and
health status of North American minority groups. Highlighting
gender and culture, Sandy suggests that the restoration
of active traditions may be the key to promoting healthy
Active Living within diverse population groups in contemporary
times. Last, our Snapshots highlight exemplary
provincial and national research projects that tackle the influence
of health determinants in the workplace, for low-income women,
families living on welfare, and for recreations programs, facilities
and services country-wide.
Health Determinants is a challenging concept to
incorporate into traditional thinking and practice around physical
activity and Active Living where the behavioral approach is especially
entrenched. Evidence-based and community driven, however, this
perspective reflects the new way of doing business in health promotion.
Ideally, by working across the many determinants or by simply adding
one or more (beyond personal health practices and coping skills) to our
professional practice, we improve the chances of creating and
sustaining a physically active
way of life for all.
Check the Implications for Practice
boxes throughout this issue to get you started thinking about health
determinants where you work, volunteer and play.
Suggested reading
For more information about the determinants of health, see the
following readings:
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Hamilton, N. &
Bhatti, T. (1996). Population health promotion: An integrated
model of population health and health promotion. Ottawa,
ON: Health Canada.
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On ecological perspectives read
Sallis, J.F. & Owen, N. (1996). Ecological Models in K. Glanz, F.M.
Lewis & B.K. Rimer (Eds.), Health behaviour education: Theory,
research and practice 2nd
ed. (pp. 403-424). San Francisco: Jossey-Bass Publishers.
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Green L.W., Richard, L. &
Potvin, L. (1996) Ecological Foundations of Health Promotion. American
Journal of Health Promotion, vol. 10 (4): 270-281. Special Issue on
Social Ecology.
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Frankish, C. J., Milligan, C. D.,
& Reid, C. (1998). A review of relationships between active living
and determinants of health. Social Science and Medicine. 47
(3):287-301.
References
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Twelve Determinants of Health
Income and Social Status
Adequate income is related to better health. People with more income
can afford better housing, food, clothing and necessities
than people with low income. Individuals from high income/status
households have different socialization experiences than those living
in low income/status households. Research shows that income can affect
health by increasing opportunities, choices and a sense of control
in one's life. Health improves with each step up the income and social
ladder.
Social Support Networks
A social support network
means having family, friends and community resources available to
provide both encouragement and help in accessing resources. To increase
their health, people need to be in contact with others. Communities
give people a sense of belonging, plus opportunities to give and
receive help.
Education and Lifelong Learning
All individuals should
have access to educational opportunities that help them achieve
their personal goals and contribute to society. Education improves
our health by providing us with greater access to information or
problem
solving skills, and by increasing opportunities for better jobs and
job security.
Employment and Working Conditions
People spend a great
part of their lives working. A person's employment history and benefits
received has a major impact on the resources available to them during
retirement. Unemployment and underemployment are both associated with
poorer health, as is work-related stress and job insecurity.
Social Environments
The importance of social
support also extends to the broader community. Civic vitality refers to
the strength of social networks within a community, region, province or
country. It is reflected in the institutions, organizations and
informal giving practices that people create to share resources
and build attachments to others.
Physical Environments
Physical environments
include both the natural (the outdoors) and built or "man-made"
settings (buildings, cities, communities, etc.). Factors in each of
these settings such as pollution of air, water or soil, crowding, road
design, and safety features are important influences on health.
Environments where we live, work and play should be free of hazards and
toxins, and be health promoting.
Biology and Genetic Endowment
The basic biology and
organic make-up of the human body are a fundamental determinant of
health. Genetic endowments are the physical qualities or traits and
pre-dispositions toward certain diseases or conditions that are
inherited through one's genes. An individual's genetic endowment along
with the biological differences between the sexes influences health
on an individual and population basis.
Personal Health Practices and Coping Skills
Personal health practices
include the things we do to prevent disease and optimize good health
such a nutritious diet, exercise, and avoidance of harmful substances.
Coping skills are how we deal with stress such as the pressures of
life, personal relationships, and health conditions. Environments and
opportunities that promote positive personal health practices and
coping skills allow up to make healthy choices and assist us in dealing
with the pressures of life.
Healthy Child Development
The promotion of health
and well-being for life has its roots in early childhood. The effect of
pre-natal and early childhood conditions and experiences on subsequent
health, well-being, coping skills and competence is powerful. Habits
and patterns established early on contribute to later health status,
making it important to provide an positive supportive environment for a
child's growth and development.
Health Services
Health services help
to take care of an individual's mind and body. Some examples are
counseling services, clinics and hospitals. The health care system
is concerned with the maintenance and enhancement of health, as
well as treatment and rehabilitation. Health services that promote
and maintain health and prevent disease can influence the overall
health of a community.
Gender
Gender refers to the
array of socially constructed identities, personal qualities and
traits, attitudes, behaviors, values, relative power and influence
that society ascribes to the two sexes on a differential basis, with
differing results. Gender roles are learned, reinforced and reproduced
through socialization in the family, other institutions and cultural
values. "Gendered" norms influence the health system's practices
and priorities. Many health issues are a function of gender-based
social status or roles. For example, until recently, researchers knew
more about causes and treatments for heart disease in men than for
women, which are less researched and understood.
Culture
Peoples' customs, traditions, and the beliefs of their family and
community all affect their health. Some
persons or groups may face additional health risks due to an
environment which is largely determined by dominant cultural values
that contribute to the perpetuation of conditions such as
marginalization, stigmatization, loss or devaluation of language and
culture, and lack of access to culturally appropriate health care and
services.
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