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PubMed1993

Health behavior, knowledge and attitudes among Swedish university students.

A range of health behaviors was related to beliefs concerning health practices and health knowledge. A questionnaire dealing with health-related practices, health beliefs and knowledge of health risk factors was answered by 166 male and 179 female students aged 18-30 years at Stockholm University. Female students reported engaging in better health behavior than males. Beliefs about the importance of health behaviors were closely related to their frequency of occurrence. There was only a weak relationship between health behaviors and knowledge of specific health matters. It is concluded that health attitudes rather than health knowledge determine health behavior.

Adolescent↗
PubMed2006

Achieving a "broad view of health": findings from the California Healthy Cities and Communities Evaluation.

Promoting a "broad view of health" is an important objective of the healthy cities movement, including recognition of the powerful role that social relations and living conditions play in the health of community members. This article presents a quantitative approach to assessing consensus and change in ideas about health determinants among local coalition members. A ranking of five determinants of health in the form of paired comparisons was included in a survey of coalition members of 20 local healthy communities projects in California. Findings revealed conflicting views among members in the planning year, with some respondents emphasizing the role of social factors and living conditions and others emphasizing the role of health care and lifestyle decisions. Data collected at the end of the funded intervention showed movement toward a broader view of health, with greater consensus on this view in select communities.

California↗
PubMedDate not supplied

[Equity and fairness in the Mexican health system reform].

OBJECTIVE: To assess the equity and fairness of the Mexican health system reform that occurred in the late 1990's. MATERIAL AND METHODS: The Mexican reform process was evaluated using the benchmark-system designed by Daniels et al. This benchmark system was adapted to the Mexican setting by adding specific indicators. A documentary review of the Mexican reform process was conducted to score its performance for each benchmark. RESULTS: Except for housing and nutrition components, the reform included few actions related to health determinants. For health care, the main reform initiatives were those related to extending the coverage of essential health services and decentralizing health care provision to the states. Reform initiatives included few activities related to fair financing, tiering, emphasis on second and third level care, accountability, and transparency. CONCLUSIONS: The late nineties reform of the Mexican health system had some positive effect on access of the poor to health care and administrative efficiency, but little impact on fair financing, quality of care, and democratic governance. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Adolescent↗
PubMedDate not supplied

A strategy for developing environmental health indicators for rural Canada.

Our understanding of and ability to describe rural health conditions can be considerably enhanced by the use of rural health indicators which allow us to compare rural and nonrural areas or areas differentially located on the urban-rural continuum in terms of various health conditions. However, while health indicators abound, there are very few that can be used to describe the health conditions of rural Canada. This paper discusses the concepts of health in a rural context and adopts a broad definition of health that goes beyond the mere absence of disease or impairment. We propose five broad categories of health indicators: health status indicators, health determinant indicators, health behaviour indicators, health resource indicators, and health service utilization indicators. The most commonly used health indicators in Canada and the datasets from which they are derived are examined in order to assess their applicability to "communities" or "regions". This review highlights the strengths and limitations of various datasets and indicators and their applicability to the "community" and "regional" scale for rural environments. Finally, challenges in data availability and use are discussed as they relate to rural health indicator development.

Canada↗
PubMed2002

Exploring the determinants of health for First Nations peoples in Canada: can existing frameworks accommodate traditional activities?

While much research has examined First Nations peoples' health in Canada, few studies have explored the role of traditional activities in enhancing health. Using data from the 1991 Aboriginal Peoples Survey (APS), this paper incorporates a set of measures of traditional activities within a determinants of health framework for understanding First Nations peoples' health. Results from the analyses undertaken show that many of the determinants of health identified in analyses of the Canadian population in general hold for First Nations peoples. While only a few statistically significant relationships between health status and traditional activities were identified, taking into account the limitations of the APS and other conceptual issues, we argue that there is the potential to move from the analysis of traditional activities to a more nuanced analysis of cultural attachment.

Adolescent↗
PubMed2005

Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education?

BACKGROUND: Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health. METHODS: The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity. RESULTS: Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education. CONCLUSIONS: Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood.

Adolescent↗
PubMed2002

Addressing social determinants of health through community-based participatory research: the East Side Village Health Worker Partnership.

The authors describe the use of a stress process model by the East Side Village Health Worker Partnership (ESVHWP), a project of the Detroit Community-Academic Urban Research Center, as a framework for understanding social determinants of health. Specifically, the authors describe the development by the ESVHWP Steering Committee of a context-specific stress process model for east side Detroit residents. The authors examine data from in-depth interviews to illuminate actions taken by community members to reduce stressors or minimize their impact on health. Finally, the authors describe the use of this context-specific stress process model and data gathered regarding actions to address community stressors to inform the development of interventions by the ESVHWP to reduce stressors or strengthen the conditioning factors that reduce the impact of stress on health. On the basis of these results, the authors discuss opportunities and challenges for partnership approaches to addressing social determinants of health in urban communities.

Adult↗
PubMed2001

Public health advocacy--determining a role for staff of a public hospital.

This study explored the public health advocacy role of staff employed at a major South Australian specialist public hospital that had made an organisational commitment to health promotion. It was concluded that staff did have a role to play in public health advocacy, though the issues pursued primarily related to disease and injury prevention rather than the broader social determinants of health. Staff gained valuable experience in the political processes of public health advocacy. The hospital had to develop organisational infrastructures to support staff so they could undertake public health advocacy on behalf of the hospital. It was also necessary for the hospital to implement other changes in order to 'get its own house in order' before issues could be addressed in the broader community.

Community Health Planning↗
PubMedDate not supplied

From concept to practice: including the social determinants of health in environmental assessments.

The present paper examines the historical evolution of health impact assessments as part of the environmental assessment process. The development of a coherent public health framework must be based on the model of determinants of health, integrating toxic and infectious risks and social impacts of projects. The integration of common concepts, processes and methodologies from the area of public health and social impact assessment challenges the quantitative model approach to risk assessment. The expert-driven risk assessment is transformed into a social learning process where local knowledge and scientific input foster a dialogue among stakeholders. The issue-oriented, iterative and participative assessment process may be applied to the health impact assessment of public policies. Sustainable development with its social objectives of empowerment, participation, equity, poverty alleviation, social cohesion, population stability and institutional development is an appropriate framework for conducting health impact assessments.

Canada↗
PubMed2003

Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canada.

Despite Canada's reputation as a leader in health promotion and population health concepts, actual public health practice for the most part remains wedded to downstream strategies focussed on behaviour change. In Canada's largest province this has led to the implementation of a heart health promotion approach focussed on diet, activity and tobacco use. This is so despite increasing evidence that these approaches are generally ineffective, particularly for those at greatest risk. In addition, these strategies appear to divert public and governmental attention away from addressing the broader societal determinants of health. Examples of Ontario public health units that have begun to address societal determinants of health provide a counterbalance to the dominant paradigm that frames health as an individual responsibility. These new approaches focus attention upon the health-threatening effects of governments' regressive social and economic policies in a manner consistent with the best principles of health promotion.

Cardiovascular Diseases↗
PubMed2000

Social determinants of health in Canada's immigrant population: results from the National Population Health Survey.

As part of the Metropolis project--a large-scale investigation of immigration and integration, including well-being of immigrants in a number of areas of social life--in this paper we investigate the social determinants of health in Canada's immigrant population using Canada's National Population Health Survey (NPHS). Specifically, we examine differences in health status and health care utilization between immigrants and non-immigrants, immigrants of European and non-European origin, and immigrants of < 10 years and > 10 years' residence in Canada. We also examine social determinants of health care utilization and health status in immigrants and non-immigrants, and evaluate the utility of large-scale, national databases for these purposes. Our conceptual approach draws upon a 'population health' perspective, which suggests that the most important antecedents of human health status are not medical care inputs and health behaviours (smoking, diet, exercise, etc.), but rather social and economic characteristics of individuals and populations. We find no obvious, consistent pattern of association between socio-economic characteristics and immigration characteristics on the one hand, and health status on the other, in the NPHS data. This does not mean that socio-economic factors in Canada are not influential in shaping immigrants' health status. In fact, the results of the logistic regression models calculated for immigrants and non-immigrants on four outcome variables in this study suggest that socio-economic factors are more important for immigrants than non-immigrants, although in ways that defy a simple explanation. The complexity of immigrants' experiences, combined with the inherent limitations of cross-sectional survey data are discussed as major limitations to this kind of research.

Adult↗
PubMed1996

Determinants of health of North-American adolescents: evolving definitions, recent findings, and proposed research agenda.

The recent literature on the determinants of adolescent health is reviewed. Four definitions of adolescent health are presented: successful transition to adulthood, successful coping, lack of mortality and morbidity, and healthy behaviors and risk avoidance. The review of determinants of health is presented within a framework focused upon adolescent characteristics, aspects of adolescents' immediate environments, and adolescents' ongoing activities and aspirations. An expanded framework which considers societal and structural factors and adolescent health is considered and a proposed research agenda presented.

Adaptation, Psychological↗
PubMed1994

An investigation to determine the health status of institutionalised street children in a place of safety in Durban.

This study determines the health profile of institutionalized street children in a Place of Safety in Durban. Fifty black street children who had been institutionalized for a period of not more than fourteen days were interviewed and health assessments were carried out. The children's weights and heights were recorded on growth charts and structured interviews were held. Generally the children were found to be deprived, both socially and physically. Minor health problems were common and some had more serious problems. Recommendations for effective primary health care are put forward.

Adolescent↗
PubMed2003

The determinants of health: structure, context and agency.

The concept of social structure is one of the main building blocks of the social sciences, but it lacks any precise technical definition within general sociological theory. This paper reviews the way in which the concept has been deployed within medical sociology, arguing that in recent times it has been used primarily as a frame for the sociological interpretation of health inequalities and their social determinants. It goes on to examine the contribution that medical sociologists have made to the debate over health inequalities, giving particular attention to contributions to Sociology of Health and Illness. These have often provided a focus for discussions outside or critical of the mainstream debates that have been driven primarily by epidemiologists. The paper reviews some of the main points of criticism of epidemiological approaches, focusing in particular on the methodological constraints that limit the capacity of epidemiologists to develop more theoretically satisfactory accounts of the inter-relationships of social structure, context and agency in their impact on health and well being. Some recent examples from the Journal of more theoretically innovative and analytically fine-grained approaches to understanding the impact of social structure on health are then explored. The paper concludes with an argument for a more historically-informed analysis of the relationships between social structure and health, using the knowledgeable narratives of people in places as a window onto those relationships.

Epidemiology↗
PubMedDate not supplied

Enhancing mastery and sense of coherence: important determinants of health in older adults.

The purpose of the study was to expand existing knowledge of the determinants of health for community-dwelling young-old and old-old people. A subsample (n = 2413) from the Health Canada Supplement to the 1994 National Population Health Survey was analyzed. The factors examined were biographic attributes, sociodemographic indicators, sense of coherence (SOC), mastery, self-esteem, informal social support, and use of health care services. Hierarchical regression analyses revealed that mastery and SOC were strongly related to health status and perceived health. Strategies discussed herein will help practitioners ensure that older adults' mastery and SOC are supported and enhanced.

Adaptation, Psychological↗
PubMed1980

China's health system: determinants.

This paper seeks to examine and explain the changes in China's health policy since 1949. It attempts to clarify the role of various determinants in the health policy-making process in various stages of China's development and discover what forces propelled the shifts in health policies and campaigns. Various social, economic and political forces are discussed as they bear on the evolution of China's health policies, and the fate of Maoist vs. pragmatic tendencies is assessed.

China↗
PubMed2006

Determinants of health plan membership among patients in routine U.S. psychiatric practice.

This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders.

Adult↗
PubMed2003

Determining public health priorities for an ageing population: the value of a disability survey.

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.

Aged↗