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PubMed1985

[Factors determining health practices: prenatal care in rural and urban environment].

A 1978 study of prenatal care patterns in one area of France showed that frequent visits to specialists was the dominant pattern in urban areas, whatever the socioeconomic characteristics, or conditions of health, of the women. In rural areas, however, the patterns adopted varied markedly according to health problems encountered during pregnancy. In the absence of illness, 64% of rural women went to their general practitioner for a reduced number of prenatal visits; when health problems were perceived, however, their practices became more similar to those of city women. These variations remained after allowing for socioeconomic and cultural differences. Overall, patterns adopted varied significantly according to area of residence.

Adult↗
PubMed1994

[Research on factors determining health: role of the environment in the 21st century].

During the next few decades, actions on matters dealing with environmental pollution will have to be aimed at: 1) eliminating environmental contaminants at the source; 2) identifying biomarkers of exposure and/or adverse health effects; 3) improving our skills at assessing the probability of occurrence of adverse health effects in the community; and 4) informing the Canadian public in a responsible manner. Primary sources of pollution related to human activities should be our deep concern: utilization of energy sources, particularly fossil fuels; agricultural activities, such as deforestation and use of fertilizers and pesticides; and industrialization, responsible for the synthesis of numerous new molecules. Clinical investigators will be faced with rare disease entities characterized by low-level, long-term exposure via food, air, water and soil, and low-incidence responses (e.g. cancer, neurotoxicity, reproductive failure, immunotoxicity). Epidemiologists and toxicologists will be pressed, by the Canadian public, to answer questions regarding the probability of occurrence of health effects as a result of exposure to environmental contaminants. Collectively, as scientists, our attitudes will have to change drastically; high in the order of importance is the need to communicate with the public and to diligently inform our fellow citizens about the relationship between health and environment. In doing so, we might find allies to support our claim that health research in Canada deserves much better support.

Canada↗
PubMed1993

The Butajira project in Ethiopia: a nested case-referent study of under-five mortality and its public health determinants.

During one year of follow-up, 306 deaths of children under the age of 5 years were included in a concurrent case-referent study that was based on a population estimated at 28,780 in 1987. A total of 612 live referents, matched for age, sex and study area, were also selected from the study population through density sampling. Data were collected by lay reporters by verbal autopsy. For the study period the estimated cumulative under-five mortality rate was 293 and the infant (0-11 months old) mortality rate was 136 per 1000. Major probable causes of death were diarrhoeal disease or acute respiratory infections (ARI). The relative importance of parental and environmental characteristics was assessed using conditional multiple logistic regression analysis. Under-five mortality was associated with paternal illiteracy, maternal ethnicity, and not being in the committee of people's organizations. Parental factors affected the infants relatively more than they did the children, especially with regard to ARI mortality. This was also noted with "absence of window", a proxy measure for evaluating the type of housing. In terms of etiological fractions a greater number of under-five deaths could be ascribed to parental than environmental conditions, with relatively more infants being affected than children.

Case-Control Studies↗
PubMedDate not supplied

Young parents' understanding and actions related to the determinants of health.

Broad health determinants are accepted as key contributors to health; however, little is known about the public's understanding of these determinants. We describe the results of a survey of young parents (18-30 years) in Alberta regarding their understanding of determinants of health, and their actions (planned or undertaken) in promoting well-being and health for themselves, their families, and their communities. A telephone survey of young parents (N = 652) was conducted, using both open-ended and fixed response questions. In the open-ended responses, social support networks (46%) and personal health practices (40%) were most often cited as contributors to family well-being and health and as current actions (62% and 54% respectively). Health services were rarely mentioned as a contributor. Most frequently mentioned barriers to well-being and health related to income (36%) and coping skills (34%). Sub-sample differences by gender, age, income, and residence were detected. Fixed response questions indicated that parents rated a broad range of health determinants as "very important."

Adult↗
PubMed2003

Evolution of the determinants of health, health policy, and health information systems in Canada.

The history of health determinants in Canada influenced both the direction of data gathering about population health and government policies designed to improve health. Two competing movements marked these changes. The idea of health promotion grew out of the 1974 Lalonde report, which recognized that determinants of health went beyond traditional public health and medical care, and argued for the importance of socioeconomic factors. Research on health inequalities was led by the Canadian Institute for Advanced Research in the 1980s, which produced evidence of health inequalities along socioeconomic lines and argued for policy efforts in early child development. Both movements have shaped current information gathering and the policies that have come to be labeled "population health."

Canada↗
PubMed2001

Parish nurses influencing determinants of health.

How are the concepts health, health promotion, faith community, and health determinants connected? How can a nurse draw on the unique features of a faith community to promote health? In this article, we explore the relations among these concepts and consider the answers to these questions. Parish nurses provide a concrete example of the interactions among these concepts. They are often hired by faith communities to intentionally promote health within and beyond the faith community. Increasingly, faith communities are being used as settings for health promotion interventions. We describe examples of how a parish nurse can influence 2 determinants of health: social support and healthy child development.

Adult↗
PubMed2000

[Evolution of socioeconomic determinants of health in childhood in the city of São Paulo, Brazil (1984-1996)].

OBJECTIVE: Two consecutive household surveys undertaken in the mid-80s and mid-90s in the city of S. Paulo, Brazil, made possible to establish time trends of several child health determinants and indicators as well as to analyse the relationships among them. The study intends to report trends in socioeconomic determinants of child health. METHODS: Random samples of the population aged from zero to 59 months were studied: 1,016 children in the period 1984-85 and 1,280 children in 1995-96. Both surveys investigated the family's per capita income and the mother's years of schooling. Nominal incomes were deflated according to the National Consumer Prices Index and expressed as values of October 1997. RESULTS: From mid-80s to mid-90s average family income doubled and the proportion of low income families was reduced by 50% while average maternal schooling increased by 1.5 years and maternal illiteracy was almost eradicated. Income concentration increased in the period. CONCLUSIONS: Increases in income and schooling are higher than those reported for the whole population in the country, which may be attributed to selective declines in fertility among the city's poorest families. The influence that changes in family income and maternal schooling may have exerted on several child health indicators is examined in subsequent articles.

Brazil↗
PubMed2000

[Evolution of environmental determinants of health in childhood in the city of São Paulo, Brazil].

OBJECTIVE: Two consecutive household surveys undertaken in mid-80s and mid-90s in the city of S. Paulo Brazil, made possible to establish time trends of several child health determinants and indicators as well as to analyse the relationships among them. The study intends to report trends in environmental determinants of child health. METHODS: Random samples of the population aged from zero to 59 months were studied: 1,016 children in the period of 1984-85 and 1,280 children in 1995-96. Both surveys investigated several housing characteristics--materials used in the building, size, occupation density, existence of shower, toilet, running water in the kitchen, and the presence of smoker dwellers--as well as access to water supply, sewage, garbage disposal and pavement of public areas. RESULTS: Improvements from mid-80s to mid-90s are observed regarding both housing characteristics and the implementation of basic services public services. The only indicator showing no improvement was the proportion of children living in slums, near 12% in both surveys. However, housing characteristics in slums showed an impressive improvement in the period between the surveys as well as the access of this population to water supply and garbage disposal services. CONCLUSIONS: Improvements in housing characteristics are consistent with increases in the purchasing power reported in the same period. The expansion of public basic services resulted from both public investments and a significant reduction in population growth. The noticeable increase in the coverage of water supply and garbage disposal in the slums indicates a more equitable delivery of the basic services. The same trend was not seen regarding sewage and street paving, which are not widespread in slum areas. The influence that changes in the physical environment may have exerted on several child health indicators is examined in subsequent articles.

Brazil↗
PubMed2005

Ethnic variation in health and the determinants of health among Latinos.

The purpose of this research is to document and explain ethnic variation in health among Latino adults in the United States. Results of analyses of data pooled from the 1997-2001 National Health Interview surveys reveal that health patterns are clearly different among Latino ethnic groups. Mexicans have health advantages, whereas Puerto Ricans experience health disparities. Cubans and Dominicans reveal a mix of health disparities and advantages, depending on the health outcome. The effects of social determinants of health are also contingent upon ethnicity. For example, worse health is associated with higher levels of socioeconomic status (SES) and acculturation among Mexicans, but with lower levels of SES and acculturation among Latinos whose origins are from Caribbean islands. We conclude that racial/ethnic comparative health research should avoid pan-ethnic groupings, and explicitly acknowledge ethnic group distinctiveness.

Acculturation↗
PubMed2003

The New York State Minority Health Survey: determinants of oral health care utilization.

OBJECTIVES: To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State. METHODS: The Minority Health Survey was a one-time, statewide, random digit-dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult "minority" population. RESULTS: About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18-25 years vs age 40 years or older), being married (adj OR=1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness-related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met. CONCLUSION: Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.

Adolescent↗
PubMed1998

Wealth, equity and health care: a critique of a "population health" perspective on the determinants of health. Critical Social Science Group.

In this paper we examine the recent ascendancy of a "population health" perspective on the "determinants of health" in health policy circles as conceptualized by health economists and social epidemiologists such as Evans and Stoddart [Evans and Stoddart (1990) Producing health, consuming health care. Social Science & Medicine 31(12), 1347 1363]. Their view, that the financing of health care systems may actually be deleterious for the health status of populations by drawing attention away from the (economic) determinants of health, has arguably become the "core" of the discourse of "population health". While applauding the efforts of these and other members of the Canadian Institute for Advanced Research for "pushing the envelope", we nevertheless have misgivings about their conceptualization of both the "problem" and its "solutions", as well as about the implications of their perspective for policy. From our critique, we build an alternative point of view based on a political economy perspective. We point out that Evans and Stoddart's evidence is open to alternative interpretations--and, in fact, that their conclusions regarding the importance of wealth creation do not directly reflect the evidence presented, and are indicative of an oversimplified link between wealth and health. Their view also lacks an explicit substantive theory of society and of social change, and provides convenient cover for those who wish to dismantle the welfare state in the name of deficit reduction. Our alternative to the "provider dominance" theory of Evans and Stoddart and colleagues stresses that the factors or forces producing health status, which Evans and Stoddart describe, are contained within a larger whole (advanced industrial capitalism) which gives the parts their character and shapes their interrelationships. We contend that this alternative view better explains both how we arrived at a situation in which health care systems are as costly or extensive as they are, and suggests different policy avenues to those enunciated by Evans, Stoddart and their confrères.

Canada↗
PubMed1995

Self-esteem and value of health as determinants of adolescent health behavior.

PURPOSE: To study the relationship between personality attributes and health behaviors and practices during adolescence. DESIGN: We have studied a total of 100 subjects aged 12-13 and 16-17 years of both sexes. To examine self-esteem and the value of health in a series of habitual practices of health, a stepwise multiple regression analysis was undertaken. The instruments used were the Gordon Personal Profile (GPP) (1978) to evaluate self-esteem, the Costa et al.'s (1989) Value of Health Scale to estimate the value of health and, the Rivas Torres (1991) Health Behavior Questionnaire to measure health behavior. RESULTS: Self-esteem explains 39% of the mental health behavior and 5% of the social health behaviors. Meanwhile, the value of health, in the case of security behaviors, explains 13%, and in relation to personal health behaviors, 9%. CONCLUSIONS: The importance assigned to certain personality attributes in relation to adolescent health behavior shows the need for additional investigations that incorporate other variables and subject groups with different ages.

Adolescent↗