PUBH1000 Lecture Notes - Lecture 4: The Who, Social Stratification, Hand Washing
MODULE 1: Health and social determinants
What is health?
• … a state of complete physical, mental and social wellbeing, and not merely the absence of disease or
infirmity. W(O,
• Dimensions of health:
- Physical
- Social
- Mental
- Spiritual
- Environmental
• Health – is a resource that permits people to lead individual, socially and economically productive lives.
It is a positive concept emphasising social and personal resources as well as physical capabilities
• Biological approach to health:
- explores the role of genes and risk markers and their interactions with other determinants of health
• Biomedical approach to health:
- sees health and illness in terms of an individuals medically defined pathology
• primary health care:
- community-based services based on the social model of health, guided by principles of equity,
acceptability, cultural competence, affordability, and universalism, and a commitment to community
and health development.
- Primary health care integrates essential health care made accessible at a cost that a country and
community can afford with methods that are practical, scientifically sound and socially acceptable as
well as essential services for health including water and sanitation, housing, shelter, freedom from
violence and adequate food.
Determinants of health:
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• Behavioural approach to health:
- Underpins the types of health promotion that focus on risk factors and lifestyle behaviours
• Determinants approach:
- Sees health and social problems in the context of broader social, structural and cultural conditions of
our society and informs public health and health promotion approaches
• Health promotion approach:
- The process of enabling people to take control over those factors that determine their health
• Public health approach:
- Social and political actions aimed at improving health, prolonging life and improving the quality of
life among whole populations through health promotion, disease prevention and other forms of
health intervention.
1. New public health: aims to learn from the political and practical experience of historical successes
and failures in public health to achieve higher standards of health, particularly of those who have
the least resources, to achieve a more just and socially responsible distribution of resources.
2. Ecological public health: emphasises relationships between the health of the planet and the health
of populations, demonstrating the essential interdependence of peoples health with the health of
the planet.
3. Population health: studies a wide range of other data sources to understand the health of whole
populations, alongside profiling health of people in local areas.
Further, population health emphasises the dual purpose of improving the health of the entire
population while targeting reduction of health inequities among population groups. IN order to
reach these objectives, population health studies the broad range of factors and conditions that
have a strong influence on peoples health to inform the work of health promotion and primary
prevention practitioners
Indigenous approaches – see that one cannot separate health from life, social and spiritual
relations and the environment
Sociological approaches – study health and illness from social, political, economic and
structural dimensions
Spiritual approaches – conceptualise health decision as the actions of a God or other
ethereal forces beyond the control of the individual
Cultural approaches – differ very widely. Most of the approaches listed here are based on
western systems but every culture has developed its own practices and beliefs about
health, illness and disease. In our multicultural, diverse world, all health practitioners
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need to become culturally competent and acquire knowledge about culturally safe health
care practices
Popular or lay approaches – people define health in different ways according to their
culture, experience and life situations. Health is related to personal expectations. Health
and illness are not either/or states because, in reality, people can feel quite healthy even
though they may be living with an illness.
Health equity?
• Equity is the absence of avoidable or remediable
differences among groups of people, whether
those groups are defined socially, economically,
demographically, or geographically.
• Health inequities therefore involve more than
inequality with respect to health determinants,
access to the resources need needed to improve
and maintain health or health outcomes
• Health equity: "attainment of the highest level of
health for all people." (healthy people 2020)
Kuhn’s cycle of paradigm shifts:
1. Natural science
Body
Behaviour
Mind
2. Mode drift
3. Model crisis
4. Model revolution
5. Paradigm change
1. Health is best described as – a productive individual, social and economic life
2. Enabling and facilitating individuals to take control over factors impacting their health is a key principle
of – health promotion approach
3. Health equity refers to - right to fair distribution of health services
4. The term used to describe measurable differences in attaining health it – health inequity
5. A persons access to money is an example of – health inequity
6. The structural drivers affecting health that form part of the commission on social determinant of healths
conceptual framework result from – social stratification and inequity
7. The social determinants of health are – fluid categories
8. What factors that affect health are more stable and less easily changed? – distal
9. Difficulty in gaining access to health care services is classified as an – intermediate determinant
10. What do Wilkinson and Marmot (1998, 2003) mean by the term social gradient? – lower socio-economic
conditions result in a shorter life expectancy for those higher up the socio-economic ladder
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