Multiple Determinants Of Health Research Articles

Evolving views of disability and public health: The roles of advocacy and public health

Promoting health, quality of life, and participation of persons with disabilities is a relatively recent development in public health. Its brief history reflects three distinct public health perspectives toward disability—a traditional approach that focuses on preventing disability, a contemporary approach that regards disability as a minority group experiencing disparities relative to people without disabilities, and an emerging perspective where disability status is considered one of multiple determinants of health. The field of disability and health has been influenced by the interaction of disability advocacy with the public health process of surveillance, epidemiology research, and intervention. Advocacy draws on political and legal arguments to press for action on issues such as health care access, control of services, and choice of residence. Public health uses surveillance to document magnitude of problems; epidemiology to identify specific groups, develop measures, and apply rigorous research methods; and intervention to improve health behaviors and health outcomes. The field of disability and public health, however, has lagged in addressing the role of environmental factors in the disabling process, in moving to societal participation as an outcome, and in implementing population scale interventions.

Childbirth and mental disorders

This review approaches the topic of childbirth and mental illness using a model of perinatal health which takes into consideration the multiple determinants of health, approached from a lifespan perspective. The paper seeks to answer four broad questions using this model and available literature: (1) What is the relationship between childbirth and mental disorders? (2) How common are mental disorders during childbearing, and what is the perinatal course of illness? (3) What are the effects of mental illness during childbearing on foetal and infant developmental outcomes? (4) How do you approach the detection and treatment of mental disorders during the perinatal period?

Data and measurement issues in the analysis of health disparities.

To describe measurement challenges and strategies in identifying and analyzing health disparities and inequities. We discuss the limitations of existing data sources for measuring health disparities and inequities, describe current strategies to address those limitations, and explore the potential of emerging strategies. Larger national sample sizes are necessary to identify disparities for major population subgroups. Collecting self-reported race and granular ethnicity data may reduce some measurement errors, but it raises other methodological questions. The assessment of health inequities presents particular challenges, requiring analysis of the interactive effects of multiple determinants of health. Indirect estimation and modeling methods are likely to be important tools for estimating health disparities and inequities for the foreseeable future. Interdisciplinary training and collaborative research models will be essential for future disparities research. Evaluation of evolving methodologies for assessing health disparities should be a priority for health services researchers in the next decade.

Different Setting, Different Care: Integrating Prevention and Clinical Care in School-Based Health Centers

School-based health centers (SBHCs) are widely credited with increasing students' access to care by making health services affordable and convenient. SBHCs can also provide a qualitatively different type of health care for children and adolescents than that delivered by community providers. Health services offered in a school setting can integrate clinical care with public health interventions and environmental change strategies. This ability to reach outside the walls of the exam room makes SBHCs uniquely positioned to address the multiple determinants of health. We describe innovative California SBHC programs focusing on obesity prevention, asthma, mental health, and oral health that represent new models of health care for children and adolescents.

The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, Canada) to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions.

A review of the strengths and weaknesses of quantitative methods used in health impact assessment

To explore some of the strengths and weaknesses of purely quantitative approaches used in health impact assessment (HIA) and the implication of this for policy making. The studies presented generally used a variety of quantitative risk assessment (QRA) methodologies. For each population, concentration-response (CR) or exposure-response (ER) functions, typically expressed as percentage change in health effect per unit change in concentration or exposure, were applied to estimates of population exposure and background rates of morbidity and mortality in order to calculate the attributable health impact or burden. In some cases, this burden was then costed according to standard economic models. In most of the studies discussed, where a reliable CR or ER relationship was available, it was possible to quantify the impact(s) of the relevant environmental stressors on health, and to estimate the associated uncertainties. QRA has an important role in producing estimates for the health impacts of those risk factors where there is a sufficient base of research to quantify relationships between population exposure and health, and to predict the effects of policies on population exposure. However, quantified HIA is not an infallible process and can give an illusion of certainty that belies the complexity of the interactions involved, particularly where multiple determinants of health are likely to be affected. It is important that any uncertainties associated with that which has been quantified, as well as the likely impacts of that which cannot be quantified, are assessed and represented comprehensively. A simplistic application of QRA estimates is an inadequate HIA, as it may encourage policy makers and others to attach more importance to those impacts that are easier to quantify but which do not necessarily have the greatest associated burden.

Analysis of associations between mortality and biological and social-economic individual determinants

Health impact assessment is an internationally recognized tool for informed decision-making. The authors participated in building statistical models for assessing the health effects of decisions made inside and outside the health sector. They used logistic regression to investigate the role of individual factors like gender, age, education and economic activity determining the all-cause mortality and diseases of circulatory system and neoplasm as well. The results of statistical modelling proved that gender, education and economic activity modify the effect of age on mortality in multiple interactions. Since several factors have impact simultaneously on mortality, modifying the others' effects, analyzing these associations only by use of multivariate statistical methods is an adequate approach. Models presented in this article can be starting points for investigations exploring the effects of multiple health-determinants and researches in which also social-economic determinants are included in health impact assessment.

Health and environment in the context of urbanization

This paper introduces a series of research projects designed to fulfill the societal role of environmental health studies by investigating (1) the dynamic and complex relationships between environmental conditions and (2) health in an urban setting. Research in this first category has revealed the existence of the combined influence of multiple physical environmental factors on health and its mechanisms. In the second category, there have been a number of studies of the integrated influence of social environmental factors on health employing an aggregate modeling of multiple determinants of health and studies of individual topics related to social determinants of health. These research projects have contributed to the formulation of specific remedies and the development of comprehensive health policies. Participatory approaches have been used to enhance capacity building opportunities and to ensure that research results reflect the actual conditions in urban societies. Healthy Cities projects and programs have been developed in close collaboration with this type of research. Urban societies have become interdependent and share the same issues globally. Further research into the relationships between health and the environment in the context of urbanization will expand the base of evidence applicable to the complex realities in modern societies.

The determinants of policy for population health

Many advocates of policy to implement the findings of research on the multiple determinants of health accord scant attention to the determinants of health policy in democratic countries. The principle determinants of the allocation of scarce resources to improving health include: the priorities of voters; the diffusion of responsibility for improving health; the absence of evidence about matters of consequence to policy makers; the arraying of some evidence in ways that frustrate policy making; resistance to addressing determinants other than clinical services and traditional public health practices among many professionals in these fields, as well as by industries that supply the health sector; and the special political influence of persons who suffer serious chronic disease and of members of their families.

An Overview of Managerial Economics in the Health Care System

Introduction. Some Basic Economic Concepts. The Demand for Health Insurance. The Changing Health Care Market. The High Cost of Health Care. The Multiple Determinants of Health. Integrated Delivery System. Measuring Costs. Connecting Value and Cost: Cost-Effectiveness Analysis. Conclusion.

Social science education as a component of medical training

The broad view of health espoused by the World Health Organization is now generally accepted by medical educators. Implicit in the new paradigm is a recognition of multiple determinants of health and of shifting divisions of professional responsibilities among providers. As a consequence, the importance of social and behavioural science education as a foundation to medical training is increasingly appreciated. At the same time medical programmes are under pressure to contend with the explosion of knowledge in basic biomedical and life sciences and with technological innovation. Curricula are being submerged in facts, causing medical schools to look for innovative teaching models that feature more flexible approaches to the diverse body of knowledge supporting professional practice. Independent learning methods are being explored and revised teaching programs are being organized around coordinating themes, such as aging, human development and environmental health. Future programmes must be designed to encourage multiprofessional approaches while fostering awareness of the important interplay between health care (both curative and preventive) and social/behavioural science. Within the curriculum students should be offered options that include sociology, child growth and development, gerontology, medical anthropology, psychology, medical geography, health economics, political science and related subthemes. More important than the inclusion of any specific discipline is the creation of an environment in which future physicians may be exposed to critical thinking across a wide range of themes that characterize the social and cultural context for medical practice. Such enquiry is also likely to drive a closer relationship between medical schools and their parent universities within which the social science expertize resides. Success will see a welcome development from a symbiotic relationship to one which is more clearly synergistic with the potential to stimulate broad improvements in health services. The goal of improved training in social and behavioural sciences is important to the future of medical education as well as to the public's health and it is essential that leadership emerge at this time.