Determinants of Health
Web of factors jointly determine the health status of human populations
WHO definitions of Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (1948). Health permits a socially & economically productive life.
Determinants of Health Socio-economic (+ education) Food (access, safe) Water (access, safe) Sanitation Behavior Health Services Genetics
Evidence base for determinants Transport Food & Agriculture Housing Water Energy Industry Urbanization Waste Nutrition Radiation
Socio-economic determinants Poverty Poverty comes in many forms, often together: income, education, health, empowerment, gender Poverty in any of these categories is a major predictor of poor health Inverse is also true
Many forms of poverty Strong access to land and natural resources is associated with increased economic growth among rural poor in developing countries. The study behind the data in the map examined the status on access to land and natural resources in selected countries, and created an index on the degree of concern.
How do we measure Poverty? GDP (Gross Domestic Product)/capita: value of all goods and services produced in a country by nationals and foreign residents during one year divided by the mid year resident population of that year. GNP (Gross National Product)/capita: value of all goods and services produced in a country by the nationals in a country plus the income of nationals earned abroad divided by the mid year resident population of that year.
Indicators of poverty http://maps.grida.no/go/graphic/global-human-development-indicators
Food Minimum dietary energy needs for an adult: 1500 kcal per day ( ½ kg of rice, maize or wheat or 1½ kg of potato or cassava) 3000 kcal for those doing manual labor, or in extreme cold. Normal growth requires also proteins & vitamins & minerals
Food Supply World food production can support ~ 7 billion people (2010). Food production is NOT the problem (yet) An equitable distribution is required to achieve food security Food distribution to those in need is the issue http://maps.grida.no/go/graphic/food_production_index
Rainfall affects food supply In many countries with rural poor, agricultural products = major portion of GDP When agriculture suffers, so does GDP http://maps.grida.no/go/graphic/calorie- consumption-in-selected-regions-of-the-world- 1975-1995
5 Yr Child Survival Most vulnerable @ 6 months, when new food is introduced nutrient density must be high as their stomachs are small Exposed to new microbes, susceptible to infections 6 months to 5 years = most vulnerable times Mortality per 1000 births 3-9 9-24 24-44 44-120 120-390
Water Minimum 5 liters safe water/person/day Drinking, food prep, washing, cleaning In disasters, 20 liters per person per day prevents water borne disease Microbes, time and work to fetch water by women 1/5 of the world s population (1.3 billion) do not have access to safe water
Water Many people in developing countries do not have access to clean, safe water
Feces = major route of transmission of communicable diseases 40% of the world (2.5 billion people) do not have sanitation Sanitation needs to protect against fecal contamination & insects breeding on excreta. Using limited energy and water in resource poor environments Sanitation
Sanitation in urban settings Percentage of urban population using adequate sanitation facilities: connection to a sewer or septic tank system a pour-flush latrine a simple pit latrine or a ventilated improved pit latrine 100 96-99 88-95 70-87 12-69
Other Environmental Determinants Housing Occupation Traffic Air Climate Natural Disasters Deaths due to road traffic accidents, 2002
1.6 billion have precarious housing conditions Failing to protect against elements,violence or theft 49% of the world is urbanized more urbanization in higher income countries (78% in 2002) Housing
Rapid growth of urban poor The fastest growing population in low-income countries
Occupation Urban sector unemployment 50% in low income countries = 5% in Japan and Luxemborg Informal sector most to survive Occupational hazards and health risks
Climate & Natural Disasters Climate change related disasters are rising & disproportionately affect impoverished people http://maps.grida.no/go/graphic/number-of-flood-events-by-continent-and-decadesince-1950. Source: Millennium Ecosystem Assessment
Climate & Natural Disasters Climate change related disasters disproportionately affect impoverished people Sources: The Office of US Foreign Disaster Assistance (OFDA); The Centre for Research on the Epidemiology of Disasters (CRED); International Disaster Database, available www.cred.be/emdat; Université Catholique de Louvain, Brussels, Belgium http://maps.grida.no/go/graphic/people-affected-by-natural-disasters-in-africa-from-1971-to-2001
Climate & Natural Disasters Most large refugee camps are located far from large cities & have poor access to sanitation & fresh water http://maps.grida.no/go/graphic/no-shelter-refugees-sanitation-and-slums