What influences our health? The traditional medical model of health is based on healthcare. When I speak to medical students and doctors and ask them what's the relationship between health and healthcare, often the first reaction is to be surprised that health and healthcare are even different things. But after a while they explained to me that better healthcare leads to better health. In other words, healthcare is the determinant of health. Now, even the most generous calculations estimate the healthcare determines only a quarter of the population's health. I would go further and say there's my world, healthcare is what you do when public health has failed. Heart disease, peripheral arterial disease, type two diabetes meniscus. These are rolled conditions that could be avoided. If we had good public health, then we wouldn't need a healthcare system to treat these problems. So healthcare for me is a testament to our failure in public health. So what actually determines our health? Well, the answer is lots of things that sit outside the individuals control. Our social and economic situation has the greatest influence on my health status, about 50 percent. Countries have a the medical model. The public health approach is based on a social model in which healthcare is only one of many determinants. I'm going to introduce you to these wider determinants. The wider determinants of health include the social, economic, and environmental factors that have an impact on health. These factors determine the extent to which a population possesses that personal, physical, and social results to avoid disease and manage its health. Most are determined by circumstance, local and national policy as well as resource allocation. Perhaps the most prominent conceptualization of the wider determinants of health was proposed by Dahlgren and Whitehead in 1991. If you haven't already seen this, I'm sure you'll come across numerous versions of this figure over your public health career. Sometimes referred to as the policy rainbow. This framework presents the rage of individual, community, and societal factors that impact upon our health. It's identifies the opportunities on levels of which to intervene. Many of these factors are outside and individuals control yet some are not. This introduced us to an incredibly important debate in public health. The idea of determinism. It is true to say that as a professional, we espouse the idea of determinism more strongly than many of our clinical colleagues. Determinism in this context is the idea that people are products of their environment. Now this idea raises considerable criticism and particularly when I'm talking to doctors. We have to recognize that people have control over their lives, they make choices, and many of these choices may not prioritize long-term health. But what this gets to is whether we hold people responsible for their lifestyle choices. Some of my colleagues would disagree with my view on this and he was come to your in position. But my personal view is that one individual choice is constrained by circumstance. We have to recognize both wider determinants and personal lifestyle choice as part of the broader picture. We shouldn't blame people for making what we deemed poor choices. Yet we count absolved from our responsibility either. Now, at the center of the rainbow factors that really are predetermined and cannot be changed. These include our age, sex, and genetics. The surrounding layers present a range of potentially modifiable factors summarized as personal lifestyle, what you eat and drink, your physical activity and if you engage in risky behaviors. Sexual networks and communities or neighborhoods and communities engaged and throwing thing doesn't individual have positive interpersonal relationships. The physical environment in particular living and working conditions, housing, employment, sanitation, and nutrition. The widest socioeconomic cultural and environmental conditions including poverty, stigma, and cultural beliefs. So as healthcare, well it's here as but one determinant and one among many. The public health approach recognizes that improving health is not as simple as improving access to healthcare services, awesomely telling people to eat better or exercise more. The conditions in which you live and work our community and interpersonal relationships all contribute to your health outcomes. Dealing with these factors is in fact far more challenging than simply giving a tablet tool performing an operation as they lie outside your personal control or choice. However, the complexity of health within the public health model means there are many opportunities to improve outcomes across a population. The wider determinants of health are core to understanding public health. So I want to be sure that I clear. Let's walk through an example of the impact of the wider determinants on our health. Let's consider housing and its impact. Now, this it seems that the people in this example indeed have a stable roof over their heads and even this cannot always be taken for granted. People living in poor quality accommodation may be exposed to mold, dampness, cold, and poor insulation. This can lead to respiratory conditions such as asthma or infections. Whatever family can't afford to pay for heating a state known as fuel poverty, well, there in insecure housing living month by month. The stress and anxiety of not having a secure housing mass severe effects on mental health and well being just as much as physical health. Children growing up in poor housing conditions are more likely to have poor academic attainment and are with increased risk of unemployment and poverty. These intern or associated with poorer health outcomes. You'll notice this quickly becomes cyclical. Health is about far, far more than just healthcare services. The conditions in which we live, grow, and work have a huge role to play in improving our health and well-being. A recognition of their importance underpins public health as a discipline.
