THE DETERMINANTS
OF HEALTH
ThS. Nguyễn Thị Thanh Trúc
Lớp: YC (ĐHQG)
Mục tiêu bài học
Học xong bài này sinh viên có khả năng:
1. Trình bày được khái niệm các yếu tố ảnh hưởng sức
khỏe
2. Phân tích được mô hình các yếu tố ảnh hưởng sức
khỏe
3. Trình bày được tầm quan trọng của việc áp dụng các
mô hình đã học khi phân tích các vấn đề sức khỏe
2
Contents
1. Determinants of health definition
2. Models of determinants of health
3. Group discussion on the modern model
4. Applications of the modern model
5. 21st century determinants of health
3
1. Determinants of health
Many factors combine together to affect the health of
individuals and communities.
Whether people are healthy or not, is determined by
WHAT?
It is
Determinants of health
(XEM VIDEO)
4
1. Determinants of health
Điều gì tạo nên sự khác biệt?
Sinh học?
Nguồn: TS. Diệp Từ Mỹ. Bài giảng” Các yếu tố
Xã hội? xã hội ảnh hưởng tới sức khỏe” 5
Điều gì tạo nên sự khác biệt?
Sinh học?
Xã hội?
TFR = 4 TFR = 2
e0 = 53 năm e0 = 71 năm
Mức chết trẻ em: cao Mức chết trẻ em: thấp
Nguyên nhân chính chết trẻ em: tiêu Nguyên nhân chính chết trẻ em: tai
chảy, viêm phổi nạn thương tích
Nguồn: TS. Diệp Từ Mỹ. Bài giảng” Các yếu tố xã hội ảnh hưởng tới sức khỏe” 6
Điều gì tạo nên sự khác biệt?
Sinh học?
Xã hội?
Life expectacy at birth, 2014
Nguồn: TS. Diệp Từ Mỹ. Bài giảng” Các yếu tố xã hội ảnh hưởng tới sức khỏe” 7
1. Determinants of health
“The context of people‟s lives determine their health, and
so blaming individuals for having poor health or crediting
them for good health is inappropriate. Individuals are
unlikely to be able to directly control many of the
determinants of health.” (WHO)
Nguồn: http://www.who.int/hia/evidence/doh/en/. Truy cập ngày 11/5/2018 8
2. Wider Model 1991
Nguồn: Canadian Council on Social Determinants of Health (2015). A Review of Frameworks on the 9
Determinants of Health.
2. Wider Model 1991
• Most widely known and widely used of all models on the
determinants of health.
• Illustrates the influence of various factors on individual
health and well-being, beginning with the most
foundational (socio-economic, cultural and
environmental conditions) and extending to the most
malleable (individual lifestyle factors).
• Useful for explaining the concept of health equity to a
broad intersectional audience.
Nguồn: http://www.who.int/hia/evidence/doh/en/. Truy cập ngày 11/5/2018 10
2. Modern Model
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 11
2. Modern Model
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 12
3. Modern Model
• Group discussion (10 students/group)
• Duration: 30‟
• Presentation: 5‟ (select 5 groups randomly)
1. Genetics and biology
2. Individual behavior
3. Medical care
4. Social circumstances
5. Environment
• Summarize
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 13
3. Modern Model
1. Genetics and biology
+ Genetic: gender, gene
+ Body structure: height, weight, waist hip ratio
+ Body function: bone density, blood pressure, nutritional
status, biochemical function, sensory function, movement
and balance, strength and robustness, fitness
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 14
3. Modern Model
2. Individual behavior
+ Psychological assets: conscientiousness level, optimism,
life satisfaction, cognitive function
+ Negative mood and affects: stress, hopelessness,
anxiety, depression
+ Risk behaviors: sexual activity, motor vehicle behavior
+ Drug use: alcohol, tobacco
+ Sleep and diet patterns
+ Physical activity
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 15
3. Modern Model
3. Medical care
+ Health literacy
+ Patient engagement
+ Quality of health care: provider cultural competence,
provider linguistic competence
+ Access to health care: quality of insurance, vaccines and
immunizations, provider availability, distance to resources
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 16
3. Modern Model
4. Social circumstances + Social status: occupation,
education level, language and
+ Gender identity
literacy level, family and individual
+ Sexual orientation income level, subjective social
status
+ Citizenship status
+ Culture and tradition: religious
+ Race and ethnicity
involvement, community and family
+ Relationship early childhood cultural norms
education and development
+ Social connectedness: quality of
+ Discrimination community, friend, family support,
intimate, civic participation
+ Work conditions
+ History of incarceration
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 17
3. Modern Model
5. Environment
+ Allergens
+ Expose to firearms
+ Pollution: water quality, carcinogen expose, lead
exposure level, air quality, tobacco use exposure
+ Location: residence quality, walkability, recreational
activity access, access to vocational training, educational
opportunities, public space quality, job opportunity,
crowding conditions, transportation quality, crime level,
access to healthy foods
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 18
4. Applications of the modern model
Individualized health care
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 19
4. Applications of the modern model
Population health
• Modernizing Healthcare
• Enabling High Quality Health Data
• Collaborating on a Global Scale
Nguồn: https://www.goinvo.com/features/determinants-of-health/. Truy cập ngày 11/5/2018 20
5. 21st century determinants of health
• Unsustainable lifestyles:
Many of the health challenges we deal with are related to
unsustainable lifestyles and unsustainable production and
consumption patterns. The obesity epidemic and the global
system of food production, distribution, consumption and
waste is one of the most obvious symptoms of this
development. It reflects paradigmatically the global flow of
ways of life, ideas and products.
Nguồn: Ilona Kickbusch (2012). 21st century determinants of health and wellbeing: a new
21
challenge for health promotion. Global Health Promotion. 1757-9759; Vol 19(3): 5–7
5. 21st century determinants of health
• The flow of people:
The total number of international migrants has increased
over the last 10 years from an estimated 150 million in
2000 to 214 million persons today; some 42.3 million
people are displaced globally as a result of conflict. We do
not yet grasp the impact of this phenomenon, which
includes tourism, migration, mobility and displacement on
the health of individuals, but it also stands in the way of
accurate assessment of the public health burden of disease
and its distribution.
Nguồn: Ilona Kickbusch (2012). 21st century determinants of health and wellbeing: a new
22
challenge for health promotion. Global Health Promotion. 1757-9759; Vol 19(3): 5–7
5. 21st century determinants of health
• The hurry virus:
Urbanization, modern media, new forms of work, women‟s
entry into the employment market – all have contributed to
time pressure and increased stress, anxiety and
depression. They also impact on poor diets and a lack of
physical activity. „The feeling of constantly having to rush
(the hurry virus) is a serious health issue, affecting not only
adults, but also children‟.
Nguồn: Ilona Kickbusch (2012). 21st century determinants of health and wellbeing: a new
23
challenge for health promotion. Global Health Promotion. 1757-9759; Vol 19(3): 5–7
