Pharmacy in Public Health:

Determinants of Health
 Learning Outcomes
• Define health determinant in the context of an
ecological framework
• Recognize that positive interactions result in
health and negative interactions in disability
or disease
• Identify health determinants
• Describe primary care and essential
medications
 Ecological Perspective
• Concerned with the environment surrounding
the individual as well as the characteristics or
behavior of the individual; the environment
includes:
– The social surroundings as well as physical
surroundings of the community
– State, national, and global environment
Environment surrounding the
individual
 Focus on Populations
• To describe the influence of the environment
on health, the focus is on:
– populations
– comparing the health of a population in one set of
environmental circumstances to a population in a
different set of environmental circumstances
 Indicators of Population Health
• Life expectancy
• Infant mortality
• Morbidity
• Mortality
• Median age
 Life Expectancy and Infant
Mortality
• Life expectancy is the average number of years
that a person can expect to live at a given age,
usually birth, based on current death rates.
• Infant mortality is the number of deaths of
infants less than 1 year of age, calculated per
1000 births.
 Life Expectancy and Infant
Mortality
• Life expectancy and infant mortality are
related
– High infant mortality will result in low life
expectancy from birth
• Examples:
– Niger—infant mortality = 112.4; life expectancy =
56.9 years
– Iceland—infant mortality = 2.9; life expectancy =
81.8 years
 Morbidity
• Morbidity describes the level of disease in a
population
– May be expressed as a percentage of the
population
– e.g., 66% of the population are overweight or
obese
 Mortality Rate
• Mortality describes the number of people
who die every year
– Usually reported per 100,000 population
– Usually standardized so that mortality rates can be
compared across populations
– Example—the mortality rate for cancer in Bolivia is
256 per 100,000 population and for Denmark, is
167 per 100,000 population
 Median Age
• The age at which half the population is older
and half younger
– e.g. the median age for Guatemala is 18.2 (half
the population is younger)
– e.g. the median age for Italy is 42 (half the
population is older)
Population measures of health,
cont’d
 Health Determinants
• The conditions or factors associated with
health are known as health determinants.
• Depends on the interaction of the person with
their environment
– Positive interactions result in health or
maintenance of health
– Negative interactions result in disability and
disease
 Health Determinants
• Internal factors—characteristics of the
individual
– May be inherited or learned
– May be physical, social, psychological, or
behavioral
• External factors—characteristics of the
community where the individual lives and
works
– May be physical, social, economic etc.
Framework for Describing Health
Determinants
Summary: Levels of Health
Determinants
Individual Level Determinants of
Health
Community Level Determinants of
Health
Community Level Determinants of
Health, cont’d
State and National Determinants of
Health
Global Determinants of Health
Roles for Pharmacists
Essential Medications
 Summary
• Ecological framework
• Health determinant
• Levels of health determinants
– Individual
– Community
– State and National
– Global
• Pharmacists’ role in public health
Reference
• Carter, Jean et al. Pharmacy in Public Health:
Basics and Beyond. 2010