HEALTH AS A

MULTIFACTORIAL
PHENOMENON
The WHO defines health as “a state of complete physical,
mental and social well-being and not merely the absence of
disease or infirmity.(physical or mental weakness )
In order to improve population health status and reduce
health inequalities, it is important to identify and
understand the main factors that protect and promote good
health. These factors are known as the determinants of
health.
Health is determined by a convergence of five levels:

Level 1: Human biology, hereditary factors, age, sex,

person’s individual characteristics.
Level 2: Individual life style.
Level 3: Social and community influence.
Level 4: Living and working condition.
Level 5: General socioeconomic and cultural and
environmental conditions.
 LEVEL 1
A. Human Biology

It includes those aspects of health (both mental and

physical) which are determined by the organic structure
and physiological functioning of the human body.
 LEVEL 1
B. Hereditary Factors
Inheritance plays a part in determining lifespan, health
and the likelihood of developing certain illnesses.
The inheritance factors are can be:
Race
Sex
Inherited Diseases
 LEVEL 2
Individual Life Style & Behavioral Influences:

Tobacco use, Unhealthy diet, Inadequate activity

Alcohol and drug use

Personal behavior:
Behaviors leading to intentional/unintentional injury.
Coping skills and how we deal with life’s stresses and
challenges.
 LEVEL 3
A. Social and Community Factors

The social and community factors that have been shown

in a variety of settings to have the greatest influence on
health are:
i. Education
ii. Social cohesion
iii. Social connectedness.
iv. Characteristics of communities
 LEVEL 3
i. Education
Education has profound health effects. More education
makes an individual more aware of healthy and unhealthy
choices and makes it easier to make healthy choices.

A low level of education is associated with poor health

status.
Low education levels are linked with poor health, more
stress and lower self-confidence.
 LEVEL 3
ii. Social Cohesion
People with strong family, cultural and community bonds
have better health than people who are socially isolated.
 LEVEL 3
iii. Social Connectedness
Social connectedness is related to the health of individuals
and communities.

Single parent families, people with mental illness, people

with disabilities, people living alone and older people are
particularly vulnerable to social isolation.
 LEVEL 3
iv. Characteristics of communities

Characteristics of communities can influence health in

many ways either direct or indirect. For example,
neighborhoods can be physically hazardous because of air
and chemical pollution, traffic, lack of sidewalks and safe
places to exercise, and the dangers of crime.
 LEVEL 4
Living and Working Conditions include:

a. Housing
b. Work
c. Employment and Occupation
 LEVEL 4
a. Housing
Overcrowding, damp and cold have direct effects on physical
and mental health.

High housing costs leave less money for other budget items
essential to good health including nutritious food, education,
and access to health services.
Poor-quality housing poses a risk of exposure to many
conditions that can contribute to poor health, such as indoor
allergens that can lead to (and increase) asthma, injuries, and
exposure to lead and other toxic substances.
 LEVEL 4
b. Work

Work can influence health in many ways, including

through links both with health care insurance and with
physically hazardous exposures in the workplace.
 LEVEL 4
c. Employment and occupation
The main factor determining adequate income is
participation in continuous employment.
As such, employment is an important determinant of
health.
In addition to providing income, employment enhances
social status and improves self-esteem, provides social
contact and a way of participating in community life, and
enhances opportunities for regular activity, which all help
to enhance individual health and well-being.
 LEVEL 4

Generally, people in employment are healthier,

particularly those who have more control over their
working conditions
 LEVEL 5
General socioeconomic and cultural and environmental
conditions depend on:

a. Income
b. Poverty
c. Ethnicity
d. Culture
e. Environment
 LEVEL 5
a. Income

There is a persistent correlation between low income and

poor health.
the low income leads to the highest rates of illness and
death.
Adequate income is a prerequisite for many other
determinants of health, for example, adequate housing, a
nutritious diet and educational opportunities.
 LEVEL 5

Income and social status

Higher income and social status are linked to better
health. The greater the gap between the richest and
poorest people, the greater the differences in health.
 LEVEL 5
b. Poverty
Poverty has long been recognized as an important
determinant of ill health.
People who are poor have worse self-reported health,
higher rates of disability, and higher rates of death,
disease and injury.
 LEVEL 5
c. Race and Ethnicity
Racial and ethnic background has profound effects on an
individual’s health.
There are advantages and disadvantages of race and
ethnicity that can affect the health.
 LEVEL 5
d. Cultural factors can have both a positive and a negative
influence on health.
Health inequalities within specific ethnic groups are as
important as health inequalities between different ethnic
groups.
Definitions of Culture:
A system of thoughts & behaviors shared by a group of
people.
Refers to an integrated pattern of belief and behavior.
 LEVEL 5
e. Environmental Factors
 The Physical Environment :
The quality of air.
Water safety.
Food safety.

Maintenance of these services is essential to protecting

population health and should be a high priority.
 LEVEL 5
 Drugs and other chemicals products.
 Control of excessive noise.
 Lighting.
 The radiation.
 LEVEL 5
 Waste disposal.
Utilities such as water and sewerage reticulation
contributed towards large improvements in population
health.