Determinants of health

The determinants of health are the biological, psychological, behavioural, social, economic, and environmental factors that determine the health of individuals and populations. Socially or politically conditioned inequalities in the distribution of determinants lead to inequities in health within or between countries. The ways that determinants act on health are complex, involving interactions between factors and effects occurring over differing timespans. These complexities present challenges for research and public policy, to understand and take action on determinants, to improve population health, and/or to reduce health inequities. In this chapter we review the four main categories of biological, behavioural, social, and environmental determinants. We then discuss the topic of social determinants of health in more detail and review a number of the main factors identified in contemporary public health literature; from education, employment, and gender to determinants of Indigenous health, and commercial determinants of health. In a later section of the chapter (‘The complexity of determinants and their interactions’) we look at some of the challenges raised by the complex, multifactorial nature of determinants of health for research, health practice, and policy action. In the final section, we discuss two particular political challenges facing governments and international bodies seeking to take action on determinants of health and health equity.

A Risk Characterization of Regulatory Arbitrage in Financial Markets

This article analyses regulatory arbitrage in financial markets from a risk-based perspective. It assesses regulatory arbitrage in terms of the risk it may pose to the attainment of a regulatory objective, in this case financial stability. Its most distinct contribution to the literature is the application of the NOAEL approach—thus far mainly used in public health literature and regulatory toxicology—to the legal analysis and management of arbitrage risks. We propose several qualitative parameters relating to the likelihood of regulatory arbitrage and the negative impact if such arbitrage should occur. The article ultimately aims to help frame the ongoing debate about policy-making and the use of risk assessment methodologies to cope with regulatory arbitrage in financial markets.

Innate Perception of Risk: Probability Ratio or Difference?

In public health literature the risk of death or disease associated with a dietary, environmental of behavioral factor is most commonly denoted by odds ratio (OR), hazard ratio (HR) or risk ratio (RR). The ratio indices have several desirable statistical properties. However, the most important question is whether there are some evolved innate norms of perception of risk that people use and what they are. We conducted a simple one question survey of 98 individuals with different age, sex, educational and professional backgrounds. The respondents were asked to judge the relative perceived risk of four different hypothetical habits for which data on the percentage of people affected by the disease with and without the habit was given. They were asked to rank the risks for the four habits. Results showed that the habits that had the highest difference between probability of acquiring the disease were ranked high on risk perception. The probability ratios did not affect risk perception significantly. Further age, sex, profession or formal training in statistics did not affect the response significantly. Even individuals that were formally trained to use OR and HR as risk indicators, preferred using probability differences over ratios for judging their own risk in the perceived context. This preliminary inquiry into intuitive statistical perception suggests that designing statistical indices based on people’s innate perception may be a better strategy than trying to train people to understand the indices designed by expert statisticians.

Dealing with excess consumption: Moving beyond redeem, replace and reduce

Our current consumption patterns cause high levels of CO2 emissions. Encouraging sustainable lifestyle changes is one tool among many to reduce emissions. Looking towards the public health literature, we identify three strategies for dealing with excess consumption: redeem, replace and reduce. We highlight the benefits and challenges that individuals face when employing these strategies. Finally, we present a promising approach to moving beyond individual-level strategies and their challenges.

A Century Later: Rural Public Health’s Enduring Challenges and Opportunities

The US public health community has demonstrated increasing awareness of rural health disparities in the past several years. Although current interest is high, the topic is not new, and some of the earliest public health literature includes reports on infectious disease and sanitation in rural places. Continuing through the first third of the 20th century, dozens of articles documented rural disparities in infant and maternal mortality, sanitation and water safety, health care access, and among Black, Indigenous, and People of Color communities. Current rural research reveals similar challenges, and strategies suggested for addressing rural–urban health disparities 100 years ago resonate today. This article examines rural public health literature from a century ago and its connections to contemporary rural health disparities. We describe parallels between current and historical rural public health challenges and discuss how strategies proposed in the early 20th century may inform current policy and practice. As we explore the new frontier of rural public health, it is critical to consider enduring rural challenges and how to ensure that proposed solutions translate into actual health improvements. (Am J Public Health. 2020;110:1678–1686. https://doi.org/10.2105/AJPH.2020.305868 )

Capturing Engagement with Cancer Information on Facebook: The Social Media Content and Context (SoCo) Elicitation Method (Preprint)

UNSTRUCTURED Most of what is known regarding cancer information engagement on social media stems from quantitative methodologies. Public health literature often quantifies engagement by Most of what is known regarding cancer information engagement on social media stems from quantitative methodologies. Public health literature often quantifies engagement by measuring likes, comments and/or shares of posts within cancer organizations’ Facebook Pages. Yet, this content may not represent the cancer information generally available to and consumed by platform users. Furthermore, some individuals may prefer to engage with information without leaving digital traces researchers can quantify. This article discusses the limitations of current approaches to assess cancer information engagement on Facebook and presents the social media content and context (SoCo) elicitation method, a qualitatively-driven mixed methods approach to understanding engagement. Two case studies are presented to highlight important findings elicited through this novel approach. The SoCo elicitation method allows for a better representation of how persons engage with cancer information. This method may be applied to future studies regarding how to best communicate health information on social media.

No More to Spend

This book is a political history of medicine in colonial and postcolonial Malawi and, in a larger sense, an exploration of the social construction of scarcity. In much of the historical and public health literature on Africa, dismal public-sector health-care spending is considered a necessary consequence of a low GDP. But is it true that poor patients in poor countries are doomed to go without the fruits of modern medicine? The history of Malawi demonstrates how official neglect of health care required political, rhetorical, and even martial campaigns by colonial and postcolonial governments. Rising demand for medical care among African publics compelled governments either to increase spending or offer rationalizations for their inaction. Because many of these claims of scarcity persist in global health discourse, the ways in which they were deployed, defended, and (at certain moments) defeated have important implications for health outcomes today.