SOCIAL

DETERMINANTS OF
HEALTH
PRESENTED BY J.KUNKEYANI
TO
NMT 2024

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BROAD OBJECTIVE
• By the end of the lesson learners should acquire knowledge
on social determinants of health and how they affect health
of individuals, family and the population

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 SPECIFIC OBJECTIVES
By the end of the lesson students
should be able to:
• Define social determinants of health
• Identify the socioeconomic factors that
determine the health of the population
• Explain effect of these socioeconomic factors
on health of the population
• Explain the role of the nurse in managing
patients who are negatively affected by the
socioeconomic factors
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 INTRODUCTION
• What makes some people healthy and others
unhealthy?
• Ill health is not necessarily caused by
microorganisms alone, many factors combine
together to affect the health of individuals and
the population.
• Whether people are healthy or not, is
determined by their circumstances and
environment surrounding them.

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 DEFINITION

• Determinants of health are those factors,

exposures, characteristics, behaviours and
contexts that determine or influence the
patterns of health.
• The World health organization (WHO) defines
social determinants of health as the conditions
in which people are born, grow, live, work and
age as well as the systems put in place to deal
with illness.

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 Definition ct’d
• These interrelated social factors can influence
the level of wellness positively or negatively
among individuals, families, populations and
communities.
• They can also increase the risk of illness and
influence the way that a person defines and
reacts to illness

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 Definition ct’d
• The factors which include social structure and
economic systems are responsible for most
health inequities as they affect the wide range
of health, functioning and quality of life
outcomes
• Generally social determinants of health is
shaped by the distribution of money, power
and resources which reflect the social and
economic environment.

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SOCIAL DETERMINANTS OF HEALTH
These include among others:
• Economic status
• Poverty
• Employment
• Education
• Life style
• Health care services

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Social determinants of health ct’d
• Ethnicity/race
• Culture
• Social support network
• Gender roles

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 1. Economic status
• The economic factors influence the health of
the individual and population
• Economic status is measured by a person’s
income, occupation or level of education
• Higher income and social status are linked to
better health because good income affords an
individual the opportunity to have a standard
life, afford to buy food, health insurance and
access health care

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 Economic status ct’d
• A person who has a large family and a low
income tends to give a higher priority to food
and shelter than to costly drugs or treatment
or expensive foods for special diets
• The greater the gap between the richest and
the poorest the greater the differences in
health

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 2. Poverty
• There is a direct relationship between poverty
and health. Poverty indirectly affects health
and well being
• Poverty affects one’s ability to buy necessities
like housing and food necessary for survival
and good health
• The poor has diminished access to care directly
because of their poverty resulting into inability
to afford the cost of health care services

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 Poverty ct’d
• They have higher rates of chronic illness,
shorter life expectancy, more complex health
problems and significant complications
• The poor tend to be less educated thus have
less knowledge of self care and behaviors that
promote health
• As a nurse you need to identify strengths and
weaknesses of poor clients without imposing
own values.

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 3. EMPLOYMENT
Unemployment
• Unemployed people and their families often
experience great psychological and financial problems
which cause health instability.
• Unemployment can lead to malnutrition due to lack
of money to buy food.
• A job gives someone not only an income but also
status, social contact, a structure for a day and self
esteem. It is therefore not surprising that being
without a job harms people’s health

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 Employment ct’d

Employment
• Employment affords an individual the opportunity to
have a standard life, afford to buy food and access
health care.
• Long, irregular working hours affect family
relationships because of detachment of the employee
from the rest of the family and this causes stress
• Occupation must have the ability to achieve a balance
between work and leisure time

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 Employment ct’d
• An employment with job insecurity increases
anxiety which can lead to heart diseases.
• Nature of occupation also influences health of
individuals. Some occupation expose people to
risk factors e.g. duration of working hours,
personal remuneration and environmental
exposure (dust, fumes/smoke)

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Employment ct’
• A person’s belief about employment and home influences
personal satisfaction and relationship with others. Job
satisfaction helps people to avoid illness

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 4. EDUCATION
• Education plays an important role in health
status.
• Higher levels of education will equip people
with more information for making health
lifestyle choices.
• More highly educated people are better able
to make informed choices about health
insurances and providers,
• Low education levels are linked with poor
health, more stress and lower self
confidence
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 Education ct’d

• A person’s compliance with the treatment that

is designed to maintain or improve health is
also affected by education and economic status
• Education may also affect perceptions of
stressors and problems, situations and give
people more alternatives

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 5. LIFE STYLES
• Lifestyles describe related practices and
behavioural patterns in a person or group
that are maintained over time.
• Lifestyles are the greatest influence on
health status i.e. lifestyles offer an
explanation to ill health or promote health
• There are four areas of lifestyles that have
relevance to human health services:

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 Life styles ct’d

1. Diet - patterns of food consumption

• Excessive consumption of carbohydrates
and fats lead to obesity and hypertension
• Personal behaviours like smoking and
alcohol drinking can predispose one to lung
and liver cancer.
• Positive changes in individual behavior can
reduce the rates of chronic disease

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 Life style ct’d

2. Marriage and the family (sexual

behaviour)
• Polygamy may cause stress and increase
risk of sexually transmitted infections in
case one partner is infected.
• Monogamy may promote peace of mind
and prevent sexually transmitted
infections.
3. Work and play (exercises)
4. Community relationships
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Life styles ct’d
These influences the health of
individuals, families and groups in the
community in many ways .

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 6. HEALTH CARE SERVICES
• Delivery of health care services is influenced by the
economic status of the state at large
• Declining economy leads to:
• Inflation which impairs the ability of the public to
obtain necessities and health care
• High levels of unemployment which then reduces
income and tax base to finance government
supported and welfare problems

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 Health care services ct’d

• Health care services must be available and

accessible with adequate human and material
resources
• Two kinds of access problems:
• Inability of the population groups to access
the health care services
• Inability of the health care systems to meet
the consumer demands

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 Health care services ct’d

Barriers that hinder access to health care

include:
• lack of availability of health services
• inability to pay for health care
• lack of private insurance
• geographic location
• language
• transportation difficulties

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 Health care services ct’d
• inconvenient clinic hours and
• negative attitudes of health care problems
towards poor clients,
• inadequate resources of the health facility
and mal-distribution of providers

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 Health care services ct’d

These barriers to accessing health services lead

to:
• Unmet health needs
• Delays in receiving appropriate care
• Inability to get preventive services
• Hospitalizations that could have been
prevented

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 7. ETHNICITY/RACE
• Race is an attribute that allows classification of
human beings on the basis of certain biological
and genetics characteristics e.g. skin colour
• Ethnicity involves belonging to a particular
ethnic group or a shared sense of peoplehood.
• Common share features of ethnicity include
geographical origin, language, religious
tradition, shared traditions, values and
symbols, food preference and common
settlement

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 Ethnicity ct’d
• These ethnic groups have specific prescribed
practices:
• Related to dietary that contribute to
nutritional status
• That are intended to promote health and
prevent illness or restore health when
illness occurs

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Ethnicy ct’d
• These practices affect health status and life expectance of
different ethnic groups or nations
• Some races are at risk of developing some diseases e.g. skin
cancers, diabetes, hypertension etc

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 8. CULTURE
• Culture provides a prescription for daily living
and decision making.
• It is culture that tells people what is acceptable
or unacceptable in a given situation. It dictates
what to do, say or believe
• Culture - customs and traditions, and the
beliefs of the family and community all affect
health.

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 9. SOCIAL SUPPORT NETWORKS
• Social support networks – greater support
from families, friends and communities is
linked to better health.
• A person generally seeks approval and support
from social networks (neighbors, peers and co-
workers) and this desire for approval and
support affects health beliefs and practices.

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 10. GENDER ROLES
• Cultural beliefs and behaviors are characteristic
of a particular gender
• Different cultures have got their own way of
defining what males or females are supposed
to do.
• This may contribute to the cause, presentation
and recognition of various forms of ill health

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 Gender roles ct’d
• The subordination of women by men results in
a distinction between roles of the women and
men and their separate assignment to
domestic and public spheres
• This creates gender inequalities which
systematically empower to the disadvantage of
the other can lead to inequities between men
and women in health status and provision of
appropriate health services

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 Gender roles ct’d
Examples
• Culturally women have always played a central role as
care takers of the sick and do household chores for
the family. As such they don’t have time to rest or
take care of themselves leading into stress which can
cause hypertension
• Within the professional jobs women assume the lowly
paid jobs, while higher paid and higher prestige jobs
are usually held by males (power positions) resulting
to stress

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 Gender roles ct’d
• Generally earning an income brings greater
autonomy, decision-making power and respect
in society
• Given the greater involvement of men in the
paid labour force and their higher earnings,
they generally enjoy more autonomy and
higher social status

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 Gender roles ct’d
• The gender differences in economic status and
purchasing power affect the health seeking
behavior and health outcomes of men and
women
• Most societies allow extramarital sex for men
resulting into greater likelihood of the spread
of sexually transmitted infections including HIV
and AIDS

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 Gender role ct’d
• Generally women have low levels of education
and inactive participation in public life affect
their knowledge about health problems and
how to prevent and treat them
• In conclusion social structures means that
one’s gender has also important health
implications in terms of:

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Gender roles ct’d
• Life position and power
• Access to resources and services
• Engagement in risk behaviors resulting into injuries or
illness

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 THE ROLE OF THE NURSE
• A nurse assesses the patient to identify these
factors
• Understanding the effects of these factors on health
allows the nurse to plan and deliver individualized
care according to the needs of the patient
• The knowledge of health determinants will help the
nurse to promote those factors that affect health
positively and discourage those that affect health
negatively

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REFERENCE
• Potter P.A & etal, Fundamental of Nursing; 2013 8th Edition, Elsevier
Mosby.

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