Key Element 2: Address The Determinants of Health and Their Interactions

A population health approach measures and analyzes the full range of factors known to influence and contribute to health. These are commonly referred to as the determinants of health.

What are the determinants of health?

Determinants of health are the individual and collective factors and conditions affecting health status.

A population health approach takes into account the entire range of determinants of health, as well as their interconnections. It uses evidence from research and other sources to link key health issues to their determinants and to show how these factors combine to cause health or illness.

Resources to Increase Understanding:

What are the determinants of health?

Key question

  • What determinants will be addressed?

A) What determinants will be addressed?

Several determinants have been identified by a large body of research as being core factors in the health status of both populations and individuals. They include:

  • The socioeconomic environment
    • Income, income distribution and social status
    • Social support networks
    • Education
    • Employment and working conditions
    • Social environments (including societal values and rules)
  • The physical environment (both the natural environment, and the human-built)
  • Healthy childhood development (including the prenatal period, as well as early childhood)
  • Personal health practices
  • Individual capacity and coping skills
  • Biology and genetics
  • Health services
  • Gender
  • Culture.

Our understanding of what makes and keeps people healthy is evolving as research reveals new insights.

This decision involves selecting specific determinants using specific criteria. These criteria will certainly include their significance to the health issues at hand, the capacity to deal with them, and the organizational mandate.

How are the determinants of health addressed?

2.1 Establish indicators for measuring the determinants of health

Meaningful action on the determinants of health requires them to be measured and tracked with valid and reliable data. The easiest way to identify which indicators to use is to draw from lists that have already been developed. Many Canadian and international research groups have such lists.

2.2 Measure and analyze the determinants of health, and their interactions, to link health issues to their determinants and inform action

There are many organizations that collect data about the determinants of health, on a regular basis.

The decision-making process discussed in key element one can be applied once all data is available.

Evidence to Support Decision-Making:

What sources of data can inform decisions about which determinants of health to focus on?

Resources that Build Capacity:

What decision-making frameworks or guides can help facilitate decisions about which determinants of health to focus on?

What do you have at the end of Key Element 2?

  1. A list of the determinants, which are most relevant to your health issue.
  2. Information about how these determinants relate and to what degree.

How does this Key Element relate to the others?

  • In many cases, it requires new research to be conducted (Key Element 1).
  • It provides a basis for selecting the best mix of interventions (Key Elements 3.5, 4, and 5)
  • It provides indicators and baseline measures, which will be the foundation of an accountability framework (Key Element 8).

Why is this Key Element important?

  • It helps avoid simple, one-dimensional answers about the causes of health status. Instead, it recognizes that it is the interaction of many biological, behavioural, environmental and socioeconomic factors that “cause” health or illness.
  • It can clarify expectations about the impact one intervention may have on any single risk factor, such as physical inactivity, and can show that a crucial protective factor may help to defend against many health problems.
  • It provides specificity, as the path that leads to any particular health outcome may be very different for different populations, like how for wealthier elements of the population, providing health education might lead to action, whereas for poor or isolated population groups, a broader determinant such as social support may have to be enhanced.

Examples Illustrating Application:

What are some examples of interventions that have addressed multiple determinants of health?