From Latrines to Vaccines: Health Determinants (w/video)

The mix of health determinants has changed drastically in the former Soviet Union. (Tashkent, Uzbekistan, 1990)

The mix of health determinants has changed drastically in the former Soviet Union. (Tashkent, Uzbekistan, 1990)

GOOD HEALTH IS FAR MORE than the absence of illness, disease, or disability. A popular definition is ‘soundness of mind and body, stamina, fitness, and the opportunity and environment to live a life that is socially and economically productive.’ It’s a tough-to-imagine ideal scenario that assumes no war, no inequality or inequity, and no worries for life’s basics like food, water, sanitation, and education in a stable, clean environment. Tough to imagine, yet ideal for good health.

In global health, we learn that good health comprises social, intellectual, emotional, spiritual, political, economical, and physical components –called ‘dimensions of health.’ Beyond that, a complex web of factors determine the health of individuals and specific populations; these are called–logically–‘health determinants.’


Here’s my video:

(Video lesson: 1:10) – From Latrines to Vaccines: Health Determinants

KEY HEALTH DETERMINANTS often cited in global health studies for impacting health include these eight:

#1 – Genetics and biology:  What’s your sex? age? Born with Down’s syndrome or HIV? Do you carry gene markers like HLA-B27, predisposing you to ankylosing spondylitis, or the BRCA gene for cancer? Do you have a family history of strokes, heart disease, diabetes? They all factor into your longevity, and health.

#2 – Socioeconomic: It’s the lottery of life. Where were you born –Beverly Hills or Botswana?  Can you make a steady income, or did it vanish in the backdrop of war, famine, or disaster? Can you be educated? Does your gender dis-empower you in your society so your access to resources is limited? Are you safe, with emotional and social support like family and community?

#3 – Food: Do you have a steady supply of nutritious food that provides calories, fat, and protein? It goes beyond food staples like flour or rice; you also need food filled with macro-nutrients, like vitamins and minerals.

#4 – Water: Do you have access to water, clean water? It’s a key element for good health, with a minimum of a gallon a day, per person. And is that water nearby? In many developing countries women’s days are consumed with body-breaking work fetching and hauling home water–often miles a day.

Double-seater outhouse I used as a kid when visiting relatives in northeastern Montana

Double-seater outhouse I used as a kid when visiting relatives in northeastern Montana. (Near Hinsdale, Montana)

#5 – Sanitation: Feces can transmit communicable diseases, like cholera.Do you have access to proper sanitation, like latrines or holes that help contain waste and possible contamination? Even better, is your toilet indoors so you’re more likely to use it? It beats defecating outside your house when you don’t feel like walking to the latrine at night, in bad weather, or past creepy insects and snakes.

#6 – Environment: Do you have housing to protect you from weather, war, and violence? How safe or dangerous is your work? Is the air clean? Is the ozone layer thin, opening an array of problems, like skin cancer?  Are you living in the aftermath of disasters like tsunamis, earthquakes, floods, or war? Stress takes its toll on health.

#7 – Behavior: Do you smoke, abuse alcohol/drugs, have unsafe sex? Do you drive safely or live where insane drivers take to the roads? Wear a helmet? Work out or get reasonable exercise? Are you careful handling food and water so you aren’t contaminated or contaminate others?

#8 – Health Services: Do you have access to healthcare and the money to pay for it? Is your doctor or clinic nearby, or several days on foot? What’s the quality? Are drugs and vaccines available? A steady drug supply is critical so treatments aren’t interrupted, as with tuberculosis. What health services are offered: preventative, curative, rehabilitative?

WHAT DOES ALL THIS MEAN?  When health determinants indicate poor conditions for healthy living and pessimistic predictions for survival, there are several ways these challenges can be addressed. A common method is tackling the problem directly (‘vertically,’ as it’s called) — such as vaccinating children for polio or passing out bednets to prevent malaria. A more difficult, longer-term ‘horizontal’ approach is addressing not only that specific problem, but also changing the healthcare system along with an entire country’s approach to issues such as contaminated water, sanitation, and overcrowding that can lead to diseases–such as polio–in the first place. A hybrid ‘diagonal‘ solution  intersects both vertical and horizontal approaches–such as vaccinating children immediately and simultaneously addressing issues in a healthcare system. That’s where a ‘who’s who in global health’ steps in.


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Selective Resources: Health Determinants
1. Social Determinants of Health: The Solid Facts (2nd ed), by World Health Organization, 2003 AND a briefer version of Social Determinants of Health, World Health Organization.
2. Determinants of Health, by Healthy People 2020, U.S. Dept of Health & Human Services.
3. Various lectures and publications by University of Washington global health professors Dr. Stephen Gloyd and Dr. Matthew Sparke. Thank you.


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