Major Determinants of Community Health

Community Health depends on the interplay of a number of complex factors which exert their influence on the life style of the individual. Some of them are beyond the control of the individual, while others are more amenable to personal  manipulation. Four  major interrelated determinants can be  identified. They  are: 

1. Genetics 
2. Health Services 
3. Environment 
4. Personal health  behaviour 

The following model  illustrates these factors and indicates some examples, of interrelationships. 

Determinants of Health 

First, let us discuss each of these determinants separately and then we will  read about their interrelationship. 

Genetics 

As you are aware, fit of the determinants to be considered is perhaps the most fundamental one i.e. genetics. It operates in several ways. Certain individuals are born with specific genetic abnormalities. which give rise to a particular nutritional problems. Few examples are given for your  understanding. 

Milk intolerance is a recent problem of infants. Some of the parents are aware of this problem. Here fundamental alteration in a diet is needed. Cereal-based diets in place of milk are suggested to such infants. It is well  known that diabetes shows a familial tendency. Certainly, the children of two diabetic parents have about a one in four chance of developing the disease at some stage of their lives. If only one parent is affected, the chances are reduced to about one in eight. You must have observed that obesity in children is also'more common when the parents themselves are over-weight.  In  this case, environment also has an influence, though undoubtedly some genetic influence does operate.  Environment in terms of the occupation may be responsible to predispose the condition of obesity. Ischaemic  heart disease also exhibits familial tendencies. It would be reasonable to suppose that there is an inborn susceptibility to  specific diseases and that the manifestation and seriousness of these is  a consequence of life experiences. The more negative factors present in the environment or personal  behaviour patterns, the more likely  the &ease will be seen. 

The examples which  you have seen are either genetic defect which have nutritional consequences or nutritional disorders in which there is some inherited trait. A more fundamental effect of genetics is its determination of sex. The disease experiences of the sexes are different and this caq be also seen in  nutritional disorders. For instance, corononary heart disease is much more common in men while iron deficiency anaemia is largely confined to women of child bearing age. 

From the illustration of the examples, you must  have realized the role genetics plays in disease causation. It is also me to say that of the four  health  determinants. 'genetics'  is the only one not  susceptible to change. 

Health services 

Provision of health services will affect health status. For example, if  no nutrition and health education is available, then people are not.able to seek help with nutritional problems. It is likely that nutritional problems like vitamin A deficiency and non- deficiency continue to exsist and the nutritional status of the community will be deteriorated. The nature of services whether preventive or curative is also important, otherwise mortality and morbidity rates among vulnerable segments of the community will be on the increasing plane. 

One of the problems of services is that  they  are often underutilized by the people who would benefit from them  most. Basing services in the community rather  than in the hospital may help  to make  them  more accessible and, therefore, increased utilisation. One example of this may be regular mobile clinic suitable to the timings of working women. 

Environment 

Both physical and social environment are important in their effects on  health. Environmental improvements  such as better sanitation and education, availability of good food, lead to  better  health  and a large proportion of the decline in mortality  and morbidity of the country may  be attributed to this. In  some instances environmental influences have been directly or indirectly deterimental to nutritional status. In case of nutrition, the environment provides a framework within which individual choice can operate.

Personal health behaviour 

Personal health  behaviour denotes the individuals choice related to health issues. Personal health  behaviour  is the ultimate decider of the food choices.'Individuals will choose  whether  to smoke or drink, whether to take exercise or be immunized and so on. 

The anti-health effects of personal behaviour can be seen to be manifested as: 

• adoption of undesirable health- habits 
• rejection of health care and non-compliance 
• indirectly a creation of high risk environment. 

Inappropriate behaviour can lead to health problems. Hence, health education is directed as persuading people to act in their own best interests. 

As indicated in the model socio-economic status is an important consideration in health, whether, a cause or consequence, it is linked with other major determinants. Poor mental capability may lead.to reduced progress in education and subsequently restrict job  opportunities. Lower income in turn  will restrict food choice. Lack of education may affect personal decision-making skills and contribute under use of services and binding more to traditions and beliefs. In order to control this, what is to be  done?  Should we make an attempt to  control environment and services or should we concentrate on influencing personal behaviour? From this, it is clear that there are  several ways in  which the  health of the  population could be manipulated.