Health and its Determinants

Health can and has been defined in various ways by a variety of individuals and/ organizations. However,
one of the more popular definitions of the term was put forward in 1948 by the World Health
Organization (WHO) as “Health is a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.”

Good health is required for human development & progress and requires cooperation of both
individuals and governments (at all levels) to achieve. The enjoyment of the highest attainable standard
of health is one of the fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition.

Types of health

There are various types of health. Some of the more popular subtypes include physical health and
mental health. Other types include social health, spiritual health, financial health and environmental
health.

a. Physical health

A person who has good physical health is likely to have bodily functions and processes working at their
peak. This is not only due to absence of disease. Regular exercise, balanced nutrition, and adequate rest
all contribute to good health.

Looking after physical health and well-being also involves reducing the risks of injury or health issues,
such as:

❖ minimizing hazards in the workplace

Good physical health often works together with mental health to improve a person’s overall quality of
life.

b. Mental health

According to the U.S. Department of Health & Human Services, mental health refers to a person’s
emotional, social, and psychological well-being. Mental health is as important as physical health as part
of a full, active lifestyle.

Good mental health is not only categorized by the absence of depression, anxiety, or other disorders. It
also depends on a person’s ability to:

❖ enjoy life
❖ bounce back after difficult experiences and adapt to adversity
❖ balance different elements of life, such as family and finances
❖ feel safe and secure
❖ achieve their full potential

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Physical and mental health have strong connections. For example, if a chronic physical illness affects a
person’s ability to complete their regular tasks, it may lead to depression and stress (mental health
issues). Mental illnesses such as depression or anorexia, can also affect body weight and overall
functioning (i.e., physical health).

Therefore, it is important to approach “health” as a whole, rather than as a series of separate factors. All
types of health are linked, and people should aim for overall well-being and balance as the keys to good
health.

Determinants of health

Determinants of health are factors that raise or lower the level of health in a population or individual.
These factors help to explain or predict trends in health and explain why some groups have better or
worse health than others. Many factors work together to affect the health of individuals and
communities. Consequently, whether people are healthy or not, is determined by their circumstances
and environment. It is therefore inappropriate to blame individuals for having poor health or praise
them for their good health as individuals are unlikely to be able to directly control many of the
determinants of health. These determinants (i.e., things that make people healthy or not) include
factors such as where we live, the state of our environment, genetics, our income and education level,
and our relationships with friends and family etc.

Determinants of health may generally be organized into four broad categories: genetic, behavioral,
policy and social determinants. These four categories are interconnected.

a. Biological/genetic determinants: Are intrinsic factors relating to the individual that impact on
health. These include age, sex, genetic make-up and body parameters like weight, blood
pressure etc.
For example, with respect to genetic makeup - inheritance plays a part in determining lifespan,
healthiness and the likelihood of developing certain illnesses. Similarly with gender - Men and
women suffer from different types of diseases at different ages.
b. Behavioral determinants: Are actions or patterns of living of an individual or group that impact
on health. Examples include smoking, participation in physical activity, dietary practices etc.
c. Policy determinants: Policies at the local, state and federal level effect individual and population
health. Increasing taxes on tobacco sales, for example, can improve population health by
reducing the number of people using tobacco products. Unfavorable conditions can result due
to substandard policies and programmes, inadequate governance and unfair economic
arrangements.
d. Social determinants of health (SDOH): This fourth category encompasses economic and social
conditions that influence the health of people and communities. These conditions are shaped by
socioeconomic position, which is the amount of money, power, and resources that people have,
all of which are influenced by socioeconomic and political factors (e.g., government policies,
culture, and societal values). An individual’s socioeconomic position can be shaped by various
factors such as their education, occupation, or income. All of these factors (social determinants)
impact the health and well-being of people and the communities they interact with. Examples of
some of these factors include

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 ▪ Income and social status - higher income and social status are linked to better health. The
greater the gap between the richest and poorest people, the greater the differences in
health.
▪ Education – low education levels are linked with poor health, more stress and lower self-
confidence.
▪ Physical environment – safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health.
▪ Employment and working conditions – people in employment are healthier, particularly
those who have more control over their working conditions
▪ Social support networks – greater support from families, friends and communities is linked
to better health.
▪ Culture - customs and traditions, and the beliefs of the family and community all affect
health.
▪ Access to medical care- Both access to health services and the quality of health services
available can impact health. Barriers to accessing health services include lack of availability,
high cost, lack of insurance coverage and limited language access. These barriers to
accessing health services lead to unmet health needs, delays in receiving appropriate care,
inability to get preventive services as well as hospitalizations that could have been
prevented.
Addressing these social determinants of health is a primary approach to achieving health equity.
Health equity is “when everyone has the opportunity to ‘attain their full health potential’ and no
one is ‘disadvantaged from achieving this potential because of their social position or other socially
determined circumstance’”. Health equity has also been defined as “the absence of systematic
disparities in health between and within social groups that have different levels of underlying social
advantages or disadvantages—that is, different positions in a social hierarchy”. Social determinants
of health such as poverty, unequal access to health care, lack of education, stigma, and racism are
underlying, contributing factors of health inequities.

Health Promotion & Disease Prevention

Health promotion and disease prevention are related concepts that largely focus on keeping people
healthy. These concepts share many goals, and there is considerable overlap between their
functions.
Health promotion as defined by the World Health Organization “enables people to increase control
over their own health. It covers a wide range of social and environmental interventions that are
designed to benefit and protect individual people’s overall health and quality of life by addressing
and preventing the root causes of ill health, not just focusing on treatment and cure.” Consequently,
health promotion programs aim to engage and empower individuals and communities to choose
healthy behaviors and make changes that reduce their risk of developing diseases and other
morbidities. Health promotion usually addresses behavioral risk factors such as tobacco use, obesity,
diet and physical inactivity, as well as the areas of mental health, injury prevention, drug abuse
control, alcohol control, health behavior related to HIV, and sexual health.

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Disease prevention may be understood as specific, population and/or individual-based interventions
aiming to minimize the burden of diseases. Disease prevention differs from health promotion
because it focuses on efforts aimed at reducing the development and severity of specific chronic
disease or diseases and other morbidities. There are 4 levels/types of disease prevention:
a. Primordial prevention: Consists of risk factor reduction targeted towards an entire population
through a focus on social and environmental conditions. Such measures typically get promoted
through laws and national policy. Because primordial prevention is the earliest prevention
modality, its intervention strategies are often aimed at children to decrease as much risk
exposure as possible. Primordial prevention targets the underlying social conditions that
promote disease onset. Some examples of commonly used primordial prevention strategies are:
▪ Government policy: Increasing taxes on cigarettes; Decreasing online advertisement of
tobacco
▪ Built Environment: increasing access to safe walking paths for individuals to exercise;
improving access to stores with healthy food options
b. Primary prevention: Primary prevention consists of measures aimed at a susceptible/ at risk
population or individual. The purpose of primary prevention is to prevent a disease from
occurring. It comprises activities that limit risk exposure or increase the immunity of individuals
at risk to prevent a disease from progressing in a susceptible individual. Primary prevention
services and activities include:
▪ Vaccination and post-exposure prophylaxis of children, adults and the elderly.
▪ Provision of information on behavioral and medical health risks, and measures to reduce
risks at the individual and population levels e.g., tobacco cessation programs and needle
exchange programs
▪ Nutritional and food supplementation; and
▪ Dental hygiene education and oral health services
c. Secondary prevention: Secondary prevention deals with early disease detection when this
improves the chances for positive health outcomes. This level of prevention emphasizes early
disease detection, and its target is healthy-appearing individuals with subclinical forms of a
disease. Subclinical disease consists of pathologic changes, but no overt symptoms that are
diagnosable in a doctor's visit. Secondary prevention often occurs in the form of evidence-based
screening programs for early detection of diseases or for prevention of congenital
malformations; and preventive drug therapies of proven effectiveness when administered at an
early stage of the disease.
Secondary prevention includes activities such as:
▪ Population-based screening programs for early detection of diseases e.g., Pap smears for
cervical cancer, colonoscopies for colon cancer, mammograms for breast cancer etc.
▪ Provision of maternal and child health programs, especially screening and prevention of
congenital malformations; and
▪ Provision of medications to control risk factors (e.g., since hypertension is a risk factor for
developing coronary artery disease (CAD) giving antihypertensives to control hypertension
in a patient at high risk of developing CAD may be a form of secondary prevention)
d. Tertiary prevention: is implemented in symptomatic patients and aims to reduce the severity of
the disease as well as of any associated sequelae (problems). Tertiary prevention aims to reduce
the effects of the disease once present in an individual. Forms of tertiary prevention are

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 commonly rehabilitation efforts and include Occupational and physical therapy in burn patients,
cardiac rehab in post-myocardial infarction patients and diabetic foot care in patients with
diabetic foot ulcers.
Many health promotion and disease prevention programs will often (in one form or another)
address social determinants of health, which influence modifiable risk behaviors. Modifiable risk
behaviors include, for example, tobacco use, poor eating habits, and lack of physical activity, which
contribute to the development of chronic disease.
Typical activities carried out during health promotion and disease prevention programs include:
• Communication: Raising awareness about healthy behaviors for the public. Examples of
communication strategies include public service announcements, health fairs, mass media
campaigns, and newsletters.
• Education: Empowering behavior change and actions through increased knowledge. Examples
of health education strategies include courses, trainings, and support groups.
• Policy, Systems, and Environment: Making systematic changes – through improved laws, rules,
and regulations (policy), functional organizational components (systems), and economic, social,
or physical environment – to encourage, make available, and enable healthy choices.

Pharmacist’s role in Public Health

Pharmacists play a vital role in maintaining and promoting public health. All pharmacists have a
responsibility to participate in global, national, state, regional, and institutional efforts to promote
public health and to integrate the goals of those initiatives into their practices. Furthermore,
pharmacists have a responsibility to work with public health planners to ensure their involvement in
public health policy decision-making and in the planning, development, and implementation of public
health efforts.

The public health duties that an individual pharmacist performs will vary, based on the individual’s
experience, abilities, training, and work setting. However, all pharmacists, working alone or in
collaboration with healthcare colleagues and administrators, can contribute to the promotion of public
health. Pharmacists have roles to play in specific public-health-related activities, including antimicrobial
stewardship and infection control; substance abuse prevention, education, and treatment; prevention
of controlled substances diversion; managing drug product shortages; immunization; tobacco cessation;
and emergency preparedness and response.

The following are examples of other activities that pharmacists can engage in to promote public health:

● Promoting population health: Pharmacists can participate in population health management by being
able to identify the needs of a population and implement necessary changes by, for example,
performing medication reviews (especially of risky or costly medications) and working with other
healthcare providers to develop care paths and chronic disease state management programs. Given the
importance of behavior as a determinant of health, pharmacists can also improve population health
through concerted actions to improve adherence to medication, diet, and exercise regimens, and
through efforts to discourage harmful behaviors such as tobacco use, substance abuse, and high-risk
sexual activity. Pharmacists practicing in ambulatory care and primary care settings are particularly well
positioned to help ensure patients have received appropriate preventive care, such as immunizations,
and screenings (e.g., mammograms, colonoscopies). Those pharmacists also have a role in population

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health management by contributing to team-based monitoring and education of patients about healthy
lifestyle choices and screening for social determinants of health.

● Developing disease prevention and control programs (including chronic disease or disease treatment
programs): Pharmacists can be involved in disease prevention and control in many ways. For example,
they can help develop institutional screening programs to check immunization status and identify
undiagnosed medical conditions (e.g., hypertension, diabetes, hyperlipidemia, depression, substance
abuse, behavioral health issues). Pharmacists can also encourage and model behaviors to mitigate
threats that are high risk to public health such as currently emerging diseases spread by viral and
bacterial vectors such as Zika, HIV, influenza (e.g., H1N1), and coronaviruses. These behaviors include
handwashing, social distancing, mask wearing, immunization, and not working when symptomatic.

● Promoting medication safety efforts in their institutions and communities: Pharmacists are ideally
suited to serve in leadership roles as an expert resource for medication safety by virtue of their
education and training and their responsibility for ensuring medication safety through use of various
technologies. Pharmacists can improve medication related processes and develop strong medication-
safety practices by counseling patients, identifying potential medication-related adverse drug events,
and putting in place strategies to prevent those events or raising awareness of possible threats to
medication safety for specific patients. Pharmacists can also promote adherence and effective
medication use through initiatives in the community and local organizations.

● Developing health-education policies and programs within their institutions that address the needs of
patients, other healthcare professionals, community leaders, and the public, individually and as
members of committees with purview over public health related activities: Another way pharmacists
advance public health is by developing, promoting, and implementing education programs aimed across
life's stages. Pharmacists can act as health educators on a variety of topics and in their role as health
educators, pharmacists can assess and improve the health literacy of individuals and groups to improve
adherence to medication, diet, and exercise regimens; reduce medication-related adverse events;
enhance the individual's role in their care and health; and build trust with pharmacists and the
healthcare system.

● Advocating for sound legislation, regulations, and public policy regarding disease prevention and
management: As medication-use experts and experienced health-system administrators, pharmacists
can and should contribute to the development of public-health related legislation and regulation and
should be involved in public program oversight and administration. Legislators, regulators, and program
managers at all levels of government should be educated to utilize pharmacist expertise.

● Engaging in public health-related research and education programs, initiating campaigns to

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