Broader determinants of health: Future trends

• Health is determined by a complex interaction between individual characteristics, lifestyle and the physical, social and economic environment
  Most experts agree that these 'broader determinants of health' are more important than health care in ensuring a healthy population.
• Economic hardship is highly correlated with poor health
  The current downturn – the deepest since the Great Depression – threatens individual and family wellbeing, especially for the unemployed and those experiencing wage and benefit cuts.
• Increased levels of education are strongly and significantly related to improved health
  Recent rises in the overall number of people in higher education and more people from poorer background in higher education should have long-term benefits for population health. However, there is uncertainty about whether improvements in access will continue.
• Work-related illness is decreasing, particularly among people with manual occupations
  Employers are also showing a growing interest in the health of their workforce. While these trends may continue, the economic environment could exacerbate work-related stress and have a negative impact.
• Improved housing conditions and greater access to green spaces should have a positive impact on health
  However the future outlook is uncertain for the most disadvantaged.
• Climate change is predicted to have both positive and negative implications for health in England

• Wider economy
  It is difficult to predict how the UK and global economy will develop in the next 20 years, and the overall effect on employment and income.
• Work environment
  Pay and working conditions could deteriorate markedly during the economic downturn. However, some large employers are recognising the benefits of investing in their staff's welfare and could act positively to improve their employees' health.
• Education
  Recent increases in the number of people going to university may stall over time. Following the introduction of higher tuition fees, applications for English universities this year are down 10 per cent.
• Environmental change
  Carbon reduction targets are likely to drive considerable technological and social change, with significant health implications. There is, however, considerable uncertainty around the scale and timing of these effects.

Source: Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried?

Several studies attempt to estimate how the broader determinants of health impact on our health. The three pie charts below depict the main findings of three research papers (click on the pie charts to enlarge):

Sources:

• McGinnis, J.M., Williams-Russo, P. and Knickman, J.R. (2002) The case for more active policy attention to health promotion. Health Affairs 21 (2) pp.78-93.
• Canadian Institute of Advanced Research, Health Canada, Population and Public Health Branch. AB/NWT 2002, quoted in Kuznetsova, D. (2012) Healthy places: Councils leading on public health. London: New Local Government Network. Available from New Local Government Network website
• Bunker, J.P., Frazier, H.S. and Mosteller, F. (1995) The role of medical care in determining health: Creating an inventory of benefits. In, Society and Health ed Amick III et al. New York: Oxford University Press. Pp 305-341.
• Dahlgren G, Whitehead M (1993). Tackling inequalities in health: what can we learn from what has been tried? Working paper prepared for the King’s Fund International Seminar on Tackling Inequalities in Health, September 1993, Ditchley Park, Oxfordshire. London, King’s Fund, accessible in: Dahlgren G, Whitehead M. (2007) European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen: WHO Regional office for Europe: http://www.euro.who.int/__data/assets/pdf_file/0018/103824/E89384.pdf.

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