It is said that, “the most powerful force for controlling medical spending is the cost conscious consumer”; however, there are other factors (determinants of health) other than medical care spending that can affect the health of an individual and ultimately the health of a population. Some of these other factors (determinants of health) include lifestyle choices, environmental factors, family history (genetics), where one work and live, one’s income and developments in technology.
Impact of Determinants of Health on Population Health
Countries need to go beyond implementing clinical interventions targeting high-risk populations to enhance population health. Evans et al., (2021) emphasized that medical thought has primarily focused on the needs of sick individuals. Although this mission is crucial for healthcare and medicine, its main focus is on treating illnesses rather than preventing them. The mission of medical care often overlooks disparities in the accessibility and standard of treatment and prevention services. Genetic, behavioral, social, and environmental factors, along with personal health care, are key determinants of health (Nutbeam & Lloyd, 2021). To truly make an impact, the country and its diverse public health system must recognize and take full advantage of innovative methods in health policy and practice.
Health spending significantly affects both health outcomes and macroeconomic issues. The public commonly attributes increasing health care costs to factors such as rising real per capita incomes, advancements in technology, and a growing elderly population. Studies consistently demonstrate that non-medical factors of health hold greater significance than medical factors (Dawes, 2020). Research starting in the 1970s and ongoing today demonstrates that inadequate social determinants of health have a negative impact on health in both the short and long term (Evans et al., 2021). Extensive research indicates that favorable social conditions are linked to improved health results. Artiga et al. (2021) found a significant correlation between social spending as a percentage of total expenditures and improved outcomes in infant mortality, life expectancy, and potential years lost, even after adjusting for health spending and GDP. Studying disparities in health care spending according to socioeconomic and demographic factors is beneficial for comprehending inequalities and creating successful policies and intervention plans.
To enhance the health of a population, one must comprehend the holistic view and the interconnectedness of elements such as biology, behavior, the built environment, and social and environmental factors. Ecological approaches to disease prevention have long been the primary focus of traditional public health models such as the agent-host-environment triad. Studying the ecology of certain pathogens and the effectiveness of environmental measures in disease control, rather than individual or behavioral interventions, has greatly advanced the control and eradication of infectious diseases. In regions with poor sanitation and water purification, it is crucial to take personal precautions like frequent handwashing and boiling water to minimize the spread of disease. Implementing environmental controls allows for earlier interventions, such as municipal water purification, to enhance health outcomes. Research conducted in recent decades has improved the understanding of the various social factors and environmental hazards that contribute to poor health (Braveman, 2023). There is a need to more comprehensively incorporate these social determinants into public health.
Various health determinant models suggest that macro-level policies and circumstances, such as social, economic, cultural, and environmental factors, significantly influence intermediary (housing, working conditions) and immediate (behavioral, biological) elements that impact health. Population health is influenced by various factors, including macro-level elements like policies and societal norms, as well as micro-level factors like sex or disease virulence, which interact in complex ways. Environmental exposures may have a greater impact on population health than individual vulnerabilities. Environmental factors combine with genetic traits to cause disease on an individual level. For example, both environmental and genetic factors influence the intricate biobehavioral activity of smoking. Alcaraz et al., (2020) demonstrated that smoking raises the likelihood of developing cardiovascular disease and cancer through its interaction with particular genes. It is crucial to acknowledge that historical and developmental factors evolve on societal and personal levels, as well as to comprehend that diseases transform as pathogens alter in virulence.
Conclusion
Equating financing clinical care with funding health would be erroneous as numerous other factors play a significant role in individuals’ well-being. While not typically linked to health, these policies have the potential to enhance health, extend lifespans, and diminish health inequalities. Adopting a health policy framework that prioritizes macro determinants of health would lead to improved population health, reduced inequality, and lower costs, based on the most reliable evidence.
References
Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C. (2020). Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA: a cancer journal for clinicians, 70(1), 31-46.
Artiga, S., Orgera, K., & Pham, O. (2020). Disparities in health and health care: Five key questions and answers. Kaiser Family Foundation.
Braveman, P. (2023). The social determinants of health and health disparities. Oxford University Press.
Dawes, D. E. (2020). The political determinants of health. Johns Hopkins University Press.
Evans, R. G., Barer, M. L., & Marmor, T. R. (Eds.). (2021). Why are some people healthy and others not?: The determinants of health of populations. Walter de Gruyter GmbH & Co KG.
Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health, 42(1), 159-73.
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