Dahlgren And Whitehead Health Determinants Model: Analysis And Implications

Analysis

Discuss about the Dahlgren and Whitehead Health Determinants Model.

The existence of the inequalities in terms of health in the society where the health is linked to the socioeconomic level has resulted in the growing awareness that most of the issues can be determined by the social factors. In this case, the social, economic and environmental inequalities can determine the risk level of people getting ill, their capability to prevent the illnesses as well as their access to the effective treatment. All these social factors have been described by the scholars using different models but the most widely used is the Dahlgren and Whitehead Health Determinants Rainbow Model (Bryant, et al., 2011). The model thus maps the association between a person, setting, and the health. The individuals are centrally placed and surrounded by different influences on health which comprise the lifestyle of an individual, the influences of the community, working and living conditions among other factors. The framework has therefore assisted the researchers to come up with the various hypotheses regarding health determinants to explore the relative influence of these determinants on various outcomes of health as well as the association between different determinants.

Structure changes, as well as the social organization regarding the causes of diseases over the last century, have changed their focus to various impacts of the health with the concomitant impacts on structure and resourcing structure of the health care. In this case, there have been 3 different stages in the movement of the public health since mid of 19^th century to the present time in the western part of Europe regarding industrialization as well as the increasing healthcare and pharmaceutical access (Gibson et al., 2010).

There was a need to take action in England between 1830s and 70s concerning housing and sanitation and the provision of the clean water and food that is adequate. These actions are evident in the national public health act in 1846 and 1875 indicating intervention by the administration through legislation to prevent the spread of diseases among the families living in poverty. 

Afterwards, it was followed by the understanding of the disease transmission era which is the germ theory. This raised the concentration on specific approaches to prevention which include the use of vaccination and immunization. Also, there was school and community health services which were aimed at supporting children and mothers. The main reason for this was to offer information as well as practical support to facilitate people to assume the responsibility of keeping themselves healthy. This was then followed by the therapeutic era where the discovery of the insulin as well as sulphonamide drugs (McCartney et al., 2010). These drugs could cure almost all the illness regardless of the daily context of the people. However, this was never the final journey as there was a need to clearly understand the social factors that could affect the health of the individual.

Black Report

Public health promotion in the 21^st century is a multi-disciplinary activity that ranges from the health and disease surveillance among the populations via the provision of the health information and advice. In this case, disease occurrence takes place in different levels which comprise the action taken by the individual to those that are undertaken by both local and international agencies (Morgan & Ziglio, 2010). Further, disease occurrence takes place in different environments such as youth centers, street, hospital setting, workplace, homes or even the nightclubs.  Based on the Dahlgren and Whitehead model, there are various social factors that influence health. These include the age sex and the hereditary factors, the lifestyle factors of an individual, the social community networks as well as the general socio-economic, environmental and cultural conditions.

Dahlgren and Whitehead’s model is a multifactorial approach that differentiates social factors and individual which offers a diagram with layers that can be peeled away. In the core of the diagram is the attributes that can be inherited which comprise the age, hereditary factors, and sex. Also, the inner layer indicates that health is partially determined the by the lifestyle of an individual which include the diet, physical activity as well as patterns of smoking. On the third layer, the model focuses an attention to the association with friends, family as well as other significant factors that are found in the community (Burris, 2011). They are therefore the downstream health determinants which include the actions of the community and the individual.  The next layer concentrates on the living and the working conditions. This includes the housing, healthcare services access, employment among other factors (Krumeich & Meershoek, 2014). Finally, the outer layer focuses on the wider socio-economic, environmental and cultural factors which comprise the economic development, political change, welfare system change, structures as well as social forces. In as much as this is not clearly indicated in the diagram, there is a possibility for the interaction between layers. For instance, a reduction in the systems of welfare services could lead to adverse effects which may hinder people getting access to adequate housing hence influencing their health.

Sex, gender, and health. It has been believed that sex instead of gender determines the health of the individuals. In this case, in most countries, the life expectancy of men is lower as compared to that of females and the same case is expected to continue (Raphael, 2011). However, in the recent days, the disadvantages on male have become significantly less as compared to before. For instance in Wales and England, between 1970 and 2003, the life expectancy of the male has increased by four years whereas the life expectancy of the women has increased by only three years (Mogford, Gould & DeVoght, 2010). Therefore, given the assumption that women are biologically advantaged regarding the life expectancy, this assumption can be challenged. The changes can be attributed to various factors such as the improved healthcare services as a result of improved healthcare re system. Also, many men have been educated on the dangers of different lifestyles which should endanger their life’s hence their life expectancy has increased.

Landlord Report

Inequalities and disparities exist between various groups in the society. The main reason for this inequality is an uneven distribution of the resources specifically based on the allocation norms which favor specific groups of persons. The difference in allocation of the resources in the society is brought about by the factors such as sexual orientation, kinship, age, ethnicity, health care, the source of wealth, political representation, education as well as the freedom of speech among other factors (Baum et al., 2013). The social inequality that is associated with the economic inequality is based on the unequal distribution of the wealth and income. In as much as economics and sociology use varied terms theoretical techniques to assess and describe the economic inequality, both fields are more concerned with the understanding of this issue. Due to the uneven distribution of the resources in the society, it leads to some people having more resources while others having none or less. This creates a scenario of social class within a society where those that are favored in terms of resource distribution are prioritized in terms of service delivery as compared to those that are resource poor.

Social inequality is fashioned by various factors that are structural which comprise the geographical location or the status of the population which is mainly underpinned by cultural identities and discourses (Embrett & Randall, 2014). For instance whether the poor are undeserving or deserving. In societies that are simple, those people that have few social responsibilities as well as statuses that are occupied by its members, they could be lower social inequality and vice versa. However, in the societies that are tribal, the head of the tribe may enjoy some privileges, use some instruments where others do not have. This causes social inequality. Another reason that has led to the social disparity and inequality in the society is the increased complexity of the society. In this case, when the population lives in the complex societies rather than the simple societies, the level of inequality tends to increase in line with the increasing gap between the wealthy and the poor members of the society.

The number of the older adults that utilizes health care services are more as compared to the younger populations. In as much as the number of the older adults differs widely concerning the status of health, most of them have at least one chronic condition which necessitates them to seek medical attention (Beltran, et al., 2011). Further, the older adults differ regarding the demographic features which result in variation in their needs for using the health services (Townsend & Foster, 2013). The projection for the utilization of the healthcare services such as Medicaid and Medicare suffers a limitation though the overall projections show that the health care service demand among the older adults will significantly rise in the coming years. This will, therefore, put more pressure on the healthcare services such as Medicaid and the Medicare budgets as well as the capability of the healthcare workers to deliver those services.

Sex, gender, and health

Averagely, the older adults’ visit offices of the physicians twice more than people below 65 years every year. The reason for the frequent visit of the older adults is the fact that most of them have chronic conditions or for pre or post-surgery visit which is not the case with the younger population. However, the older adults are less likely to seek preventative care as compared to the young adults (Potvin, 2012). Some of the chronic conditions that affect the older adults and make them regular users of the healthcare services include hypertension, diabetes, cancer, heart disease and joint problems. Most of them, therefore, tend to seek medical attention form the health care providers. Due to these visits, it helps in the improvement of the health outcome of the older adults since the healthcare services offer them the best opportunity to find appropriate care form different healthcare facilities.

The older adults are particularly vulnerable as they move between different types of care. Since there is no proper coordination among the healthcare providers in different environments, this can lead to the care fragmentation which therefore places the older adults at high risk for duplication or absence of the required services that would address the condition at hand. The vulnerability also increases due to stress which is due to the movement from one facility to another in search of the care (Koh et al., 2010). The changes in medication as a result of facility change lead to adverse effects of drugs which will lead the transition of care form the hospital setting to the long-term care setting such as the nursing home or the private home settings (Barton & Grant, 2013). Also, there are instances of incomplete procedure during discharge from the hospitals which may be associated with the re-hospitalization that is unnecessary (Jinks, Ong & O’Neill, 2010). Further, this kind of care fragmentation may be due to the poor coordination between the care providers who care for the older adults in different environmental settings hence increasing the failure to meet the standards of care quality.

The health care services have ensured that the older adults have access to wide variety of healthcare services. This includes the provision of the appropriate drugs that help in treating their chronic conditions. In this case, the medical services foot out some bills for the older adults who consume most of the over the counter medications. Some of these medications that are widely used by the older adults include the anti-hypertension, drugs for cholesterol control, pain relief and drugs for the control and treatment of the heart diseases. Some of this medication have become cheaper to the older adults since the costs are shared with the healthcare services hence can better improve their health outcomes (Sheiham et al., 2011). However, the availability of the drugs over the counter has increased resistance in various diseases such as bacterial which have increased the risk of the older adults but the adverse effects are outweighed by the significance of the healthcare services. Therefore, healthcare services have helped to improve the health quality of the older adults.

Inequalities and disparities

Conclusion

The existence of the health inequalities are unfair practices and avoidable in health status between groups of communities and individuals. The health of individuals are determined by our lifestyle, genetics, the care we receive as well as the wider determinants. These are also influenced by our social, physical as well as environment comprising employment, education as depicted by Dahlgren and Whitehead model.  With the clear understanding of the relationships between all these social factors, it assists the healthcare professionals on their perspective regarding illnesses, health as well as the causes of what makes people ill or well which finally impact on the kind of treatment.

References

Barton, H., & Grant, M. (2013). Urban planning for healthy cities. Journal of Urban Health, 90(1), 129-141.

Baum, F. E., Laris, P., Fisher, M., Newman, L., & MacDougall, C. (2013). “Never mind the logic, give me the numbers”: Former Australian health ministers’ perspectives on the social determinants of health. Social Science & Medicine, 87, 138-146.

Beltran, V. M., Harrison, K. M., Hall, H. I., & Dean, H. D. (2011). Collection of social determinant of health measures in US national surveillance systems for HIV, viral hepatitis, STDs, and TB. Public Health Reports, 126(3_suppl), 41-53.

Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy, 101(1), 44-58.

Burris, S. (2011). Law in a social determinants strategy: a public health law research perspective. Public health reports, 126(3_suppl), 22-27.

Embrett, M. G., & Randall, G. E. (2014). Social determinants of health and health equity policy research: exploring the use, misuse, and nonuse of policy analysis theory. Social Science & Medicine, 108, 147-155.

Gibson, M., Petticrew, M., Bambra, C., Sowden, A. J., Wright, K. E., & Whitehead, M. (2011). Housing and health inequalities: a synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health & place, 17(1), 175-184.

Jinks, C., Ong, B. N., & O’Neill, T. (2010). ” Well, it’s nobody’s responsibility but my own.” A qualitative study to explore views about the determinants of health and prevention of knee pain in older adults. BMC Public Health, 10(1), 148.

Knol, A. B., Briggs, D. J., & Lebret, E. (2010). Assessment of complex environmental health problems: Framing the structures and structuring the frameworks. Science of the Total Environment, 408(14), 2785-2794.

Koh, H. K., Oppenheimer, S. C., Massin-Short, S. B., Emmons, K. M., Geller, A. C., & Viswanath, K. (2010). Translating research evidence into practice to reduce health disparities: a social determinants approach. American journal of public health, 100(S1), S72-S80.

Krumeich, A., & Meershoek, A. (2014). Health in global context; beyond the social determinants of health?. Global health action, 7(1), 23506.

McCartney, G., Thomas, S., Thomson, H., Scott, J., Hamilton, V., Hanlon, P., … & Bond, L. (2010). The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008). BMj, 340, c2369.

Mogford, E., Gould, L., & DeVoght, A. (2010). Teaching critical health literacy in the US as a means to action on the social determinants of health. Health Promotion International, 26(1), 4-13.

Morgan, A., & Ziglio, E. (2010). Revitalising the public health evidence base: An asset model. In Health assets in a global context (pp. 3-16). Springer New York.

Potvin, L. (2012). Intersectoral action for health: more research is needed!.

Raphael, D. (2011). A discourse analysis of the social determinants of health. Critical Public Health, 21(2), 221-236.

Sheiham, A., Alexander, D., Cohen, L., Marinho, V., Moysés, S., Petersen, P. E., & Weyant, R. (2011). Global oral health inequalities: task group—implementation and delivery of oral health strategies. Advances in Dental Research, 23(2), 259-267.

Townsend, N., & Foster, C. (2013). Developing and applying a socio-ecological model to the promotion of healthy eating in the school. Public health nutrition, 16(6), 1101-1108.