Module 3 - The Determinants of Health
MODULE 3 | LESSON 3
Translating determinants into health risks
INTRODUCTION
Exploring how determinants of health show up as health risks.
Translating health determinants into health risks involves understanding how various factors influencing health can increase the probability of developing specific diseases or conditions in your community. This process requires identifying factors, assessing their impact on health, and ultimately connecting those impacts to increased risk for certain health problems.
The determinants of health are a theory or framework to understand the broad structures and factors that determine health. The determinants themselves cannot necessarily be translated directly into lived experience and measurements, this step illustrates how we can situate structural determinants in place and in experience.
Learning Points
Using the determinants of health and translating them into health risks that show up in our built environments begins the process of measuring impact in a tangible way. This step takes us into HIA territory.
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An example of a commercial and social determinant of health would be the prominence of gig work, this signals a lack of worker rights, zero hour contract and shift work, and lack of unionisation.
How this shows up in a given space could be a high number of people working delivery shifts,
spending the majority of their time on polluted roads,
at high risk of traffic accidents,
high exposure to climate risk such as inadequate shelter, hydration and rest during a heatwave
High risk of stress related diseases due to financial precarity.
There are health risks of traffic pollution, unsafe and poorly maintained traffic infrastructure, inadequate public realm amenities, finance related stress.
As shown, a broad structural determinant such as gig economy is experienced on the ground in a wide and multiple range of health risks depending on the location.
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Another example would be the commercial determinant of materiality. The specific materials used on a construction site and their levels of toxicity are likely to be measured in a lab/in a vacuum.
Once identified, the next step is to assess the health risk of this toxic material in place. To do this you would need to address
Where is this material being used? How does the community live and spend their time here? How many occupants are in or around this space?
What alternatives are there to avoiding time inhaling this material?
What underlying conditions are there that may make this community more susceptible to experiencing high toxicity?
What is the ventilation in this space? What are the levels of external air pollution that would impact choosing to ventilate the space?
These questions ground the determinant of materiality into place and experience.
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Another example would be the determinant of public transport infrastructure and provision, this could be translated into health risks by considering
Distances and accessibility to work, schools and healthcare services
Time and cost of doing multiple journeys
Density of population and users of this mode of transportation
Levels of pollution on these service routes
The associated health risks would be exposure to high levels of pollutants throughout the day, frequency of exposure, and age, development and susceptibility of those exposed. The level of stress related health risks due to experience of cost, quality and efficiency of the infrastructure.
KEY LEARNINGS
Broader health determinants are measured by considering and situating the determinant in place and experience for those affected. Once contextualised, these can be understood as health risks.
Health risks are tangible as well as multiple and complex, and tend to capture multiple determinants of health at play in any given area.
It is always important to consider how a determinant of health is experienced by people in context as there are factors of susceptibility to take into account.
Conversations around lived experiences and ‘day in the life’ will expose the determinants of health at play.
QUESTIONS TO ASK YOURSELF
Have I role played different members of my community across a day in their life? An individual’s exposure and experience of health risk is impacted by their existing health, the conditions of their home and work, the ongoing levels of stress they may be experiencing, as well as their age.