Health Determinants and Health Promotion
What you must understand
Determinants are the factors that shape health: biological (genetics, age), behavioural (diet, activity, smoking), social (income, education, employment, social support), environmental (housing, air quality, climate), and political/economic (policy, health system access). Understand the social determinants of health framework and the Ottawa Charter (1986) five action areas: build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services. Know the three health promotion approaches: medical/preventive, behavioural/lifestyle, and socio-environmental. Distinguish primary, secondary and tertiary prevention.
Traps in questions
- Listing determinants without linking them to a specific health outcome.
- Confusing the Ottawa Charter action areas with the WHO prerequisites for health (peace, shelter, education, food, income, stable ecosystem, social justice, equity).
- Overstating individual responsibility and ignoring structural barriers - a lifestyle approach alone rarely closes inequities.
- Mixing prevention levels: immunisation is primary; screening is secondary; rehabilitation is tertiary.
Worked example
A community has high childhood obesity. A behavioural approach runs a school fitness program (develops personal skills). A socio-environmental approach improves playground access, restricts junk-food advertising and subsidises healthy food (builds healthy public policy, creates supportive environments). A strong answer uses both and justifies why the socio-environmental approach is more sustainable and equitable.
Rule of thumb
For any promotion strategy, name the determinant it targets, the Ottawa Charter area it uses, and the prevention level it represents.