 What makes people sick or healthy? This is one of the key questions in this course. It's one of the things that we're going to be thinking about a lot as we talk about public health. Moving into this, I think we should first start by defining this, because we don't want to have to say what makes people sick or healthy every time. We want to use a good word that sort of puts it all together, and when scientists are talking about this, they talk about determinants, and I need to spell it right here, not with a funny H there, determinants of health. They use the word determinants because these things determine how healthy you'll be, so just like how you would use it for lots of other things. So how about we first take a look at maybe two ways that I like to divide this up? And this is something I've kind of just made up on my own. This is not necessarily something that you find out there in charts or things like that, but on the left I'd like to write determinants, and on the right I would like to write health. Now if we go back and take a look at that original definition that we had of health, you're going to find health divided up into three things. So you've got your physical health, you've got your mental emotional health, and then you've got your relational health. So how you're doing with other people in your society or in your family or things like that. Now I kind of imagine when I think about these things, about them sort of overlapping, because they definitely do. In each part of our lives we have these things that, you know, how our physical life relates how we relate to people or how we feel emotionally or things like that. So no one determinant or no one sort of aspect of our health is purely physical. A lot of times it's either mental and emotional and physical or relational and physical like here. And so you would want to have a little bit more nuanced of a view of what health means. So I think it's a good idea to divide it up into sort of a diagram, something like this. Determinants work exactly the same way. If you kind of look, I found one study that was talking about this, I think it was a Canadian study, and the determinants were sort of divided up and I thought was a pretty cool way. I thought they, I like the terms that they use. You've got lifestyle, up here, and then we've got environmental. And then you have bio, medical. And I put a dash there because I wanted to make sure that it could all fit. So let's do the same thing here though. So here you've got the biomedical, which sometimes interferes with the lifestyle, sphere of things, and sometimes the environment comes in and touches on both of those things, or one or the other. And so then you have these spaces in between these determinants, these things that determine how healthy we are. These spaces in between are then taken up by, they sort of create the health that we have. So determinants translate into the health that we'll someday have, or that we have at the moment even. So these things can translate, each one of these translates also into one of these circles over here to the right. So all of these things, you could have one thing that was a single determinant that could just affect maybe your mental life, but that's probably a little bit less likely. In general, whenever you have some sort of determinant, it's going to affect your complete health, your total health, and maybe it will affect it in more than one way. Just like I'm highlighting these little spaces in between. So what are these determinants of health? How about we take a look and we're going to make one of our famous lists of what this looks like. So I'm just going to write determinants over here, determinants, and I'm going to make a really big bubble. And I'm not going to divide them up into groups because they're going to be different for every single person and every single case of something that comes up. But I'm just going to write down kind of in list form what we have inside. So income and status is one. So how much money people are making has a big effect on their ability to make money and to do things like get health care and things like that. So I need to, sorry about this, taking just a second, status. Now let's move down to listen with social support. So whether you have people in your lives who are helping you out, taking care of you, people, networks that are kind of there for you if you need help. Education and literacy. I'm not going to write literacy, but education is a very important one. You've also got employment. So what you do as a job can have a big effect on your health. So someone who does factory work might have different health care problems and someone who does office work or something like that. You've got social environments. I'm just going to write environments like that. Social environments just means who you're friends with, who you're hanging out with, who you're around, who's in your family. These things determine the influences that you have on you. So maybe you have people who are sort of pushing you in one direction or another. This could be with different maybe habits that they have or drugs that they take or substances that they use or things like that all have an effect on your health. You also have your physical environment. So what environment are you walking around in? This has a huge effect on you. Think about something that if you're walking around in a nuclear waste site, you have a very different physical environment than if you're walking around in an unpolluted piece of the savannah in Africa. So you have very different environments there. Personal practices or skills. So these things also have an effect on how healthy you are. If you're able to realize that maybe you're doing something wrong and are able to change it and have like sort of habit-building abilities, then you might be able to change your habits and maybe make yourself a healthier person. So that is also something. Childhood has a huge effect on people. So how you were as a child, how you developed as a child can have a huge effect. Now, it's all reversible. Things are not everything, but many things are reversible from childhood. But you have to be aware of them, a lot of things. But childhood development has a very big effect on people's health. Biology, obviously, and biology as in genetics as well. So maybe you have a genetic predisposition to something. So maybe your family has a history of cancer or something like that. That could definitely have an impact on your health. It's not necessarily something you can't change. There are ways of fighting certain things. But just as a matter of fact, that is the way it goes. You've also got healthcare services. Now, this is a huge one, healthcare services. And healthcare services can have a huge effect on the way that you're health expresses itself. If you have a doctor who's able to tell you that you're going to get something and you can then steer your way around it, that's one way that health services help you. Also, if you get sick and you're able to get care early on for free or you're able to at least afford it, well, then you'll be able to have a healthier future. And you also will avoid some of the negative side effects that come down the road from having some sort of illness. Also, your gender plays a role. This is sadly a really big deal. A lot of people dependent on their gender or their gender identity are sometimes discriminated against. And so if you have a gender that's somehow discriminated against in a certain society, you might not be as able to reach to get some kind of care. Or if your gender plays a role in your ability or maybe your pride in seeking help or something like that, well, then that plays a role in your determinants and the way that your health will play out. And I think lastly, I'll just write culture. It's a really broad term and it's also not a very perfect term. It's kind of a blunt hammer, but culture also can determine a very big part of your health just on certain traditions and things like that. So that kind of gives you an idea of some of the determinants. They're all obviously connected in very bizarre ways and they all fall on that sort of three-circled chart that I made in the last slide. So when you're thinking about these things and maybe even building more onto this list, be sure to include these things. Be sure to think about maybe the side effects of these things. So sometimes people will be talking about a disease and they'll be thinking, okay, well, this is the determinant, but sometimes they're wrong. Sometimes the determinant is actually even further back. Maybe we can take an example of something like something that I've been thinking about a lot recently, which is bad cardiovascular health in the United States. So people have bad hearts and people are getting a lot of heart attacks in the United States because people are eating too much and that's an obesity problem to some degree. So a lot of people would put obesity as the core social determinant or the core determinant, but actually the determinant lies back here with these things here. You've got maybe culture or you've got healthcare services or genetics and lots of other things combining social environments and things like that, education that are all determining that obesity. So it's not necessarily the obesity that is the cause of the cardiovascular problems or the heart problems, but it's actually these things even deeper than that. So you also want to be sure that when you're looking for determinants that you're looking for the really, the really, really deep stuff, not the shallow stuff. So these things are all connected in very complicated ways, but if you think your way through it, you can usually find the source. All right, so that was our lesson about what makes people healthy or sick. You can check out more lessons like this at alversity.org.