Iso tc tc 215/sc n339 Date: August 2003 iso/pdts


Non-medical determinants of health



Yüklə 435,4 Kb.
səhifə3/6
tarix02.01.2018
ölçüsü435,4 Kb.
#19219
1   2   3   4   5   6

6 Non-medical determinants of health

6.1 Non-medical determinants of health dimension description

The dimension of non-medical determinants of health is described in Table 6.

NOTE 1 In order to better understand geographic or temporal variations in health status and health system performance, a variety of non-medical determinants of health have been included in the framework.

NOTE 2 Non-medical determinants of health are those that fall outside of the sphere of medical/health care, generally speaking, but that have been shown to affect health status, and in some cases, access to health care services.

Table 6 — Non-medical determinants of health dimension description

Sub-Dimension

Description

Examples of indicators

Health behaviors

Aspects of personal behavior and risk factors that epidemiological studies have shown to influence health status.

• Smoking rate • Physical activity

Socioeconomic factors

Indicators related to the socioeconomic characteristics of the population, that epidemiological studies have shown to be related to health.

• Unemployment rate • Low income rate • High school graduation •

Social and community factors

Measures the prevalence of social and community factors, such as social support, life stress, or social capital that epidemiological studies have shown to be related to health.

• School readiness • Social support • Housing affordability • Literacy

Environmental factors

Environmental factors with the potential to influence human health.

• Water quality

Genetic factors

Factors outside those normally influenced by individual behaviors or by the social, economic or physical environment. Genetic factors determine predisposition to certain conditions.

• Rates of genetically determined diseases (eg Down's syndrome)



7 Health System Performance

7.1 Health system performance dimension description

The dimension of health system performance is described in Table 7.

Table 7 — Health system performance dimension description
Table 7 (continued)



Community and health system characteristics

8.1 Community and health system characteristics dimension description

The dimension of community and health system characteristics is described in Table 8.

Table 8 — Community and health system characteristics dimension description

Sub-Dimension

Description

Examples of Indicators

Resources

contextual information about financial, physical, human or other types of resources

• number of physicians per capita • provider compensation • asset ratios • % expenditure on teaching compared to service delivery • % expenditure on research

Population

contextual information about the characteristics of the population

• health insurance enrolment • % population over 65 years of age • % residing in urban centers

Health Services

contextual information about the configuration, organization, sustainability or utilization of the health care system

• number of coronary artery bypass graft (CABG) per capita • number of home care services provided per capita




  1. 9. Dimension relationships

  2. 9.1 General


Tables 1 through 4 and 5 through 8, respectively, provide examples of indicators that are useful to monitor in order to understand health status from the perspective of a population for the four dimensions of the health indicators conceptual framework. However, these dimensions are not independent. Indeed they each have influences on other categories of indicators, according to Figure 1.

Figure 1 – Relations: Health indicators

NOTE Figure 1 in Unified Modeling Language (UML) defines the high level interactions of the major determinants / indicators of health status. Health system performance, non-medical determinants of health, and the community and health system characteristics all Influence the health status package. In turn, the health status dimension has bearing on the characteristics of the community and the health systems associated with that community.

9.2 Relationships

9.2.1 Relationships –General

It is clear from the depiction in Figure 1 that health status is influenced by the other three determinants of health status. On further examination it becomes clear that community and health system characteristics also influences both health system performance and the non-medical determinants of health. Less obvious but also important is the influence of health status on the community and health system characteristics. Health status clearly changes the community as well as many of the services that are offered to that community. The communities with poor health status may have lower employment rates that can affect the rate of health insurance enrolment as well as other health factors. Changes in the community can cause changes in non-medical determinants of health, which in turn influence the overall health status of the population. These community characteristics influence the performance of the health system due to factors both within and outside of the health system’s direct control. The health system performance influences the health status of the population, which changes the community characteristics. The way in which relations influence specific sets of classes or categories can be classified by weight of influence. The weight of each type of relation can be specifically qualified by value. By way of example, the ‘Requires’ relationship is stronger than the ‘Leads to’ relation, which in turn is stronger than the ‘Influences’ relation (which directionally is non-specific).

9.2.2 Relationships – Health status

Health status is complex (see Figure 2). Health conditions can lead directly to death or can, through changes in well-being or human function, lead to death. Well-being in turn can influence health conditions and, through health conditions, well-being can influence human function. This link between well-being, human function and health conditions emphasizes the integral communication between happiness, health and function. The symmetric Influences relationship between health conditions and well-being represents the intertwined double headed caduceus that symbolizes excellent health care. The emphasis of this central relationship promotes and stresses the importance of holistic allopathic healthcare.

Figure 2 – Relationships: Health status

NOTE Figure 2 in UML depicts the relationships of the health status dimension. Health conditions, lack of well-being and poor human function (such as disabilities) can lead (cause) to death. This death rate is an important indicator of health status. Health conditions can cause death in multiple ways and can cause impairment in human function. Health conditions affects the well-being of individuals and populations and well-being can have an important effect on health conditions.

9.2.3 Relationships – Non-medical determinants of health

The non-medical determinants of health span the gambit from nature to nurture (see Figure 3). The relationship of each of these entities to health status can vary greatly between populations. Cultural aspects of care are considered under the health behaviors and social and community factors categories. As longitudinal care becomes an increasing reality, it is clear that the non-medical indicators will become more important in the care of a

ISO/PDTS Health indicators definitions, relationships and attributes

population. Life style changes are among the most important interventions available to healthcare systems globally. Emphasis on these determinants of health will provide a more positive change in health status (in terms of quality of life and years of life saved) than any other single health intervention known today.

Figure 3 – Relationships: Non-medical determinants of health

NOTE Figure 3 in UML depicts the relationships of the non-medical determinants of health. Environmental factors and social and community factors influence health behaviors while genetic factors predispose to health behaviors. In turn, health behaviors and genetic factors predispose to social and community factors.

9.2.4 Relationships –Health system performance

Health system performance is centered on acceptable and appropriate care. Features such as competence, continuity, efficiency and safety clearly influence or lead to acceptability (see Figure 4). Appropriateness and acceptability influence one another. Competence requires efficiency and leads to acceptability. Competence

ISO/PDTS Health indicators definitions, relationships and attributes

influences safety. Competence in medical training is emphasized to achieve the goal of acceptable practice. Acceptability is not a minimum criterion, but instead is excellence of care with the provision of evidence-based practice supplemented by experience-based practice where sufficient evidence does not exist to direct medical decision making.

Figure 4 – Relationships: Health system performance

NOTE Figure 4 in UML depicts the relationships of the health system performance dimension. Acceptability influences Appropriateness and Appropriateness influences Acceptability. Competence, safety and continuity lead to Acceptability. Competence leads to Appropriateness. Continuity and Competence both influence safety. Competence leads to efficiency and efficiency requires competence.

9.2.5 Relationships – Community and health system characteristics

Community and health system characteristics show the interaction between health systems, populations and resources (see Figure 5). As resources become more constrained this set of indicators becomes more influential with regard to the overall health of a population. Populations require care. They have to have resources to set up the appropriate health infrastructure and utilize the health system’s resources in the course of providing care. The health system is sustained by resources from the population and the health of the population influences what resources are within the means of the population and also what resources will be extended to the healthcare system.

Figure 5 – Relationships: Community and health system characteristics

NOTE Figure 5 in UML depicts the relationships of the community and health system characteristics. The health system cares for a population which utilizes the health system. The population creates and utilizes resources that are supplied to the health system. The health system utilizes these resources in the provision of care.

  1. 10. Attributes

  2. 10.1 General


Each of the classes of health indicators is an object that passes knowledge up both in detail and in aggregate to the root class. Each class can aggregate the data from its subordinate classes based on their attributes and relationships. The root class understands the relationships between each of its members and is capable of aggregating the information into a level of health status from all of the indicators.

10.2 Attribute visibility and type

The data contained in the classes of health indicators are represented as attributes specific to that class. Attributes retain two main properties of Visibility and Type, which determine how other classes interact with each other.

10.2.1 Visibility of an attribute

The visibility of an attribute or class determines how other classes interact with other attributes or classes. Attribute and classes can be defined as public, protected or private. Attributes that are available to all other classes are declared to be public. Public attributes are visible to all classes, and can be referenced directly. In Figures 2 through 5, public attributes are preceded by the ‘+’ sign. Protected attributes, represented by the ‘#’ symbol, can be referenced only by the class that defines the attribute, or any subclass of the parent class. Private attributes are represented by the ‘-’ symbol, and can be referenced only by the class that defines the attribute. If any class requires access to a private attribute of another class it must do so through an interface provided by the owning class.

10.2.2 Type of an attribute

An attribute’s type refers to the data type for that attribute: an integer, string, object etc. When a class references an attribute for another class, it will receive a value of the type for that attribute. Each health indicator class has a public Concept attribute of type long, which uniquely represents each health indicator. The attributes specific to each health indicator class are defined in Clause 10.3.

10.3 Health indicator class attributes and definitions

10.3.1 Health status dimension

10.3.1.1 Health status dimension: Class “death”

Table 9 – Health status dimension: Class “death”

Attribute

Definition

Concept

An attribute of type long that is a unique identifier, which




represents each health indicator

Immediate cause

The most direct cause of death, as opposed to predisposing conditions that contributed to the patient’s instability

Acute conditions

Conditions that have been present only during the episode




of illness leading up to the patient’s demise.

Chronic conditions

Conditions that were present prior to the onset of the episode of illness, which led up to the patient’s demise

Age

The patient’s age in years from birth. This value is an




integer

Sex

An identifier of the genetic gender of the patient at their time of death (eg XX, XY, XXY, XYY, XO, XXX). It may also be




useful to hold the patient’s stated or phenotypic gender in the model

Expected life span

The current life expectancy by category for any given




population at any given point in time




  1. Yüklə 435,4 Kb.

    Dostları ilə paylaş:
1   2   3   4   5   6




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©genderi.org 2024
rəhbərliyinə müraciət

    Ana səhifə