Lecture 2 – Social determinants of health
• Defining what makes something a determinant and what makes it social
A determinant is an influence, factor or (potential) cause physical environment, medical care,
genetics and biology, social circumstances and individual behavior.
Social Determinants of Health (SDOH) are the conditions in which people are born, grow, live, work,
age in. These circumstances are shaped by the distribution of money, power, resources.
• Examples of social circumstances and how they impact health
Age
No previous infection
Rank (officer or not)
Arm of service (forward or base)
Part of the civil population or not
• What a social gradient is and how this is related to health
The social gradient = people who are less advantaged in terms of socioeconomic position have worse
health (and shorter lives) than those who are more advantaged.
Children 12-16 who follow a more practical (vmbo) rather than theoretical (vwo) study usually drink
more often, exposing them to Alcohol Use Disorder and higher health risks. Higher educated people
are more satisfied with life, more have a paid job and their health is better.
• Ways to “measure” the severity and frequency of a disease
Severity of disease:
Mortality = death rate
Case-fatality ratio = proportion of patients who die
Morbidity = impact of the disease on overall health
Frequency of disease:
Incidence rate = how quickly a disease occurs in a population
Prevalence = proportion of a population with a condition in a given time frame
Life expectancy cannot be accurately measured.
• Why equity matters when we talk about (population) health
Inequality = 1 side of the tree has more apples, so 1 population has more food
Equality = evenly distributed tools and assistance, but 1 population cannot reach the apples
Equity = custom tools so 2nd population can also reach the few apples with a larger ladder
Justice = everyone gets the same tools/opportunities, both sides have enough apples.
Health equity are inequalities that are socially produced, systematic in their unequal distribution
across the population, avoidable and unfair.
• Theory: the Rainbow model, the CSDH framework
and an update
Rainbow model: relationships between different
factors and health (1991).
,CSDH Framework to advance health equity
from WHO (2010).
New framework from the WHO (1/2024).
Monitoring social determinants of health
equity.
• Examples of policies and data for COVID-19
and a note on ongoing conflicts
Africa has a low COVID-19 vaccination rate. For the booster vaccination, the percentage also dropped
for the rest of the world.
Crisis’s in Gaza, Ukraine, Sudan due to political conflict
• What our role can be in the system
Sharing an apple or fixing the apple tree (to have more apples)
Lecture 3 Global burden of disease
Able to define the Global Burden of Disease and relevant concepts
A concept that describes death and loss of health due to disease, injury and risk factors.
It measures the impact of living with illness and injury, and dying prematurely.
It is calculated in terms of Disability Adjusted Life Years which quantify the number of Years of Life
Lost to death and the number of Years of Life a person lives with Disability caused by the disease.
DALY = YLL (mortality) + YLD (morbidity
, Group 1: communicable, maternal, perinatal and nutritional conditions (CDs)
- Spreadable diseases from humans (gonorrhoea) or food (salmonella) or insect bites (malaria)
WHO classifications:
1. Large-scale impact on mortality, morbidity, disability
2. Potential epidemics
3. “Easily” controlled with cost-effective interventions
Group 2: Non-communicable conditions (NCDs)
- Chronic diseases like cancer, asthma, cardiovascular, diabetes, neoplasms, mental disorders
Group 3: Injuries, traffic accidents, falls, violence, suicide, homicide
Able to describe demographic and epidemiologic transitions
Demographic transition:
high fertility/high mortality low
fertility/low mortality
Epidemiologic transition:
1. Disease + animal attacks
2. Sanitation/medicine
3. Heart disease/cancer
4. Medical advances
5. Potential resurgence of
infectious disease
due to globalization.
Other causes of Triple and double GBD are:
- Population growth, aging
- Globalization: mobility causes more risk of infection and access to McDonalds
- Urbanization: sedentary lifestyle + more risk of infection
- Climate change: less crop yield and air pollution diseases
Understand shifts/trends in GBD
Shift in causes of YLL: CDs used to be the main cause, but now its NCD (especially HIC).
LMIC struggles with double burden of disease: onset of NCDs whilst CDs remain high.
Triple burden of disease: all 3 groups.
Understand why the GBD is measured and how to measure it
Reliable health data and statistics are the foundation of health policies, strategies, evolution and
monitoring. Evidence is the foundation for sound health information for the general public.
Policy/Enabling environment:
- Change/develop policies to improve population health
- Compare health of populations
- Identify and quantify health inequalities
Organizational:
- Ensure appropriate attention to addressing health & burden of disease Design and
implement health interventions
- Provide debates on priorities for planning/services, research, professional training
• Defining what makes something a determinant and what makes it social
A determinant is an influence, factor or (potential) cause physical environment, medical care,
genetics and biology, social circumstances and individual behavior.
Social Determinants of Health (SDOH) are the conditions in which people are born, grow, live, work,
age in. These circumstances are shaped by the distribution of money, power, resources.
• Examples of social circumstances and how they impact health
Age
No previous infection
Rank (officer or not)
Arm of service (forward or base)
Part of the civil population or not
• What a social gradient is and how this is related to health
The social gradient = people who are less advantaged in terms of socioeconomic position have worse
health (and shorter lives) than those who are more advantaged.
Children 12-16 who follow a more practical (vmbo) rather than theoretical (vwo) study usually drink
more often, exposing them to Alcohol Use Disorder and higher health risks. Higher educated people
are more satisfied with life, more have a paid job and their health is better.
• Ways to “measure” the severity and frequency of a disease
Severity of disease:
Mortality = death rate
Case-fatality ratio = proportion of patients who die
Morbidity = impact of the disease on overall health
Frequency of disease:
Incidence rate = how quickly a disease occurs in a population
Prevalence = proportion of a population with a condition in a given time frame
Life expectancy cannot be accurately measured.
• Why equity matters when we talk about (population) health
Inequality = 1 side of the tree has more apples, so 1 population has more food
Equality = evenly distributed tools and assistance, but 1 population cannot reach the apples
Equity = custom tools so 2nd population can also reach the few apples with a larger ladder
Justice = everyone gets the same tools/opportunities, both sides have enough apples.
Health equity are inequalities that are socially produced, systematic in their unequal distribution
across the population, avoidable and unfair.
• Theory: the Rainbow model, the CSDH framework
and an update
Rainbow model: relationships between different
factors and health (1991).
,CSDH Framework to advance health equity
from WHO (2010).
New framework from the WHO (1/2024).
Monitoring social determinants of health
equity.
• Examples of policies and data for COVID-19
and a note on ongoing conflicts
Africa has a low COVID-19 vaccination rate. For the booster vaccination, the percentage also dropped
for the rest of the world.
Crisis’s in Gaza, Ukraine, Sudan due to political conflict
• What our role can be in the system
Sharing an apple or fixing the apple tree (to have more apples)
Lecture 3 Global burden of disease
Able to define the Global Burden of Disease and relevant concepts
A concept that describes death and loss of health due to disease, injury and risk factors.
It measures the impact of living with illness and injury, and dying prematurely.
It is calculated in terms of Disability Adjusted Life Years which quantify the number of Years of Life
Lost to death and the number of Years of Life a person lives with Disability caused by the disease.
DALY = YLL (mortality) + YLD (morbidity
, Group 1: communicable, maternal, perinatal and nutritional conditions (CDs)
- Spreadable diseases from humans (gonorrhoea) or food (salmonella) or insect bites (malaria)
WHO classifications:
1. Large-scale impact on mortality, morbidity, disability
2. Potential epidemics
3. “Easily” controlled with cost-effective interventions
Group 2: Non-communicable conditions (NCDs)
- Chronic diseases like cancer, asthma, cardiovascular, diabetes, neoplasms, mental disorders
Group 3: Injuries, traffic accidents, falls, violence, suicide, homicide
Able to describe demographic and epidemiologic transitions
Demographic transition:
high fertility/high mortality low
fertility/low mortality
Epidemiologic transition:
1. Disease + animal attacks
2. Sanitation/medicine
3. Heart disease/cancer
4. Medical advances
5. Potential resurgence of
infectious disease
due to globalization.
Other causes of Triple and double GBD are:
- Population growth, aging
- Globalization: mobility causes more risk of infection and access to McDonalds
- Urbanization: sedentary lifestyle + more risk of infection
- Climate change: less crop yield and air pollution diseases
Understand shifts/trends in GBD
Shift in causes of YLL: CDs used to be the main cause, but now its NCD (especially HIC).
LMIC struggles with double burden of disease: onset of NCDs whilst CDs remain high.
Triple burden of disease: all 3 groups.
Understand why the GBD is measured and how to measure it
Reliable health data and statistics are the foundation of health policies, strategies, evolution and
monitoring. Evidence is the foundation for sound health information for the general public.
Policy/Enabling environment:
- Change/develop policies to improve population health
- Compare health of populations
- Identify and quantify health inequalities
Organizational:
- Ensure appropriate attention to addressing health & burden of disease Design and
implement health interventions
- Provide debates on priorities for planning/services, research, professional training
