1.2 The Health System

There are several factors (or determinants 1. Biology: the age and sex of the person; the genetic makeup including heritable diseases. At the current time, biological factors are the hardest to change, although many are hopeful that genetic engineering may change this at some point. For this reason, most public-sector investment in public health aims to affect the behavioral, social, environmental and medical access determinants. . 2. Behaviors: alcohol, tobacco, substance abuse; risk-prone lifestyles, such as working as a miner or prostitute. . 3. Social: discrimination, income disparities, socioeconomic status, education, occupation, class, social support. Poorer people often lack time and opportunity to exercise. Food for a healthier diet tends to be more expensive and takes longer to prepare. A strong and consistent finding of epidemiological research is that there are health differences among socioeconomic groups. Lower mortality, morbidity, and disability rates among socioeconomically advantaged people have been observed for hundreds of years. . 4. Environment (or total ecology): where a person lives, sanitary and crowding conditions, air and water quality, lead exposure, and the design of neighborhoods. Some of the most dramatic improvements in population health during the twentieth century include: improved water, food, and milk sanitation, reduced physical crowding, improved nutrition, and central heating with cleaner fuels. Most Americans live in urban areas, which are often associated with harmful health behaviors, such as exercise, diet, sexual behavior, alcohol and substance abuse. Cities also have higher levels of air pollution, which may cause cardiovascular and respiratory disease. Crowded buildings may increase the risk of lead exposure as well as asthma. Those that live in rural areas have other risks, such as exposure to pesticides. . 5. Medical care: access to quality health care; having insurance. For example, the availability of Medicaid (health insurance for the poor) was expanded greatly with the passage of the Affordable Care Act. This resulted in greater access to medical care for a previously underserved population. Similarly, the nationwide shift to high-deductible insurance plans has actually reduced accessibility to affordable healthcare for many. ;