Inventing our future Collective action for a sustainable economy

42
Figure 4.1: The main determinants of health 27
General socio-economic, cultural and environmental conditions
Education
Agriculture
and
food
production
Work
environment
Living and working
conditions
Social and community networks
Individual lifestyle factors
Age, sex and
constitutional
factors
Unemployment
Water &
Sanitation
Health
Care
Services
• The second is the life course approach. There is substantial evidence that health – both good and
bad – is transmitted from one generation to the next through economic, social and developmental
processes: babies born to poorer families are more likely to be born prematurely, are at greater risk
of infant mortality and have a greater likelihood of poverty, impaired development and chronic
disease in later life. 28 Against this backdrop, the life course approach focuses on the experience
of health from conception through childhood and adolescence to adulthood and old age. It argues
that there are critical points at the transition between life stages where an individual may move
in the direction of advantages or disadvantages in health. 29
4.3 The two approaches need to be regarded as cross-cutting: individual determinants are manifested
in different ways at different life stages, and as an individual moves from one life stage to the next,
the nature of the determinants will change.
4.4 In the paragraphs that follow, we examine each of the ‘layers’ within Figure 4.1, drawing on evidence
and analysis from across the East of England to understand better the processes underpinning the
data described in Chapter 3. As the strategy prepared by the Norfolk, Suffolk and Cambridgeshire SHA
observes, around 15% of health differences are explicable in terms of genetic and biological factors, 30
the other influences on health – which are the focus for Healthy Futures – are explicable in terms
of these broader determinants.
Housing
27 Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health Stockholm: Institute of Futures Studies, 1991
(Diagram reproduced with the publisher’s permission).
28 Tackling Health Inequalities: 2002 Cross-Cutting Review HM Treasury (Crown copyright).
29 See, for example, ‘Childhood disadvantage and adult health: a life course framework’, Hilary Graham and Chris Power,
Health Development Agency (HDA), 2004
30 Health Strategy 2005-2010 Norfolk, Suffolk and Cambridgeshire Strategic Health Authority, 2005.