Biological and Physical Determinants of Health: Why They Matter to Providers

The Olympics are the best-known global athletics competition, boasting the feats and prowess of individuals from more than 200 countries. During the Winter Olympics, it’s not uncommon for athletes from Norway to excel in sports like skiing because it’s a big part of life in their Scandinavian country. Basically, where they live is a notable determinant of the most popular sport. 

It’s not unusual for determinants to shape our life, from biological and behavioral factors to sociocultural, economic and ecological ones. Although some determinants can be influenced, others are more difficult to control. 

What are Determinants of Health?

In healthcare, determinants consist of access, cost, quantity and quality of services. As noted by the World Health Organization (WHO), they also include factors that make people healthy — or the opposite — such as:

• Income and social status: Higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
• Education: Low education levels are linked with poor health, more stress and lower self-confidence.
• Physical environment: Safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. People in employment are healthier, particularly those who have more control over their working conditions.
• Social support networks: Greater support from families, friends and communities is linked to better health. Customs, traditions and the beliefs of the family and community all affect health.
• Genetics: Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
• Health services: Access and use of services that prevent and treat disease influences health.
• Gender: Men and women suffer from different types of diseases at different ages.

Understanding Determinants of Health 

You might be surprised to learn that clinical care is estimated to account for only 10-20 percent of the modifiable contributors to health outcomes in a population; the other 80-90 percent are health-related behaviors, socioeconomic factors and physical environment factors. Though biological determinants are important at the individual level, social determinants of health (SDOH) are key at the population level. 

Understanding the various determinants of health (DOH) and how they affect individuals can be confusing. Although more recent attention has been paid to SDOH, biological and physical determinants of health play an important role in healthcare, especially for providers striving to better understand their patient populations. In this blog, we’re breaking down the differences between these two lesser-discussed determinants and how they affect the health of individuals. 

Biological Determinants of Health 

The three primary biological determinants that play a role in the health and illness of individuals are race, sex and age. Others consist of inherited conditions, brain chemistry, hormone levels, nutrition, body structure and functioning and some mental or psychological characteristics. Subclasses include genetic, single-gene, chromosomal and multifactorial. 

That’s fancy language for describing how a person’s biological and genetic composition affects their overall health. As fixed individual attributes that a person can’t control, these determinants can have more of an impact on the health of certain groups than others. 

A common example of this is sickle cell disease, which is a condition an individual inherits when both his or her parents carry the gene for it. The sickle cell gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India and Saudi Arabia. 

Once again, the effect factors such as these have on an individual’s health isn’t equal. Biological and genetic factors combined with health behaviors affect health up to 25 percent, while social and physical ones account for 75 percent.      

Physical Determinants of Health

You might think physical determinants of health refer to a person’s activity level. You’d be wrong. They’re factors in a person’s physical environment that impact them. Examples of physical determinants of health include:

• Natural environment, such as plants, weather or climate change
• Built environment, such as buildings or transportation
• Worksites, schools and recreational settings
• Housing, homes and neighborhoods
• Exposure to toxic substances and other physical hazards
• Physical barriers, especially for people with disabilities
• Aesthetic elements, such as good lighting, trees or benches

Individuals interact with their physical environment through the air they breathe, the water they drink and the places they live. Their environmental influences can be both positive and negative, from easier access to healthcare providers to a higher risk of being a victim of crime. Something as simple as access to a neighborhood with sidewalks can create more opportunities for a person to engage in physical activity, whereas someone living in a more rural area typically relies more on a vehicle for transportation. 

Take, for example, air quality. Air pollution is associated with increased asthma rates and lung diseases and an increase in the risk of premature death from heart or lung disease. Similarly, the availability of a safe water supply can markedly impact an individual’s health because water contaminated with chemicals, pesticides or other contaminants can lead to illness, infection and increased risks of cancer. Both of these environmental factors are those most of us probably take for granted. 

Why Do Physical Determinants of Health Matter?

For those of you who might not believe a person’s physical environment makes that much of a difference, take into account these statistics:

• Approximately 83 million people still do not have adequate sanitation systems.
• Hazardous chemical risks, such as exposure to toxic pesticides, lead and mercury tend to disproportionately impact children and pregnant women.
• Exposure to toxic chemicals can lead to chronic and often irreversible health conditions, such as neurodevelopment problems and congenital defects and diseases associated with endocrine disruption.
• Living in socioeconomically disadvantaged neighborhoods has been linked to higher rates of injury in both adults and children.
• Proximity to hazardous sites may be more prevalent in low-income or minority neighborhoods. 

Simplifying Patient Outreach 

Sifting through all the various determinants of health and how they’re integrated can be complex. However, utilizing technology to reach and engage your patients doesn’t have to be.