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Poverty and Health

Determinants of Health

2011-03-21 14:31:36

A visualization of determinants of health portraying the various layers of social, economic, political, cultural, and environmental factors, sourced from Dahlgren and Whitehead (1991) (3). 



Through the work of researchers such as Sir Michael Marmot, we now understand that good health does not lie solely with medical interventions but also with living conditions and personal choices (4, 5). Determinants of health are lifestyle-based properties affected by broader social, economic, and political forces that influence quality of personal health. These attributes include but are not limited to education level, employment, income level and distribution, housing, childhood development, food security and nutrition, race, gender, and stress. Such factors have been shown to have marked associations with risks for different illnesses, life expectancy, and life-time morbidity. In recent decades, increasing health disparities in developed countries and between developing and developed countries have been associated with these social factors. While public health workers and policymakers seek to reduce this divide, they face challenges in designing and implementing programs that are comprehensive enough to address issues that have complex, long-term, causal relationships with specific disease pathways. However, both the motivation and action to develop effective research and intervention methods continue to grow in this field of public health (1).



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Areas of Work

  • Utilizing health promotion and health education approaches to promote informed, comprehensive, upstream participatory decision-making and action
  • Determining associations between social factors and health status  
  • Creating scientific methodologies for examining social factors in health
  • Reducing health disparities and promoting equal access to health care
  • Applying social theory to health and illness
  • Measuring and monitoring social factors
  • Human Security
  • Violence
  • Urban Health and Healthy Settings
  • Worker's Health 


The below figures demonstrate that improved social conditions and better health status often have a positive, step-wise, incremental gradient association (2). Click on the figure to enlarge:

Click to enlarge: Income and education disparities in child health by (a) infant mortality, (b) health status, (c) activity limitation, and (d) sedentary behavior: United States, 1999-2005

Click to enlarge: Income and eudcation disparities in adult health by (a) life expectancy, (b) health status, (c) heart disease, and (d) diabetes: United States, 1988-2007


  1. Braveman PA, Cubbin C, Egerter S, Williams DR. 2011. The social determinants of health: coming of age. Annu. Rev. Public Health 32:3.1-3.18
  2. Braveman PA, Cubbin C, Egerter S, Williams DR, Pamuk E. 2010. Socioeconomic disparities in health in the United States: what the patterns tell us. Am. J. Public Health 14:20–35
  3. Dahlgren G, Whitehead M. 1991. Policies and strategies to promote social equity in health: background document to WHO – strategy paper for Europe. Institute for Future Studies: Stockholm
  4. Marmot M. 2005. Social determinants of health inequalities. Lancet 365: 1099-1104
  5. Marmot MG, Davey Smith G, Stansfeld S, Patel C, North F, et al. 1991. Health inequalities among British civil servants: the Whitehall II study. Lancet 337:1387–93


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Socioeconomic characteristics, lifestyle and health in US

2010-03-28 10:57:37

Obesity and diabetes are major public health problems in many countries in the World. The interaction of several factors, including socioeconomics characteristics of the population, access to food services, food consumption, and lifestyles among others impacts on both health problems. Interaction among obesity and diabetes determinants is a theme for research and  analysis in order to evaluate intervention programs and orient public policies to improve population health.

US Department of Agriculture (USDA) has collected a core set of indicators, which are accessible and documented in the Food Environment Atlas. We have used these data to produce an interactive visualization to explore the situation of obesity and diabetes in Unites States of America.

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Compendium of indicators for monitoring regional and global noncommunicable disease response in the Americas

2009-10-19 15:08:22


This Country-level approach to surveillance of Chronic Non Communicable Diseases (NCDs) uses a step-wise method through the reporting of core and expanded data sets. The PAHO Inter-programmatic NCD surveillance working group developed first compendium of the indicators during the period of March 2007 to June 2008 (called Minimum, optimum and optional data set for NCDs).

The scope of the work is based on WHO’s principles for risk factor surveillance and PAHO’s Core Health Data Initiative. This second revised edition of the Compendium (2014) includes global and regional level indicators to measure NCD prevention and control and it was developed collaboratively, with a number of individual chronic disease surveillance stakeholders from within PAHO/WHO and other organizations.

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Virtual Technical Meeting: Elimination of Neglected and Other Poverty-Related Diseases (June 2009)

2009-08-05 16:37:50

vulnerable populatioins

This meeting and the materials prepared in conjunction with it fall within the framework of the topic “Elimination of Neglected Diseases and Other Infections Related to Poverty in Latin America and the Caribbean,” which was presented and approved by the 144th Session of the Executive Committee, June of 2009, and will be presented in the next Directing Council of the Organization in September 2009.

Objective of the Meeting: To inform the technical counterparts of the Ministries of Health in greater detail regarding the proposal that has been presented to the Governing Bodies of PAHO, indicating rationality, indicator goals and terms.

Participants: The participation of representatives of the Ministries of Health is expected. On the part of PAHO, the technical group preparing the proposal will be present, as well as some of the regional advisers responsible for the subjects that are part of the draft proposal.

Date: 15-17 June 2009.

For the agenda, technical notes, and 10 presentations on the proposed resolution and the current situation of various neglected and poverty-related diseases, see below.

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