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<meta name="citation_author" content="Emily Orille">
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Health</span></h1><p class="contribs">Orille E, Steck MB, Brannan GD.</p><p class="fm-aai"><a href="#_NBK608013_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-167899.s1"><h2 id="_article-167899_s1_">Summary / Explanation</h2><p>
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<b>Introduction                                                                                                                                                                </b>The Office of Disease Prevention and Health Promotion's (ODPHP) Healthy People 2030 vision is for "a society in which all people can achieve their full potential for health and well-being across the lifespan." To achieve this, 3 areas, "well-being, healthy life expectancy, and summary mortality and health," were identified to measure the health of the population (ODPHP. <a href="https://health.gov/healthypeople" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Healthy People 2030</a>).</p><p>In a seminal paper, Kindig and Stoddart defined population health as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group."<a class="bibr" href="#article-167899.r1" rid="article-167899.r1">[1]</a> This definition embodies both outcomes or results and determinants or contributing factors. Compared to a more traditional approach of focusing on individual factors such as genetics and lifestyle, population health embraces additional determinants that may include healthcare policies, public health, and social and physical milieu.<a class="bibr" href="#article-167899.r1" rid="article-167899.r1">[1]</a> Population health determinants can serve as a preventative approach and address root causes rather than symptoms like a biomedical approach.<a class="bibr" href="#article-167899.r2" rid="article-167899.r2">[2]</a>                                                                                                                                                                                                                                                    Results from a recent scoping review found 57 frameworks, or organizational structures, to define the components of population health.<a class="bibr" href="#article-167899.r2" rid="article-167899.r2">[2]</a> In addition to individual health status and health behavior, other crucial factors were identified, including social determinants of health and healthcare system performance.<a class="bibr" href="#article-167899.r2" rid="article-167899.r2">[2]</a> The following sections will discuss several determinants of health. These factors do not make up a complete list of population health determinants, and their categorization varies in the literature, they also do not exist in isolation but rather in a complex, interrelated matrix (ODPHP. <a href="https://health.gov/healthypeople" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Healthy People 2030</a>).<a class="bibr" href="#article-167899.r1" rid="article-167899.r1">[1]</a></p><p>
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<b>Determinants of Health</b>
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</p><p>
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<b>Genetics and biology: </b>The link between genetic factors and their physiologic outcomes in health and disease is part of population health. Links of family history to certain conditions (such as heart disease and depression) have been well-established.<a class="bibr" href="#article-167899.r3" rid="article-167899.r3">[3]</a> This category can also include how extrinsic factors affect an individual's genome, such as smoking-induced deoxyribonucleic acid methylation at specific genomic loci.<a class="bibr" href="#article-167899.r3" rid="article-167899.r3">[3]</a> The Framingham Heart Study, which began in Framingham, Massachusetts in 1948 (and is still ongoing), is considered the longest population-based cardiovascular study.<a class="bibr" href="#article-167899.r4" rid="article-167899.r4">[4]</a><a class="bibr" href="#article-167899.r5" rid="article-167899.r5">[5]</a> Landmark studies resulted from it, including those that identified key genetic factors, such as male sex and elevated cholesterol and blood pressure, as major risk factors for cardiovascular disease.<a class="bibr" href="#article-167899.r4" rid="article-167899.r4">[4]</a><a class="bibr" href="#article-167899.r5" rid="article-167899.r5">[5]</a> The study's data are part of a study that found hundreds of new loci for high blood pressure traits.<a class="bibr" href="#article-167899.r6" rid="article-167899.r6">[6]</a></p><p>
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<b>Individual behavior and lifestyle: </b>Individual behavior and lifestyle include intrinsic factors such as a patient's ability and motivation to engage in their health care and access to technology.<a class="bibr" href="#article-167899.r7" rid="article-167899.r7">[7]</a> Extrinsic factors relating to individual behavior can include healthcare system factors like the ability to schedule appointments and the attitude and perceived skills of the healthcare providers.<a class="bibr" href="#article-167899.r7" rid="article-167899.r7">[7]</a> Exposure to things such as tobacco, poor diet, alcohol, and firearms all fall under this domain.<a class="bibr" href="#article-167899.r7" rid="article-167899.r7">[7]</a> The Framingham study established links between smoking, lack of physical activity, and cardiovascular disease.<a class="bibr" href="#article-167899.r4" rid="article-167899.r4">[4]</a></p><p>
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<b>Social determinants: </b>The World Health Organization defines the social determinants of health (SDOH) as "the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life" (ODPHP. <a href="https://health.gov/healthypeople" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Healthy People 2020 and 2030</a>).<a class="bibr" href="#article-167899.r8" rid="article-167899.r8">[8]</a> SDOH are nonclinical and nonbiological social factors that impact health. SDOH includes fundamental causes of disease such as racism and discrimination, unequal distribution of power, income, wealth, education, and societal values of equity and fairness that impact health directly and indirectly via intermediate structural factors, including healthcare access, healthcare quality, support services, housing and transportation and intermediate individual factors" (ODPHP. <a href="https://health.gov/healthypeople" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Healthy People 2020 and 2030</a>).<a class="bibr" href="#article-167899.r8" rid="article-167899.r8">[8]</a><a class="bibr" href="#article-167899.r9" rid="article-167899.r9">[9]</a><a class="bibr" href="#article-167899.r10" rid="article-167899.r10">[10]</a><a class="bibr" href="#article-167899.r11" rid="article-167899.r11">[11]</a> Examples of SDOH domains include:</p><ul><li class="half_rhythm"><div>Policy: The Institute of Medicine considers policy development a critical element of public health.<a class="bibr" href="#article-167899.r12" rid="article-167899.r12">[12]</a> The government or healthcare organizations work to improve the health of a population. Examples include the Affordable Care Act, tobacco sales taxes, and car seatbelts (ODPHP. <a href="https://health.gov/our-work/national-health-initiatives/healthy-people/healthy-people-2020" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Healthy People 2020</a>).<a class="bibr" href="#article-167899.r13" rid="article-167899.r13">[13]</a> These are intended to be implemented in the population as a whole.                                                                                                                                    </div></li><li class="half_rhythm"><div>Healthcare systems and services: This category relates to how healthcare is delivered and accessed by a population. Healthcare systems can be evaluated for their quality, patient-centeredness, and cost-effectiveness.<a class="bibr" href="#article-167899.r2" rid="article-167899.r2">[2]</a>                                                                               </div></li><li class="half_rhythm"><div>Physical environment factors: The physical environment of a population includes factors such as sanitation, quality housing, air pollution, and crowding. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by the properties of the physical environment.<a class="bibr" href="#article-167899.r14" rid="article-167899.r14">[14]</a></div></li><li class="half_rhythm"><div>Ecological factors: Ecological factors also affect health based on the interconnectedness of living organisms and their environment.<a class="bibr" href="#article-167899.r15" rid="article-167899.r15">[15]</a> Changes in the ecosystem brought about by climate change, loss of biodiversity, and ocean acidification, to name a few, can impact pollution, the availability and quality of clean air, water, food—and, subsequently, health.<a class="bibr" href="#article-167899.r16" rid="article-167899.r16">[16]</a> Societal vulnerabilities in the form of infectious disease outbreaks and spread in nontraditional geographic regions have been documented as being due to increasing climate hazards such as severe flooding, extreme temperatures, and drought.<a class="bibr" href="#article-167899.r17" rid="article-167899.r17">[17]</a></div></li></ul><p>The complex interrelatedness of these domains allows professionals working in population health to formulate a varied definition of population health.<a class="bibr" href="#article-167899.r2" rid="article-167899.r2">[2]</a> This insight allows for inherent uniqueness when comparing various populations and targeting factors important for each one.<a class="bibr" href="#article-167899.r2" rid="article-167899.r2">[2]</a> For clinicians, understanding the determinants of population health provides awareness of factors that can directly and indirectly affect the delivery of health care and influence individualized patient and population health outcomes. The more healthcare professionals educate themselves on determinants of population health, the more opportunities there will be to investigate, address, and overcome the barriers to providing optimized, versatile, and individualized patient care. Collectively, these efforts will lead to improved outcomes for patients and their communities.</p></div><div id="article-167899.s2"><h2 id="_article-167899_s2_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-167899.s3"><h2 id="_article-167899_s3_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-167899.r1">Kindig D, Stoddart G. What is population health? <span><span class="ref-journal">Am J Public Health. </span>2003 Mar;<span class="ref-vol">93</span>(3):380-3.</span> [<a href="/pmc/articles/PMC1447747/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1447747</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12604476" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12604476</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-167899.r2">Chan SL, Ho CZH, Khaing NEE, Ho E, Pong C, Guan JS, Chua C, Li Z, Lim T, Lam SSW, Low LL, How CH. 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The built environment and mental health. <span><span class="ref-journal">J Urban Health. </span>2003 Dec;<span class="ref-vol">80</span>(4):536-55.</span> [<a href="/pmc/articles/PMC3456225/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3456225</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/14709704" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14709704</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-167899.r15">Parkes MW, Poland B, Allison S, Cole DC, Culbert I, Gislason MK, Hancock T, Howard C, Papadopoulos A, Waheed F. Preparing for the future of public health: ecological determinants of health and the call for an eco-social approach to public health education. <span><span class="ref-journal">Can J Public Health. </span>2020 Feb;<span class="ref-vol">111</span>(1):60-64.</span> [<a href="/pmc/articles/PMC7046913/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7046913</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31792844" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31792844</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-167899.r16">Li AM. Ecological determinants of health: food and environment on human health. <span><span class="ref-journal">Environ Sci Pollut Res Int. </span>2017 Apr;<span class="ref-vol">24</span>(10):9002-9015.</span> [<a href="/pmc/articles/PMC7089083/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7089083</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26552789" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26552789</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-167899.r17">Semenza JC, Rocklöv J, Ebi KL. Climate Change and Cascading Risks from Infectious Disease. <span><span class="ref-journal">Infect Dis Ther. </span>2022 Aug;<span class="ref-vol">11</span>(4):1371-1390.</span> [<a href="/pmc/articles/PMC9334478/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9334478</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35585385" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35585385</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Emily Orille declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Matthew Steck declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Grace Brannan declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK608013_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Emily Orille</span><sup>1</sup>; <span itemprop="author">Matthew B. Steck</span><sup>2</sup>; <span itemprop="author">Grace D. Brannan</span><sup>3</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Michigan State University, McLaren Macomb</div><div class="affiliation"><sup>2</sup> Michigan State University College of Osteopathic Medicine, McLaren Macomb Hospital</div><div class="affiliation"><sup>3</sup> GDB Research and Statistical Consulting/McLaren Macomb Hospital</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">October 6, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Orille E, Steck MB, Brannan GD. Determinants of Health. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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