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Introducing public health
Introducing public health

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4 Influences on health

In the UK, a broad definition of public health is taken, and efforts to enhance people’s health and wellbeing is seen as an important part of public health activity. In Activity 4 you will consider influences on your own health and wellbeing.

Activity 4: Influences on your health

Timing: Allow 30 minutes

In the word document provided, draw a circular diagram with yourself at the centre. Position the factors that influence your health around the circle. If the link to your health is indirect use dotted lines and if there is a direct link use thicker lines. Use distance to denote effect; the closer to you, the stronger the impact.

Discussion

How many different influences did you include? Are there any patterns in terms of which factors were connected directly and indirectly? You may have focused on immediate factors such as your age, your genetics or lifestyle factors such as diet and physical activity. You may have started thinking about wider social and economic factors.

If we take housing as an example, housing quality (e.g. damp) can have a direct impact on health. Housing can also have an indirect impact on our health through, for example, influencing our social networks or access to services depending on the areas we live in. You may have started thinking about how broader factors such as economic recession or climate change can also influence health.

In the activity above you started to consider influences on health. The Dahlgren and Whitehead rainbow is a well-established description of how influences at different levels (and influences within layers) interact to determine health (Dahlgren and Whitehead, 1993). Figure 3 shows how individual lifestyle factors (Layer 4) are embedded in and influenced by social and community networks (Layer 3), and by living and working conditions (Layer 2). These are, in turn, influenced by the wider socio-economic, cultural and environmental conditions within the country in which individuals live (Layer 1).

Described image
Figure 3 The Dahlgren and Whitehead rainbow
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This interactive diagram illustrates the five layers of the social determinants of health. These layers are:

Layer 1: general socio economic, cultural and environmental conditions. The macro-policy environment, which includes structures and policies (for example tax and benefit systems), determines the distribution of income, wealth and levels of poverty in a society and across societies.

Layer 2: living and working conditions include the level of unemployment, the work environment, the home environment, and health services.

Layer 3: the meso-level of social and community relationships includes social networks, the local sense of commonality and cooperation, and the sense of belonging that people feel.

Layer 4: the micro-level of lifestyle factors includes drinking, smoking, diet and levels of physical activity.

Layer 5: the innermost layer includes individual factors such age, gender and constitutional factors.

Figure 3 The Dahlgren and Whitehead rainbow

When considering influences on health, you may have focused on immediate factors such as lifestyle. Dahlgren and Whitehead’s rainbow highlights that considering the context of an individual’s life makes it clearer that our lifestyle ‘choices’ can be influenced by wider socio-economic factors. This understanding of the social circumstances that lead to unhealthy behaviour is sometimes referred to as the ‘causes of the causes’.