D  E  G  H   I  M  O  P  Q  S

 

D

Determinants of Health

The Determinants of health are factors which influence health status and determine health differentials or health inequalities. They are many and varied and include, for example, natural, biological factors (e.g. age, gender and ethnicity); behaviour and lifestyles (e.g. smoking, alcohol consumption, diet and physical exercise), physical and social environment (e.g. housing quality, the workplace and the wider urban and rural environment), and access to health care (Lalonde, 1974; Labonté 1993). All of these are closely interlinked and differentials in their distribution lead to health inequalities.

(HIA Glossary of Terms, WHO)
Disadvantaged / vulnerable / marginalized groups

These terms are applied to groups of people who, due to factors usually considered outside their control, do not have the same opportunities as other, more fortunate groups in society. Examples might include unemployed people, refugees and others who are socially excluded.

(HIA Glossary of Terms, WHO)

E

Evaluation

Evaluation involves making a judgement as to how successful (or otherwise) a project has been, with success commonly being measured as the extent to which the project has met its original objectives. Both the “process” (activities) and “outcomes” (what is produced, for example in terms of changes in the health of those targeted by the project) can be monitored and evaluated.

(HIA Glossary of Terms, WHO)
Equity in Health

Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential if it can be avoided. (WHO EURO, 1985)

More succinctly, Equity is concerned with creating equal opportunities for health and with bringing health differentials down to the lowest possible level. (Whitehead, 1990). HIA is usually underpinned by an explicit value system and a focus on social justice in which equity plays a major role so that not only both health inequalities and inequities in health are explored and addressed wherever possible (Barnes and Scott-Samuel, 1999).

Evidence Based

The evidence base refers to a body of information, drawn from routine statistical analyses, published studies and “grey” literature, which tells us something about what is already known about factors affecting health.

(HIA Glossary of Terms, WHO)

G

Good Practice

A ‘good practice’ refers to a specific methodology or treatment that has been judged optimal after weighing the available outcome evidence. Often the terms ‘good practice’ and ‘best practice’ are used to describe the same, but ‘good practice’ is often a preferred term, since it does not imply that no further innovation or revision is required.

The term ‘best practice’ was invented in business management and began to appear in medical, nursing, and hospital administration literature in the early 1990s. In policy there is special interest in good practice exchange, as unlike commercial enterprises there is no competitive incentive to keep best practices secret.

(DETERMINE Project, 2007)
Gradient

Health inequalities are often observed along a social gradient, which is a “stepwise or linear decrease in health that comes with decreasing social position” (Marmot 2004). This gradient exists in all countries, either rich or poor, and the pattern can observed when looking at factors such as income, level of education, geographic region, gender, or ethnicity. This means that the more favourable your circumstances are, the better your chances of enjoying good health and a longer life.

(DETERMINE Project, 2007)

H

Health Gain

Improvement in health status.

(HIA Glossary of Terms, WHO)
Health Equity Audit (HEA)

A Health Equity Audit (HEA) is a review procedure, which examines how health determinants, access to relevant health services, and related outcomes are distributed across the population, relative to need. An HEA advises decision-makers at all levels of governance to prioritize resources in the planning of policies, strategies and projects in a way that reduces health inequities.A HEA distinguishes between health inequalities and health inequities, and the overall objective is thus not to allocate resource equally across the population, but to prioritize these according to actual needs of different segments or geographic locations.

(NHS Health Development Agency, 2005)
Health Impact

A health impact can be positive or negative. A positive health impact is an effect which contributes to good health or to improving health. For example, having a sense of control over one’s life and having choices is known to have a beneficial effect on mental health and well being, making people feel “healthier” (Wilkinson, 1996).

A negative health impact has the opposite effect, causing or contributing to ill health. For example, working in unhygienic or unsafe conditions or spending a lot of time in an area with poor air quality is likely to have an adverse effect on physical health status.

(HIA Glossary of Terms, WHO)
Health Impact Assessment (HIA)

Health Impact Assessment (HIA) is a practical tool, which allows for evaluating the health impact of policies, strategies and initiatives in sectors that indirectly affect health, such as transportation, employment and the environment.

The overall goal of HIA is to inform decision-makers of adverse health effects of proposed actions, and support identification of appropriate policy options.

(HIA Glossary of Terms, WHO)
Health in All Polices (HiAP)

Health in All Policies (HiAP) is a policy strategy, which targets the key social determinants of health through integrated policy response across relevant policy areas with the ultimate goal of supporting health equity. The HiAP approach is thus closely related to concepts such as ‘inter-sectoral action for health’, ‘healthy public policy’ and ‘whole-of-government approach‘.

(EuroHealthNet, 2011)
Health Inequalities and Health Inequity

Health inequalities are preventable and unjust differences in health status or in the distribution of health determinants between different population groups. They exist across the EU, both between and within the Member States. Acting to reduce health inequalities means tackling social and economic determinants that impact unequally on the health of the population in a way that is avoidable and can be dealt with through public policy at all levels

It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the first case it may be impossible or ethically or ideologically unacceptable to change the health determinants and so the health inequalities are unavoidable.

In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health. Inequity – as opposed to inequality – thus has a moral and ethical dimension, resulting from avoidable and unjust differentials in health status.

(Final report of Commission on SDH, WHO)
Healthy Public Policy

Healthy public policy is a key component of the Ottawa Charter for Health Promotion (1986). The concept includes policies designed specifically to promote health (for example banning cigarette advertising) and policies not dealing directly with health but acknowledged to have a health impact (for example transport, education, economics) (Lock, 2000).

(HIA Glossary of Terms, WHO)

I

Impact Assessment

Impact assessment is about judging the effect that a policy or activity will have on people or places. It has been defined as the “prediction or estimation of the consequences of a current or proposed action” (Vanclay and Bronstein, 1995)

(HIA Glossary of Terms, WHO)
Inequalities Audit / Equity Audit

A review of inequalities within an area or of the coverage of inequalities issues in a policy, programme or project, usually with recommendations as to how they can be addressed.

(HIA Glossary of Terms, WHO)

M

Monitoring

Monitoring is the process of keeping track of events. For example, the monitoring of a project may involve counting the number of people coming into contact with it over a period of time or recording the way in which the project is administered and developed.

(HIA Glossary of Terms, WHO)

O

Outcomes

The effect the process has had on the people targeted by it. These might include, for example, changes in their self-perceived health status or changes in the distribution of health determinants, or factors which are known to affect their health, well-being and quality of life.

(HIA Glossary of Terms, WHO)
Ouputs

The products or results of the process. These might include, for example, how many people a project has affected, their ages and ethnic groups or the number of meetings held and the ways in which the findings of the project are disseminated.

(HIA Glossary of Terms, WHO)

P

Policy Response

A policy response can be a strategy, policy, framework or other kind of programme or action led by government that has been, or is being implemented.

(EuroHealthNet, 2011)
Primary Health Care

As stated at the Alma Ata Conference: “Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”

(Key concepts, WHO Commission on SDH)
Programme

The term programme usually refers to a group of activities which are designed to be implemented in order to reach policy objectives (Ritsatakis et al., 2000).

Project

A project is usually a discrete piece of work addressing a single population group or health determinant, usually with a pre-set time limit.

(HIA Glossary of Terms, WHO)

Q

Qualitative and Quantitative

Generally speaking, quantitative evidence is based on what can be counted or measured objectively whilst qualitative evidence cannot be measured in the usual ways and may more subjective, for example, encompassing people’s perceptions, opinions and views.

(HIA Glossary of Terms, WHO)

S

Social Determinants of Health

The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.

The Social Determinants of health are the factors that have the most significant influence – for better or worse -, on health. They include the social, economic and the physical environment, as well as the individual’s particular characteristics and behaviours.

(DETERMINE Project, 2007)
(Key concepts, WHO Commission on SDH)
Socio-economic Status

The socio-economic status of a person describes an individual’s or family’s relative position in society. This is defined by indicators such as educational attainment, occupation, income and house or car ownership.

(DETERMINE Project, 2007)
Strategy

The term strategy usually refers to a series of broad lines of action intended to achieve a set of goals and targets set out within a policy or programme (Ritsatakis et al., 2000).

(HIA Glossary of Terms, WHO)

 

Sources used for this Glossary:

 

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