We continue this week with the other determinants of our health.
- The Environment: At least three broad dimensions of the environment have some bearing on our health. These are the physical environment, the social environment and the economic environment.
The physical environment in which people live, work and play plays a crucial role in shaping their health situation. Cramped and dirty living spaces coupled with a lack of green spaces in some areas of our highly populated cities can be expected to impact negatively on the residents of those areas. Air pollution is, for instance, considered by WHO as a major public health emergency factor. Up to seven million premature deaths are estimated every year to be associated with exposure to air pollution, which is also responsible for chronic obstructive pulmonary diseases, lung cancer, pneumonia, etc. In addition, the toxic particles that get to the lungs continue into the bloodstream and the cardiovascular system can cause ischemic heart diseases, neurological disorders, etc.
Poorly designed work environments and low safety standards in factories can increase the chances of higher workplace accidents and negatively impact the health of the workers and visitors to those places. Lack of safe drinking water, poor road networks, etc. directly and indirectly influence the health of persons in the environment negatively. The point is that where and how we live, work and play can help or be detrimental to our health.
The social environment comprises all facets of our relationships with our families, friends, colleagues, etc. The quality of these social connections has a bearing on our health. According to research by DeSilva and Colleagues in 2005, social participation and integration in our immediate social environments such as neighbourhoods, schools, and workplaces appear to be important to both our mental and physical health. Equally found to be important is the stability of the social connections, such as the composition and cohesion of households as well as the existence of trusted and supportive individuals and systems. Strong social connections, support networks and social capital reduce stress while engendering resilience and collective efficacy. On the other hand, social isolation, discrimination and lack of support have adverse effects on health outcomes.
Unsafe, difficult and frustrating neighbourhoods and work conditions can create stress which may have biological consequences. Features of social environments that may operate as stressors, such as perceptions of safety, have been linked to mental health. Ditto for factors that could buffer the adverse effects of stress such as social cohesion and social capital.
Just starting out a career decades ago, my boss told me to ensure that I enjoyed my work and build healthy relationships with my colleagues. He explained that because we spend most of our waking hours on workdays at our places of work, difficulties, strains and enduring frustrations in the office and with colleagues would make us unhappy, and unproductive and ultimately hurt our physical health and emotional sanity in ways we may or not understand.
The economic environment to all the factors that shape what we can do in our lives that relate to our finances and the future hopes and fears that we have about them. These include job/career opportunities, our income as individuals and households, the local, national and global economies, the presence or absence of socio-economic protection systems that can either ease or hurt the economic burden of our health requirements, etc.
All other factors remaining the same, the higher the income and social status we enjoy the better are our chances of enjoying good health. Individuals facing financial difficulties would often not be able to afford nutritious food or access healthcare services. The two factors and others can entrench these individuals in a difficult-to-escape cycle of poverty. As has been seen over the last year, increased economic challenges in our country arising from high costs of importation, local production and distribution have tremendously increased the mental and physical stress that our people are going through. Economic and social factors lumped together are jointly determined by some studies as accounting for 30% to 55% of health outcomes.
- Individual behaviour and lifestyle: Health behaviours refer to the actions that we take or refuse to take, that can improve or damage our health. They range from our dietary choices to our physical exercise regimen and on to more complex emotional coping mechanisms. Positive health behaviours are established to outrightly prevent or help us manage the risks of chronic illnesses just as bad health behaviours can cause health issues and/or exacerbate existing ones. Our positive or negative health behaviours can be intentional or unintentional, shaped partly by constructs of the environments that surround us. Obviously, our genetic makeup and living and working conditions can help or make things more difficult. But our behaviour and lifestyle choices, are also crucial in determining our health situation, and thankfully they are reasonably within our control.
Speaking at a public gathering in 2022, former president Olusegun Obasanjo said “I was diagnosed with diabetes 40 years ago, and I am still fit and active. But there were people who were diagnosed, and within five years, they died. The difference is education, lack of education, or carelessness, not managing the disease… Knowing what you should do and what you should not do; knowing what you should eat and what you should not eat, and doing everything in moderation matter…” The former president is said to have decent dietary discipline and a regimen of regular exercises into his eighties. I think he is an excellent role model for people with various medical issues and might be a good case study for healthy lifestyle and behaviour.
Our various environments, lifestyles and behaviours can and do impact our health realities. We need to understand them to help ourselves. And most importantly, engage with medical professionals for specific advisory and any necessary actions.
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