Tuesday, January 4, 2011

Biological, Psychological and Social factors, which influence health, health choices and delivery of care

Are you free from disease and illness? Yes! But you are not healthy. Health and illness of an individual is  determined by various factors, they may either intrinsic or extrinsic. According to WHO (1948) "Health is the state of complete physical, mental and social well being not merely absence of disease and infirmity.” An individual is not healthy if he is not physically fit, psychologically perfect (free from stress, well sleep patterns etc) and socially normal (healthy social relationship). Your health is determined by these factors or determinants. The determinants of health were first described by Thomas McKeon. The Lalonde report identified 4 major components of the health concepts: human biology (biological factors), health care systems, environment and lifestyle (Glouberman, & Millar, 2003).
Health promotion advocates quickly recognized that an excessive emphasize on life style could lead to a “blame the victim” mentality. Smoking for example is not merely a matter of personal choice but also a function of one’s social environment. In addition these factors not only determine the health of an individual but health delivery system and delivery of care is heavily influenced.
As we know the biology of an individual is different from another with age and sex, psychological, and social factors are also varies with person to person therefore health choices and delivery of care is also varies. In current situation it is a challenge to health professionals is not only preventing disease and overcoming it when it occurs but also helping people to achieve that goal. While health care planning is delivered to a particular community or an individual every health care professional should have knowledge of multiple determinants of health, health choices and delivery of health care system in order to achieve particular goal of that plan. This paper will discuss about biological, psychological and social factors of an individual’s health, health choices and influence of these factors on health delivery system.
When we talk about biological factors of health, different systems and natural process of the body (like growth and development, aging), and genetic composition will take place in our mind. These key factors of human biology are crucially responsible for health of an individual. When we deal with biological factor the four important points arise in mind: the gene or genetic composition, external and internal agencies and finally aging process. These four factors account, occurring in innumerable combination and chronologies, totality of the human health experience both individual and collective.  Hypothetically, if the first three of these four factors could be eliminated through a perfect design or genetic set, no accidents or external disruption and ideal maintenance or balanced internal dynamics, then the body would have the opportunity to die of “ natural causes”- aging, which rarely if ever occurs with either (Bortz, 2005).
   First of all 30,000 genes, human genome were widely blamed for illness and well being. This fact has now largely been displaced by the recognition that genes actually represents only restricted arbiters of health whose repertoires  depends on different cueing. Quantitatively Strohman (1993) estimated that less than 2% of human illness is attributable to a faulty single gene locus. Virtually all diseases exhibits mosaic patterns with genetic complexity. An approach widely used to quantify genetic contribution is to investigate the health history of identical twins. Initially if genetic factors are only contributors to arbiters of health and other 3 factors are negligible, identical twins would die simultaneously of the same disease which is out of case.  Next common neurological diseases in older people have been shown to have low concordance among twins (Strohman, 1993). Further studies of monozygotic and dizygotic twins indicate that heredity accounts for 15% to 20% of difference in human longevity (Bortz, 2005). Genes matter however their real significance lies not in their essence but their interrelations with other components.
Secondly the external and internal agency of individual is also his/her fortune of illness and well being. The external agency of an individual represents different environmental biological arbiters like microorganism (bacteria, viruses. Parasites and injuries caused due to external environment). For the most part of the body they are acute in their representation and usually confined to a defect in one of the body’s component part. These external biological agencies are the responsible for new development of the majority of the current medical enterprise of hospitals, surgery, and pharmacy. The technical advance has allowed address and readdress of countless illness states that were unapproachable just a few decades ago (Burtz, 2005). The new type of health care delivery system “prevention” was also existed while considering external agency as a health determinant. Most infection, injuries and malignancies are preventable and prevention them is a strategy for preferable to curing them. “The shield is a nobler than the spear” (Oliver Wendell Holmes).
   By the contrast the era of the dominant of external agents as a prime factor of health has been replaced by the reality of disordered internal function as the principal causes of the chronic illness pattern today. Instead of environment being threat to well being, internal agency connotes an appropriate and constant interplay of the host and environment. The environment becomes the source of organic order, stability, and, therefore health. The new conceptualization of homeodynamics was evolved to describe this phenomenon. Homeodynamics is a term which describes how environmental energetic stimuli are inscribed on to the organism through myriad (Yates, 1994). In addition extraordinary plasity of all parts of our body is vivid demonstration of how the body is constantly remodeling in response to the energetic field in which body is immersed. For example the converse of stress is disuse; disuse means too little energetic interchange, usually manifested through a sedentary lifestyle (Burtz, 2005). The internal agency new idea of biological factor is being a key tool to deliver health care in some cases. For an illustration allostatic load is a better predictor of cognitive decline and cardiovascular performance in older persons than more standard parameters (Seeman et al, 1997). Allostatic load is a term to quantify cumulative physiological toll exerted body over time by effort to adapt to life experience (McEwen, 2001). In final point external and internal biological factors has great influence on health of an individual and his choice and delivery of health care.

     The most important biological determinant of health is aging. The aging process can lead to gradual deterioration of mental and physical health condition, reduction in expected years of active and healthy life and complete or partial cease in participation in the labor market. Likewise, alterations in the health status-characteristics of advance age- are more chronic than acute and more progressive than regressive. Aging is the result of entropic decay inherent in metabolic process, which is partially but incompletely offset by countering mechanisms. Aging is wear and tear minus repair (Burtz, 2005). In addition when we provide a health care to a person we have to bear in mind all physical, mental and social aspects of health. Particularly in elderly adult because during aging process a series of internal and external modifications takes place, as well as changes in the functions of individuals organs and systems that induce changes in the state of health, as a product of lower functional reserve and lower capacity for response and adaptation, a phenomenon known as homeostenosis, which leads to greater probability of organ failure and illness (Ocampo, 2010). In other hand health assessment of elderly people is fundamental to bear in mind that it is integral and such than go beyond the traditional clinical history therefore this assessment must consider the psychological, familial, social economic and functional dimensions that’s why aging is also influencing factor in individuals health choice and delivery of care.

Psychological factor  is also considered as an important  for well being and illness of an individual. Many diseases especially mental disorders are considered to be more by psychological factors than biological. Emotional status, anxiety, behavior, perception, knowledge about health and illness etc are taken under psychological factors of health. Knowledge and perception about health of individual is very important factors for determination of his/ her wellbeing and illness. There are many factors that influence an individual’s choice of daily activities of living which are related to level of intelligence and personality (especially for work and play activities). From the birth, emotion and intellectual development is continued through play, to gradually help the development of communication and interpersonal skills that are essential to the activities of daily living (Lindon, 2005). On the same way psychological factors have all most all influence on our every part of daily living activities. For example anxiety has greater effects on breathing; panic state eating and drinking, elimination and other daily activities of living (Holland, Jenkins, Solomon, & Whittam, 2008).

        In other hand the impact of stress on health, although to some extent due to the brain’s influence on psychological process such as body’s immune response is also mediated by adaption of health- impairing habits as coping strategies (e.g. smoking, alcohol abuse). In addition psychological factors are not only determinants of health and wellbeing of individual however these influencing the issues such as physician-patient ,and  nurse-patient relationship, compliance with medical procedures, anxiety as related to the medical procedures, and burnout in helping profession(Stroebe, 2000). A recent study has shown that the physiological effects on coronary heart disease and clearly describes about psychological risks factor in developing atherosclerosis. The hemodynamic and neuroendocrine responses to stress are characterized by release of catecholamine and corticosteroids, increase in heart rate, cardiac output, and blood pressure (Krantz, & manuck, 1994), and changes in processes relevant to clotting processes (haemostatic and thrombosis) such as coronary vasoconstriction, platelet aggregation or plaque rupture (Muller et al, 1990 Patterson et al 1995). In patients with atherosclerosis these physiological changes may increase vulnerability to clinical event. Stress-induced autonomic nervous system activation might also predispose to cardiovascular event by promoting the development of atherosclerosis overtime and/or dysfunctions of cells in the coronary artery lining or by directly triggering lethal arrhythmias through alteration of neural transmission to the heart (McCeney & Krantz 2005).  

      Next, social environment is also an important factor influencing health, health choice and health care delivery. The social compartments like culture, norm, values, belief, economic condition etc. various social factors are not only affecting an individual’s health however these may sometime become a major inequalities for health choice and health care delivery. Therefore socio-economic, educational, cultural and environmental conditions- are important considerations in planning and implementing initiatives that are responsive to the needs of specific communities and groups. Communities’ actions have been shown to involve both individual empowerment to influence and control the determinants of health and quality of life (Steinberg, 2006). The direct influence of various social factors on mortality and morbidity has been shown in recent year. In other hand the health choice and delivery of care is also influenced. Many studies have shown that major infectious diseases linked with poverty of material conditions but also non-communicable diseases-both physical and mental –and violent death in every region of the world outside Africa add substantially to the burden of communicable disease in sub-Saharan Africa (Marmot, 2005). In addition there is evidence that variety of adult and childhood disorders and evidence on the state of mental health in general in high, middle, and lower income countries (Yearwood, 2010).

     It has long been recognized that social factors affect the health in both individuals and populations. Just as a disease cannot exist as a single entity but only in individual person,  each individual must live within a society. Change to that social group produces a change within individuals which is reflected in changing patterns is clearly demonstrated by association between illness and drug use. Evidence for the link between smoking or alcohol intake and illness in both individuals and populations is irrefutable. As a drug use increases in the society, so will complications increase resulting in more illness and more presentation to public health professional and doctors (Owens, 2007). In other hand a recent new view has been emerged to describe social factors and its influence on human genome which incorporates social factors in to biomedical research views and reported that social factors interacts with biologic process leading to disease (Roux,2007). As an illustration, Caspi et al reported that a functional polymorphism in the promoter region of the serotonin transporter gene (5-HTT) moderates the relationship between stressful life events and depression, such that stressful circumstances were only related to depression in the presence of genotype.

Socioeconomic status is an individual’s occupation, economic resources, social standing and education, is powerful predictor of cardiovascular risks also. Socio-economic factor can also refer to the standing a house hold, rather than individual. Evidence is clear that there is a social gradient affecting coronary artery disease (Adler & Ostrove, 1999).   Numerous pathways have been proposed for the effects of socio-economic status on disease, including access to medical care, nutrition, living conditions, and risk-related behaviors, such as low levels of physical activity ( Kuczmarski et al. 1994). In spite of strong relationships, these traditional risk factors explain only about one-quarter of the socio-economic status-coronary artery disease gradient. More recently, psychological variables have also   comeunder scrutiny as possible mechanisms.

How biological, Psychological and social factors influencing health    choice and delivery of care:
 The term choice is usually taken to refer to a conscious, deliberative mental process whose endpoint is a process a person’s action, belief or speech. The process of choice is also a motivational, emotional or attitudinal, process as well as a being constrained by the agent’s knowledge, mental capacities and scope for choice.

Biological, psychological and social factors are contuneously  shaping and reshaping of an individual’s health. The socio-economic status of an individual and health choices are heavily influenced, as a result health complication and economic cost has been rising. For a example in China, Lao people’s republic, and Vietnam, to set up and maintain any health system even if it is a system with strong primary health care basis. As a result, people are often able to access health services only by contributing substantial out of their poverty. It can also result in people delaying to seek appropriate care, so that more intensive and expensive care is required when and if they eventually do seek care. In addition low levels of government funding for health sector tend to maintain a high level of dependency on external funding for primary health care (WHO, 2002).  In another hand we cannot blame only social, biological and psychological factors of individual in health choice and health delivery of care however the health care delivery system is also one of the responsible factor. For example distance, availability and accessibility of health care centers.

    According to Anderson and Newman (1973), paying a visit to a health facility is determined by three sets of factors 1) predisposing factors such as age, gender, race/ethnic groups and social status 2) enabling factors include conditions that facilitate or inhibit the use of health services such as insurance coverage, income, distance to health care centre, availability of regular source of care and 3) need or health status variable which may include perceived need and urgency, level of distress and presence of psychiatric co-morbidity.

   In addition the health belief model (HBM) suggested by Rosen stock (1996) assumes that consumer attitude and beliefs are important determinants of health Acton. However  Leavitt reported that within this framework, beliefs concerning four set of variable are used to account for variation in the health care utilization when cues to action such as symptoms, are present. They are the individual’s view of his/ her belief about the severity to illness defined either in terms of physical harm or interface with social functioning, his/ her perception of benefits associated with actions to reduce the level of treat or vulnerability and his/her evaluation of potential barriers associated with the proposed action which can be physical, psychological or socio-economical (Ghanim, 2004).

  It could be argued that the most important factors in affecting an individual’s use of health facilities in an given country do not necessarily have the same significance in other countries because of the different in environment, socio-economic and cultural aspects, beliefs and health care system and policy.

Health is the state of complete physical, mental and social well being not merely absence of disease and infirmity. This definition of health by world health organization clearly indicates the different factors of health. Individual’s health determined by his/her physical (biological factors), mental (psychological) and social (surrounding ambient). Biological factors related to an individual’s health are his/ her genetic composition, internal homeodynamics and his or her homeostasis, and external factors like microorganisms, injury etc. along with this factor natural process aging is obviously influence his/her health. We can ignore these biological determinants of health when delivering health care to an individual. It is never underestimated to influence of psychological factor into an individual’s health, if somebody physically weak but he/she had strong mental attitude it helps to cure physical weakness. Psychological factors also interact with biological and social factors as a result an individual’s health might significantly change. The final and most important factor is socio-economic factor. Individual’s culture, family, belief, economic condition, attitude and knowledge of health and illness significantly influencing individual’s choice towards health care system, procedure , treatment. All these factors are determining the health of an individual, when health care professional delivering health care to their clents , they have duty to provide such type of care that cure each individual’s all three aspects of health -biological, psychological and social. Health care professionals should have duty to provide such type of holistic care to their client ,in other hand policy makers should  responsible to make such type of policy that exclude all health inequality.



1)    Adler, N. E., Ostrove, J. 1999, ‘Socioeconomic status and health: what we know and what we don’t, Department of psychology, Macalester college, st. Paul, Minnesota USA. 
2)    Bortz, W., 2005. ‘Biological basis of Determinants of Health, American journal of public health, vol.95, No.3, pp. 390-392.
3)    Ghanim, S. A, 2004, ‘Factors influencing the utilization of public and private primary health services in Riyadh city,’ JKAU: Econ. & Adm, vol. 19 No. 1, pp 3-37.
4)    Glouberman, S., & Millar, J. 2003, ‘Evolution of the Determinants of Health, Health policy and Health information in Canada,’ American Journal of Public Health, Vol. 93, No.3, pp. 388-391.
5)    Holland, K., Jenkins, J., Whittam, S. (2en Ed.)2008, Applying the Roper-Logan-Tierney Model in Practice, Churchill Livingstone Elsevier.
                        6) Kuczmarski, R.J., Flegal. K.M. (2000) Criteria for definition of
                             overweight in transition: background and recommendations
for the United States. American Journal of Clinical Nutrition
72, pp.1074–81.
7) McCeney, M & Krantz, D, 2005. ‘Effects of psychological and social factors on organic disease: A critical assessment of research on coronary heart disease, Annu.Re.Psychol, Vol. 53, No 341-369.
8)    McEwen, B.S., 2001, ‘The neurobiology of stress; from serendipity to clinical relevance, Brain res, Vol.886, pp 172-189.
9)    Merton, M. 2005, ‘Social Determinants of health,’ Lancet, vol.365, pp1099-1104.
10) Muller, L. A., 1989, ‘Influence of training and activity on muscle strength,’ Arch psy. Medicine rehab, vol.51, pp.449-462.
11) Ocampo, J. M, 2010 ‘Self rated health: Importance of use in elderly adults,’ Colombia medica. Vol. 41, no.3 pp277-285.
12) Owens, D. 2007, ‘Physical psychological and social…..the challenge of general practices’, The Honkong college of general practitioners pp.49-50.
13) Roux, A. V., 2007, ‘Integrating Social and Biological factors in health research a System Review: AEP, vol. 17, No.7, pp. 569-574.
14) Seeman, T. E., Singer, B. H, & Rowe, J. 1997, ‘Price of Adaptation-price of Allostatic load and its health consequences,’ Arch internal medicine, vol.157, pp.2259-2268.
15) Steinberg, A. M. 2006, ‘Factors affecting health poverty and environment, World Health Organization 2006- commission on social Determinants of health.
16) Stroebe, W. 2000, ‘Social psychology and health (2end.), Open University press, Celtic court 22 Ballmoor, Buckingham MK18 1XW
17) Strohman, R., 1993. ‘Ancient genome, wise body and unhealthy people; limits of a genetic paradigm in biology and medicine,’ perfect bol.med, vol.157, No.112, pp.112-145.
18) WHO, 2002,’Reducing risks promoting healthy life: World Health Organization report 2002, Geneva.
19) Yearwood, E. L., 2010, ‘The Social Determinants of Health and Mental health: Global Foundations for Improving Child and Family Mental HealthJournal of Child and Adolescent psychiatric Nursing, Vol. 23, No. 3, pp196- 197.


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