219 Analele UniversităŃii din Oradea, Fascicula Ecotoxi cologie, Zootehnie și Tehnologii de Industrie Alime ntară, 2013 Bibliometric study regarding… [613548]

219 Analele UniversităŃii din Oradea, Fascicula Ecotoxi cologie, Zootehnie și Tehnologii de Industrie Alime ntară, 2013

Bibliometric study regarding links between health d eterminants and sustainable
development

łîrŃ Dorel Petru, Rahotă Daniela

Public Health Directorate of Bihor County, Str.Libe rtăŃii nr. 34, Oradea, Bihor County,
Romania, [anonimizat]

Abstract
There are several models of health determinants tha t have a major impact in determining health policie s
at local, national and global. Sustainable developm ent is more urgent attention of policy makers becau se
of climate change. This paper explores the links be tween the health determinants and sustainable
development. Were analyzed 61 articles (or summarie s thereof), resulting in PubMed database search.
Even if stronger link between health inequalities a nd sustainable development, the findings indicate
several linkages and ways to influence the determin ants of health in order to ensure sustainable
development.

Key words
sustainable development, health determinant, health policy, food security

INTRODUCTION

In 1997 D.Ruwaard defined health determinant as "factor or any condit ion that
has an effect on health or in quantitative terms ha s a measurable effect on
health" (cited by Marcu A and all., 2002, p.5).
Current literature describes several models of the determinants of health.
Should not be forgotten that the evolution patterns of health determinants is
dependent on advance knowledge of disease etiology and pathophysiology.
Prior to 1970 it was generally accepted that health was determined by the
amount of medical services for the treatment of dis eases, known medical model
of health determinants. Lalonde Report, published i n 1974 by the Canadian
Ministry of Health, found that morbidity and mortal ity data that approximately
50% of Canadian deaths could have been avoided and are related to behaviors
such as smoking, alcohol consumption, diet, sedenta ry and accidents.
The epidemiological determinants of health emerged in the 70s, called Dever
model includes four factors: human biology, environ mental factors, behavior
and health system (Enăchescu, 1998, p.8)
The model of determinants of health (Dahlgren & Whi tehead, 1991), is used for
setting policies in the European Union because it b elieves that decisions at EU
level can and should have a significant impact on t hese determinants. For
example, decisions that are consistent with the int ernal market can support or

220 undermine national public health objectives, while funding from EU funds and
programs can be implemented in a number of areas to strengthen national
efforts to reduce health inequities.
In 2005, WHO established a Commission for the Socia l Determinants of Health
in order to achieve a joint effort of scientists an d practitioners to provide
evidence of policies that can improve health by foc using on the social
conditions in which people live and work. Results o f this committee include
developing conceptual framework for action on the d eterminants of health 0
WHO CSDH, 2008. The low level of health can not be explained solely by
pathogens and genes, but most diseases are rooted i n social factors, ie how we
grow, we work and live. While they are related to i ndividual behaviors, such as
smoking or alcohol consumption are also included so cial and economic
conditions in which people live and major influenci ng their health. These are
the so0called social determinants of health (SDH), which are defined as
structural determinants and conditions of daily lif e responsible for a large part
of health inequities between and within countries.
Social determinants include the distribution of res ources, income, goods and
services and the circumstances of their lives, incl uding their access to quality
care at an affordable price, schools and education, conditions of work and
leisure, housing and environmental condition. The m ore these factors unevenly
distributed within or between different population groups, the lower is the
overall level of health and wellbeing and health in equalities are greatest (.
Rohregger B, 2011).
“Development is defined sustainable when it meets t he needs of the present
without compromising the ability of future generati ons to meet their own
needs” (Frazzoli C, Petrini C, Mantovani A., 2009). Sustainable development
involves the economy, living space, energy supply, urban infrastructure, food
production systems, environmental conservation. The se are goods that we
value. But their value because they are the basis f or the survival and health of
populations (McMichael AJ, Butler CD., 2006).
The practice of public health must take into accoun t beyond health and disease
models, including physical and social determinants of health and to integrate
sustainable development challenges (Labonté R., 199 3). Correlations between
public health and sustainable development are in “s ix interacting environmental
spheres: a viable natural environment, a sustainabl e economic environment, a
sufficient economy, an equitable social environment , a convivial community,
and a livable built environment. (Labonté R., 1993) .

221 MATERIAL AND METHODS

The paper aim is to identify links between determin ants of health and
sustainable development, based on articles publishe d and indexed in the
database PubMed.com (http://www.ncbi.nlm.nih.gov/p ubmed). It was applied
to search for articles according to syntax: Search: health AND determinants
AND sustainable AND development. The search result ha s been finding a
number of 72 articles. Data about the articles foun d were included in a database
in Excel, for each articles were included the follo wing records: journal, article
title, authors, scale study (international, nationa l, sub) continent (continent)
referred to the study, studied area (were establish ed following areas: policy and
health systems, infectious diseases, non0communicab le diseases, nutrition,
environmental health, women and child health, accid ents / disasters, oral health,
if the article has a summary, if available (free) f ull article in English, if it
contains links between areas studied (determinants of health and sustainability).
Of the 72 articles in the search results a total of 61 were summary, based on
which we could establish the extent of the study, a nd the study continents.
Thus, 45 articles related to international studies (comprising several countries),
6 studies were national and 10 articles related sub 0issues (municipalities or
counties). Specifying continent where the study was performed was found in 44
articles, the remaining articles (17) were related to health policy issues
applicable on all continents. The most common conti nent of Europe has been
reviewed studies (20 studies), followed by Africa ( 9) Asia (7), North America
(5) South America (4) Australia and Oceania (2).
For each article I have established one or more are as studied that have
identified in the summary and, if there is, article . Field studied in each article
shown in the following table (Table 1).
Have been identified links between health determina nts and sustainable
development in the case of 20 articles / abstracts analyzed, in the remaining 41
were not identified links. Error factors resulting from the search were related to
various terms such as "sustainable development of c ontrol programs",
"sustainable retinopathy screening", "sustainable v ector control and disease",
"development of sustainable healthcare Policies" et c.

222 Table 1
The areas for analyzed articles
Areas
Policies and health systems Communicable diseases
Non0
Communicable diseases Food Environmental health health of women and children Injuries/ Disasters Oral Health Number of articles 41 7 10 15 22 4 3 2

RESULTS AND DISCUSSIONS

Articles analysis reveals a link between inequaliti es in health and sustainable
development, sustainable development would reduce h ealth inequities. In the
context of climate change, it is important to simul taneously practical approach
inequities in health and sustainable development (B owen KJ and all, 2012).
Moreover, adaptation to climate change requires sus tained action to reduce the
health inequities through interventions on social d eterminants of health (Friel S
and all, 2011).
Multisectoral approach and more disease prevention can result in immediate
benefit to the determinants of health and sustainab le development, in addition
growing levels of schooling and productivity and re ducing inequities
(Nakagawa J et all, 2013). Global action for sustai nable development,
including poverty eradication to determine 0 one of the determinants of health 0
was underlined by United Nations Conference on Susta inable Development,
Rio +20 (Buss PM and all, 2012). Health, quality of life and sustainable
development are closely linked, it is important to involve professionals in urban
planning that takes into account health determinant s “the physical and social
environment in which people live and the nature of their lifestyles” (Capolongo
S and all, 2011).
It is known that changing the type of physical acti vity, nutrition and
consumption of alcohol and tobacco increases the bu rden of non0communicable
diseases in low and medium income countries. It is important to assure
adequate disaster response and disaster prevention to reduce the risk in the
context of vulnerability, climate change and sustai nable development (Iain B.,
2010).
Food safety contributes for health of population an d sustainable development.
Action is needed in the food chain (to prevent chem ical and microbiological
contamination of food by HACCP implementation, deve lopment of new
toxicological measurements etc.) As a precondition for avoiding future social
costs, food is a consumer product with greater impa ct in the population

223 (Frazzoli C, Petrini C, Mantovani A., 2009). In the food safety, an important
component is the elimination of hunger, especially “hidden hunger” – chronic
micronutrient deficiency, in the most sustainable m anner for the environment.
Attention should be paid to factors that contribute to long0term food insecurity
and hunger hidden (Burchi F, Fanzo J, E. Frison, 20 11).
Health care, especially medical facilities are larg e consumers of energy (heat,
electricity) in providing medical services to the p opulation. Performance and
energy efficiency of medical units should be weighe d against ethical standards
as a precondition to decrease carbon emissions in t he health system (Verderber
S, Fauerbach J, Walter B., 2008).
Climate change and globalization have led to the sp read of infectious diseases:
“tuberculosis, malaria, cholera and dengue fever, h ave proven unexpectedly
problematic, because of increased antimicrobial res istance, new ecological
niches, weak public health services and activation of infectious agents (e.g.
tuberculosis) in people whose immune system is weak ened by AIDS”
(McMichael AJ, Butler CD., 2006), decrease in life expectancy in poorer
regions of the world, increasing health inequities is therefore considered the
current validity of the principles of the Ottawa Ch arter for Health Promotion.
“Linkages between the health sector and civil socie ty, including those
struggling to promote development, human rights, hu man security and
environmental protection, should be strengthened.” (McMichael AJ, Butler
CD., 2006, p.22).
Medical education should strongly consider both hea lth determinants and
sustainable development, and the terms like "Primar y Prevention", "Health
Promotion", "Health Protection", "Health Determinan ts" should be re0defined
and the new ones such as "Quality of Life" and "Sus tainable Future" (Bencko
V, Hnilicová H, Klein O, 2005).
Very helpful in influencing both health determinant s and sustainable
development policies at the local level is the heal th impact assessment (HIA). A
study in London on the development of urban transpo rt strategy shows that
rapid HIA recommendations were taken into account i n the planning process.
The authors conclude that the application of HIA le d to adaptation policies and
improve health issues “HIA is an effective method b oth for bringing about
significant change in policy proposals and in incre asing policy makers'
understanding of determinants of health and hence i n changing attitudes of
policy makers” (Mindell J, Sheridan L, Joffe M, Sam son0Barry H, Atkinson S.,
2004). The historical development of the applicatio n of HIA and environmental
assessments led to the development of a public heal th model that takes into

224 account the determinants of health, including toxic risks, infectious and social
impact of projects. “Sustainable development with i ts social objectives of
empowerment, participation, equity, poverty allevia tion, social cohesion,
population stability and institutional development is an appropriate framework
for conducting health impact assessments.” (Banken R., 1999).
Communities with a high incidence of infectious dis eases “under pressure from
a barrage of endemic diseases” are those where qual ity of life achieved with
difficulty. Strategies for prevention and control o f infectious diseases must
consider “knowledge base, beliefs, perceptions and practices of the population
by incorporating active community participation in preventive and intervention
practices” (Wijeyaratne PM, Arsenault LK, Murphy CJ ., 1994).
Since 1990, the world has developed the current "he althy cities" or "healthy
communities" as a way to integrate and focus health policy public health center
(Labonté R., 1993).

CONCLUSIONS

There is a strong and direct link between health in equities and sustainable
development. Reducing health inequities through act ion multi ensure
sustainable development in the communities.
Disaster prevention and appropriate response to dis asters reduce health risks.
Given the increasing occurrence of disasters due to climate change , it is
necessary training of medical personnel and the pop ulation for this type of
situation .
Food security contributes to health through proper nutritional support , and
through food chain contamination is prevented adequ ate food and is considered
sustainable .
Green energy used by health care facilities can con tribute to sustainable
development and consequently decrease the carbon fo otprint of social activities.
Links and joint action between the health system an d civil society organizations
influence major social determinants of health.
Medical education must adapt and improve their cont ent according to the
identified interdependencies between social determi nants of health and health.
Health impact assessment and healthy cities & healt hy communities are
practical interventions that influence policy decis ions applicable at local level
(below national) in improvement health determinants and beyond in influence
on sustainable development. Keypoints of conclusion s are presented in Box 1.

225 Box 1 – Links between health determinants and susta inable development: keypoints
0 there is a strong link between health inequities an d sustainable development,
0 multi0sectorial interventions,
0 disasters: prevention and response,
0 food security,
0 green energy for health care units,
0 must be developed shared actions between health sec tor and civil society
organizations,
0 health education,
0 health impact assessment,
0 healthy cities & healthy communities.

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