Determinants of Health and the Biopsychosocial Model

Health is not merely the absence of disease but a state of complete physical, mental and social well-being. Health is produced, unequal, and shaped by determinants that extend beyond clinical care.

Determinants of Health

1. Individual factors: genetics, lifestyle, behaviour.
2. Social determinants: income, education, employment, housing, social support.
3. Environmental determinants: air, water, neighbourhood, climate.
4. Service factors: access, quality, and coverage of health and care systems.

The Biopsychosocial Model

Integrates:

• Bio — physiological, genetic, and neurological.
• Psychological — cognition, emotion, coping, appraisal.
• Social — relationships, culture, community, environment.

Positions the person-in-environment and recognises that physical and mental health interact (comorbidity, stigma, chronic stress).

Assessment

A biopsychosocial assessment collectively gathers history across dimensions to produce a formulation, not a diagnosis alone.

Study Points

1. Distinguish social determinants from lifestyle determinants.
2. Explain the bio, psycho and social dimensions of depression.

Mental Health and Community Health Systems

Mental Health and Mental Disorder

• Mental health: the component of well-being encompassing emotional, psychological and social functioning.
• Common conditions: depression, anxiety, psychosis, substance misuse, dementia.
• Public health approach: promotion, prevention, treatment, rehabilitation across the population.

Non-Communicable & Communicable Diseases

• NCDs: cardiovascular disease, diabetes, cancer, chronic respiratory disease — with shared (social, behavioural) risk factors.
• Communicable: infectious disease control, vaccination, hygiene — and emerging/epidemic response.

Stigma and the Social Response

Stigma, discrimination and exclusion produce unequal care and outcomes for mental and chronic illness; anti-stigma work and community education matter.

Health Impact of Neighbourhood and Living Conditions

Housing, water/sanitation, and environment underpin control of communicable disease and reduction of chronic risk.

Study Points

1. Describe promotion, prevention, treatment, and rehabilitation in mental health.
2. How do social determinants shape the distribution of NCDs?

Clinical Interventions and Multidisciplinary Care

Evidence-Based Interventions

• Psychological: CBT, DBT, interpersonal and family therapy, motivational interviewing.
• Psychosocial: psychoeducation, social skills training, counselling.
• Biological/pharmacological (prescribed by clinicians, managed with consent and monitoring).

The Care Pathway

Screening/assessment → formulation → intervention → review → rehabilitation/aftercare.

Multidisciplinary Team (MDT)

Medical, nursing, psychology, social work, occupational therapy, and peers collaborate; social workers connect clinical and social care and liaise around housing, welfare and family.

From Hospital to Community

• Deinstitutionalisation and community mental health teams.
• Recovery-oriented care: hope, autonomy, participation, social-worth inclusion.

Review Questions

1. Outline a multidisciplinary care plan for someone with schizophrenia.
2. Distinguish recovery from the 'medical-deficit' frame.

Healthcare Delivery, Justice and Equity

Models of Care and Delivery

• Primary, secondary and tertiary care; at primary care the social dimension is strongest.
• Community healthcare delivery: outreach clinics, health education, home care, school health.
• Health-insurance coverage and the circuit from prevention (safety nets) to treatment.

Health Equity and Justice

• Health inequality across income, gender, disability, ethnicity, region.
• Social justice lens: equal access to appropriate, affordable, non-discriminatory care.
• Macro-level action: funding decisions, universal coverage, and policies on the social determinants.

The Role of Social Work

• Enhancing access — addressing social barriers (welfare, housing, transport).
• Advocacy, care coordination, and psychosocial support.
• Educating about health and supporting self-management.

Review Questions

1. Why does community social work improve health equity?
2. Design a health-inclusion plan for a marginalised urban community.
3. What is universal health coverage and how is it achieved?