FIGURE 3-1 Determinants of health: The 21st century field model.
SOURCE: Ratzan et al., 2000.


Health and well-being are not primarily determined by the health care system; but the health care system is where most of the costs are. Public health professionals work to keep people out of the system by stressing the importance of primary and secondary prevention. In global health, there is an emphasis on the social and environmental determinants of health. One example is the focus on maternal education, which has led to greater improvements in health and well-being worldwide than anything else, Ratzan said. Cancer, heart disease, and type-2 diabetes are costly to treat, but they can be prevented through relatively inexpensive and cost-effective interventions, including effective communication. Health literacy is at the nexus of creating better communication and education so as to increase the effectiveness of both primary and secondary prevention efforts. Primary prevention refers to actions designed to avoid illness and stay healthy. Secondary prevention refers to interventions aimed at recovery from an illness or injury or managing an ongoing, chronic condition or disability that affects function. People need simple instructions about what they need to do to stay healthy and avoid disease. They need ways to measure or score themselves on how well they are doing, Ratzan said. Furthermore, those who are already living with an illness need information on managing their condition or disability that affects everyday life.

To measure effectiveness of preventive care, Ratzan proposed using a health literacy scorecard which would contain a limited number of

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