Perception of Lay People Regarding Determinants of Health and Factors Affecting It: An Aggregated Analysis from 29 Countries

IntroductionHealth is a global issue in this era. The prevalence of chronic diseases is increasing drastically, and is predicted to increase over the next two decades (1). There is a dramatic re-emergence of old infectious diseases like tuberculosis and cholera, and appearance of new ones, like HIV and hepatitis C (2). Integrated preventive care, rather than treatment, is more effective in tackling the growing burden of both infectious and chronic diseases. In order to generate these preventive measures, cause of illness and disease models need to be understood. Although these precautionary measures are very effective, but they are difficult to achieve because health is influenced by a number of related factors, all of which need to be coordinated to implement and adopt preventative policies. Previously, it was thought that occurrence of a disease could be explained through "bio-medical model" that assumed that disease is caused by a specific etiological agent inside the body (3), but now health behavior, environment, socio-economic status, and genetic factors are also considered to be closely interrelated to health along with biological factors (4).The "Social-determinants-of-health school" and the "health field concept" are important continuations of these health theories (5, 6). Infectious diseases are not an exception for these disease models (7), and personal behavior, environment, and socio-economic status are closely related to many infectious diseases (8), e.g., the prevalence of diarrhea and cholera are influenced by clean water, sanitation, and proper hygiene.This transition regarding determinants of health raised scholars' interest in public views on health and its determinants (9), and this enhanced centrality of public views has become the norm in health policy as well (10). Previous studies have either focused on health and its determinants in scientific view or just stressed the significance of public opinion for policymaking (9, 11). However, few efforts have been made to evaluate the concept of lay people regarding determinants of health and factors affecting it. People belonging to different social status, education level, and health state have different perceptions regarding health (12) which further influence their health behaviors. There is little point in developing health plans without understanding how people's belief about health are affected by their individual circumstances, thereby influencing the take-up of services (13). Up to our knowledge prior studies which assessed public opinions and beliefs regarding illness limited their focus to only one specific disease, like obesity or hypertension (14, 15) also ignoring the factors effecting people's attitude. Furthermore, these studies were done at national level, representing the situation in one country only.Therefore, our study aimed to evaluate the general (not disease specific) perception of lay people regarding determinants of health at a global level and to identify the effect of various social and demographic factors on public believes. This might help policy makers in developing a good concept of preferences and misconceptions of health among lay people and in designing and implementing reform proposals that can influence their behavior, thus helping to control the disease burden throughout the world. To achieve these goals, we performed a multi-level analysis on data from 29 countries, most of which are high-income countries.Materials and MethodsData sourceThe study was a cross sectional multilevel one. Data source is 2011 International Social Survey Program (ISSP) data. ISSP is a continuing annual program of cross-national collaboration based on voluntary participation of countries. The topic of 2011 survey was "health and health care", and it included data from 29 member countries. We included all 29 countries in this study. Data and questionnaire for 2011 module is available on ISSP website (16). …