Health Determinants: Ghana’s Physical Environments

By: Leah Kennedy

Now that my preceptorship is coming to an end, it’s surprising to think that I am only a week away from finishing my degree. As I reflect on my last four years as a nursing student there is one thought that continues to linger in my mind. It is the concept of health, and how for my entire life I have actually never realized how lucky I am to be in good health. My health is single- handedly one of the major elements of life that I have taken for granted. Truth: for rich or for poor, without health you have nothing.

I remember my first day of nursing school; my instructor asked my group to brainstorm all the characteristics that can affect an individual’s health. I find it somewhat ironic that the 12 Determinants of Health was the first concept I had learned as a student nurse and is now the last concept I will reflect on for the remaining week as a student.

Health Canada has identified 12 key health determinants that directly influence the health of a society and its citizens.

 Income and social status
 Employment
 Education
 Social environments
 Physical environments
 Healthy child development
 Personal health practices and coping skills
 Health services
 Social support networks
 Biology and genetic endowment
 Gender
 Culture

For the purpose of this blog post, I will focus on physical environment. Ghana’s physical environment differs greatly from that of Canada and plays a major role in an individual’s health. The World Health Organization defines environment, as it relates to health, as “all the physical, chemical, and biological factors external to a person, and all the related behaviors.” Maintaining a healthy environment will aid in decreasing injury, increasing quality of life, increasing disease prevention, and increasing control measures.

The World Health Organization states the following, “globally, nearly 25 percent of all deaths and the total disease burden can be attributed to environmental factors”. Examples of these factors can include exposure to hazardous substances found in air, water, soil, and food. Furthermore, natural and technological disasters, physical hazards, and nutritional deficiencies are other examples in which physical environment can play an influential role in personal health.
In Ghana, I see first hand how environmental factors play a role in health and health practices. For example, when it rains, it is not unusual for the streets and gutters to be flooded and backed up with sewage water. As a result, disease outbreaks like cholera are not uncommon. Furthermore, “poor water and sanitation play an important role in malnutrition and several infectious diseases associated with malnutrition, including diarrhea and other diseases caused by intestinal parasites that are related to poor water, sanitation, hygiene, and food safety.” (World Health Organization, 2006).

Another common factor in Ghana is the issue of overcrowding. Many contagious diseases such as tuberculosis can be interrelated to the issue of overcrowding. For example, crowding in households, hospitals, market areas, and/or other settings, will increase the probability of pathogen transmission, which will then increase the likelihood of prolonged periods of time with close contact and exposure between susceptible people and infectious cases.

In Ghana, the issue of road traffic accidents is on a whole another level compared to those in Canada. The World Health Organization, explains that the “frequency of road traffic injuries can be influenced by environmental conditions related to land use policies and practices; inappropriate road design; urban structure and density and poor matches of road design and vehicles”. Other environmental issues include poor street lighting and signs, poor road maintenance and narrow roads.

Nevertheless, it is important to acknowledge that there are initiatives in place to help solve environmental issues that contribute to poor health. Interventions can be cost-effective and will go beyond improving health; they will at times contribute to the well being of an entire community. This is why maintaining a healthy environment is vital to increasing quality of life and years of healthy life.


Association of Faculties of Medicine of Canada. (2014). Determinants of health and health inequities. Primer on Population Health. Retrieved from

Prüss-Üstün, A., & Corvalán, C. (2006). Preventing disease through healthy environments. The World Health Organization. Retrieved from

Public Health Agency of Canada. (2014). What Determines Health. Retrieved from


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