TABLE 1.

Overview of indicators and issues in the hierarchy of social and environmental health determinants

DPSEEA level	Indicator items	Key issues
Driving forces	Population size and structure (age, sex)	Demographic transition
	Birth rate, fertility	Fertility level
	Life expectancy	Aging
	Poverty prevalence	Economic development
	Social barriers to equality	Economic inequalities
	Income distribution	Gender, ethnic, and social discrimination
	Economic level and growth (GDP in straight dollars or PPP$)	Globalization
	Types of economic activity and trade	Urban/rural development
	Health and environment policies and legislation	Urban planning and design
Pressures	Technology use	Knowledge development
	Energy use	Sustainability
	Agricultural land use and production	Resource conservation
	Water use, water access	Emergence of deprived urban areas
	Availability of sanitation	Infrastructure development
	Solid waste volumes
	Hazardous waste volumes
	Transport trends
	Existence of breeding grounds of disease vectors
State of the environment	Climate, trends	Geographic constraints
	Air quality	Natural conditions
	River water quality	Microenvironmental variations
	Ground water contamination
	Drinking water quality
	Food contamination
	Housing quality
Exposures (it is the differential exposure and vulnerability at the exposure level where we see direct relationships with inequalities in health effects)	Specific exposure studies (air, lead, water, and climate)	Risk transition
	Studies of specific disease vectors (e.g., mosquitoes)	Exposure hot spots
	Workplace environment surveys	Total human exposure
Effects	General health situation, mortality trends	Epidemiologic transition
	Specific environmental effects	Health inequalities
	Environmental burden of disease
	Occupational injuries and diseases
	Traffic crash injuries
Actions	Policies and programs for prevention at each DPSEEA level	Development of new policies to meet the health challenges of the future