Next we identify the distal determinants in our list.
And these are the determinants that are little bit further removed from
the outcome.
These are often times associated but not causally linked to the outcome.
We'll be using two categories for distal determinants.
The first are environmental determinants,
which are characteristics of the environment.
The other are non-modifiable distal determinants, and
these are typically individual level characteristics that are not
modifiable with public health intervention like changing someone's education level.
Alternatively, they could be truly non-modifiable, like race,
something you are born with.
The importance of the distal determinants and more specifically the non-modifiable
determinants is that these determinants help us to identify the group
of people we should target for intervention.
Now that we've sorted our key determinants,
we can begin to draw them into a picture.
The first box on the far right side is the outcome.
For our problem definition we can simply write infant mortality.
Notice we did not write infant mortality rate because we know that
there are numerous statistics we could use to measure infant mortality.
That being said, the infant mortality rate is standardized to the size of
the population because the denominator is the number of live births.
So there are benefits to using this specific indicator of
infant mortality rate.
So let's start drawing our picture.
First, we draw in the proximal indicators that are the direct causes of
infant mortality.
Here I've identified congenital malformations, low birth weight and
short gastration, respiratory distress, sudden infant death syndrome or
SIDS, and accidental suffocation or strangulation bed.
These determinates can directly result in infant mortality.
I found them in the literature and other web based resources.