Topic 5 examines three interconnected categories of health determinants that operate beyond the traditional biomedical and behavioural frameworks. Environmental determinants of health encompass the physical, chemical, biological, and built environmental conditions that influence morbidity and mortality. Physical factors include ambient air quality and water purity; chemical exposures involve industrial pollutants, pesticides, and consumer product toxins; biological factors encompass pathogens, vector-borne organisms, and allergens such as mould. The built environment — comprising housing quality, transport infrastructure, green spaces, food systems, and urban design — mediates health through its effects on physical activity levels, social interaction, nutritional access, and exposure to hazards. Both indoor and outdoor environments contribute to health outcomes, with indoor air pollution, inadequate ventilation, and poor housing conditions recognised as significant risk factors. At the macro level, climate change operates as an environmental meta-determinant, producing cascading effects through altered disease vectors, extreme weather events, food and water insecurity, and respiratory impacts.

Commercial determinants of health describe the mechanisms through which profit-driven entities influence population health, both directly and indirectly. The World Health Organization identifies several pathways: supply chain practices, labour conditions, product design and packaging, research funding, lobbying activities, and preference-shaping through targeted marketing. These commercial activities impact a wide spectrum of risk factors including tobacco use, alcohol consumption, dietary patterns, physical inactivity, and air pollution exposure. The effects are not uniformly distributed; young people, low- and middle-income countries, and communities experiencing socioeconomic disadvantage bear disproportionate burdens from harmful commercial practices.

Digital determinants of health (DDOH) represent an emerging conceptual framework that addresses the structural and social conditions governing equitable access to digital health technologies. Key elements include digital health literacy (the capacity to find, comprehend, evaluate, and apply electronic health information), access to equipment and broadband infrastructure, digital skills and usability competence, and digital inclusion. DDOH must be distinguished from digital health, which refers to the technologies themselves (telehealth platforms, electronic health records, health apps, AI-supported diagnostics, remote patient monitoring). While digital health focuses on innovation and clinical application, DDOH addresses who benefits from these innovations and who is excluded. Economic implications of digital exclusion compound existing health inequities, as those lacking digital skills face barriers to both healthcare access and broader economic participation. For paramedic practice, recognising these determinant categories supports holistic patient assessment and contextualises why certain communities experience disproportionate health burdens.