Now, twenty years after beginning her original studies, the understanding of the factors and influences on health and disease prevention behaviours have changed and evolved considerably. Professionally, community nutritionists and dietitians have moved from working from a model of individual lifestyle behaviours, to one of health promotion, and most recently to incorporating a population health approach to nutrition programs. More recent research shows that factors such as income, social status, education and social support seem to outweigh the effects of available health services and even individual health practices. There is a direct relationship between the key determinants of health and health status. Health improves as social status and income increases.
High income determines the ability to buy sufficient and nutritious food.
Support from families, friends and communities is associated with better health. Higher levels of education increase opportunities for income, job security and provides a sense of control over one's life. Unemployment, underemployment and stressful work are associated with poor health. Social stability, recognition of diversity, safety, good working relationships and cohesive communities provide a supportive society. Clean air and water are key physical and environmental factors.