Social Determinants of Health

Social Determinants of Health

• Factors in society and living conditions impact wellbeing.
• Social, economic, and political conditions shape health, illness, and life experiences.
• Interventions on social determinants can improve health, requiring a holistic approach.
• An ecological population health model highlights the impact of social and physical environments on disease and injury patterns across the life cycle.
• These environmental factors are not fixed and vary geographically.

Determinants Continuum

• Determinants range from proximal (direct impact) to distal (indirect impact).
• Distal determinants, like resource distribution, are harder to change but have widespread health effects.
• Social factors significantly contribute to the global burden of disease and health inequalities.
• The Solid Facts (Wilkinson and Marmot) proposes ten social determinants, supported by evidence.
• The Whitehall study, which began in Britain in the late 1960s, demonstrated an inverse social gradient in mortality, proving that health inequalities extend beyond the health consequences of poverty.
• The 10 social determinants are:
  • Social gradient
  • Stress
  • Early life
  • Social exclusion
  • Work
  • Unemployment
  • Social support
  • Addiction
  • Food
  • Transport

Mortality and Health Disparities

• Mortality rates are higher for those in lower-status occupations, with lower incomes and less education.
• Social structures can increase vulnerability to ill health.
• Poor health is linked to powerlessness from discrimination, poverty, and social disorder.
• Health and disease correlate with socioeconomic status: more advantaged groups generally have better health.
• Health disparities stem from unequal social relations like economic exclusion, gender inequity, and racism.

The Solid Facts and Health Equity

• The Solid Facts critiqued society initiating the WHO Commission on Social Determinants of Health in 2005.
• The Commission aimed to create policies and interventions which target positive change towards equity.
• The Commission declared that social injustice is a significant cause of death, and reducing health inequities is ethically imperative.
• Inequality and equality are dimensional concepts.
• Health inequalities are measurable differences in health status among individuals or groups.
• Health inequity involves unfair and remediable differences in health among social groups, related to social justice.

Equality vs. Equity

• Equality means providing the same resources to everyone.
• Achieving true equality is difficult because everyone must start from the same context and need the same resources, which is not the case.
• Health equity requires ensuring people have the necessary tools and resources, potentially requiring additional support based on need.

Achieving Health Equity

• Recognizing unjust and preventable health disparities.
• Failures to address access to appropriate services create health inequalities that are socially produced, systematic, avoidable, and unacceptable.
• Addressing health disparities requires considering factors outside the health sector like housing, transportation, and the economy.
• Intersectoral action is crucial because responsibility for social determinants extends beyond healthcare.
• Health equity involves fairness and justice in how society organizes living conditions, with social justice approaches prioritizing health as a human right.
• Health equity requires empowering disadvantaged groups to control factors shaping health, with public health measures avoiding top-down approaches.
• Social determinants of health can be changed through policy and social pressure at various levels.
• Health is political, due to differing views on government responsibility for health outcomes.