The Social Determinants of Health

Health is commonly thought of as an individual issue, shaped by the behaviours and genetics of each person. However, evidence suggests health outcomes are more effected by the social realm rather than individual choices. This means that a range of factors influence our experiences of health and illness. The ‘social determinants of health’ refers to the social factors that impact health. It is important to note that in this context ‘health’ not only refers to physical health but mental health too. All of our health topics are influenced by this model. The video below provides an overview of the social determinants of health.

What factors determine health?

Social influences are wide reaching and there is no universally accepted definition of these. The diagram below categorises the determinants of health into four groups. Listed below are examples of the social determinants of health, although there are many more than those discussed.

Environment and economy

• Environment: Living in an environment with safe drinking water, little air pollution, and safe infrastructure promotes health.
• Economy: when people are paid higher wages, they experience better health outcomes. Economic inequality is heavily tied to health outcomes and evidence suggests it effects health even when individual behaviours are controlled for¹.

Family and whānau, and community

• Family/whānau: a safe family environment is an important predictor of health. When issues like domestic violence and addiction are present in a family, the whole family experiences poorer health outcomes.
• Community: when communities feel their customs, traditions, and beliefs are supported they experience greater health. In New Zealand this is particularly important when considering Māori communities due to colonization’s negative impact¹.

Education, housing, support, workplaces, transport, recreation

• Education: high education levels are linked to greater health, less stress, and improved self-confidence.
• Housing: issues such as overcrowding and dampness impact health.
• Social support: loneliness is one of the primary predictors of poor health. Having a social circle that can provide practical and emotional support improves health.
• Workplaces: employed people have better health outcomes, particularly when they have a sense of control over their working environment and are paid a fair wage.
• Transport: safe roads and accessible public transport allows all citizens to fully participate in society, an outcome linked to positive health.
• Recreation: when people can enjoy their life and engage in activities that make them happy their health improves.
• Heath services: effective and responsive health services which all citizens can access for prevention and treatment improves outcomes.
• Social status: the treatment of certain social groups like ethnicity, sexuality, and gender impact health. For example, women experience higher rates of illness due to social disadvantage, and ethnic and sexual minorities have poorer health due to discrimination, exclusion, and exploitation¹.

Individual Health

• Genetics: genes play in a role in how likely you are to develop certain illnesses
• Health behaviours: factors such as emotional coping skills, a healthy diet, and exercise mediate how we experience stress and our likelihood of getting ill¹.

Why is it important to consider the social determinants?

Conceptualising health as purely the result of individual choices like smoking, eating fast-food, or not exercising ignores a strong evidence base that suggests social factors are more influential. This is problematic for two reasons.

1. It encourages a victim blaming mentality. A person’s health is made up of a huge breadth of social influences and their individual choices account for only a tiny sliver of these. Therefore, for example, if someone gets lung cancer it is unfair to solely blame their choice to smoke on their illness because;

• Firstly, factors such as the family they grew up in, the availability of cigarettes in their environment, and the support services available to them greatly influence smoking behaviours.
• Secondly, issues like economic inequality and social support impact health regardless of individual choices – this is why a poor smoker is more likely to get ill than a rich smoker.

People often don’t have control over the social determinants that influence their health, and because these account for a large portion of poor health outcomes it is unjust to place all the responsibility on the individual.

2. It detracts attention from root causes. Focusing on individual health behaviours distracts us from the true issue at hand: that society greatly disadvantages certain groups, and that these hardships are the root of poor health. Rather than only treating individual level behaviours we should strive to also create systemic change. An example of this is Women’s Health Action’s event the Big Latch On. This event not only provides individual level support to mothers, it also works to create social change in the public’s perceptions of public breastfeeding. This targets many of the social determinants of health as it improves individual health, education, social support and status, community support, and health services.

Useful links

World Health Organisation » information on the global social determinants of health. 

The Last Straw » a useful game for educating groups on how social determinants impact health.

Interesting TED Talk » ‘Social determinants of health’ by Claire Pomeroy

Inequality.org » a helpful summary of research on how inequalities lead to poor health

References

¹World Health Organisation (2003). Social determinants of health: The solid facts. Denmark. Retrieved from http://www.euro.who.int